PEDIATRIC DERMATOLOGY
The authors describe a phenomenon called “PIGMENTED TRANSVERSE NASAL BAND.” This consists of an asymptomatic 1-2mm wide band of macular pigmentation seen in children (Caucasians) and adolescents and young adults (skin of color, particularly of Indian ethnicity). This band is located at the junction of the upper two-thirds and lower one-third of the nose, just proximal to alae nasi. There is a female preponderance and a familial predilection.
TO READ MORE: Agarwal K, et al. Pigmented transverse nasal band: A review. Indian J Dermatol Venereol Leprol. 2022;88(2):144-147. doi:10.25259/IJDVL_820_19.
INFECTIOUS DISEASES
TO READ MORE: Sons JS, et al. A case of HIV-associated generalized syphilitic alopecia mimicking alopecia universalis. Int J Dermatol. 2022;61(1):e1-e2. doi:10.1111/ijd.15721.
Although this study was done in Spain, it surprisingly revealed that among surveyed podiatrists, 86.3% considered complementary TESTS FOR ONYCHOMYCOSIS (KOH, culture, PCR) necessary, but only 21.4% used such tests routinely.
TO READ MORE: Aldana-Caballero A, et al. Assessment of Visual Diagnosis by Podiatrists for HPV and Onychomycosis: The Need for Complementary Tests. J Fungi (Basel). 2022;8(2):135. Published 2022 Jan 29. doi:10.3390/jof8020135.
(Editor’s note: I really wonder what a contemporary survey study of U.S. dermatologists would show in this regard!)
This recent Danish laboratory survey disclosed INCREASING TERBINAFINE RESISTANCE among clinical Trichophyton isolates. As the authors state: “Susceptibility testing is highly relevant in non-responding cases.”
TO READ MORE: Astvad KMT, et al. Increasing Terbinafine Resistance in Danish Trichophyton Isolates 2019-2020. J Fungi (Basel). 2022;8(2):150. Published 2022 Jan 31. doi:10.3390/jof8020150.
(Editor’s note: Antifungal resistance is NOT confined to places like India. It is becoming reality throughout the industrialized world.)
A retrospective nationally representative review of 1242 adult inpatients treated for SKIN AND SOFT TISSUE INFECTIONS, piperacillin-tazobactam and vancomycin use was the same across all ethnic/racial groups. However, clindamycin (considered inferior and associated with a higher risk of C. difficile superinfection) was used almost twice as often in Black compared to White patients. Cefazolin (considered clinically superior and less risky) was administered more than twice as frequently in White compared to Black patients.
TO READ MORE: Wurcel AG, et al. Variation by Race in Antibiotics Prescribed for Hospitalized Patients With Skin and Soft Tissue Infections. JAMA Netw Open. 2021;4(12):e2140798. Published 2021 Dec 1. doi:10.1001/jamanetworkopen.2021.40798.
PSORIASIS
A year-long, prospective German study of 331 obese psoriasis patients found that SECUKINUMAB 300mg given every two weeks was more effective compared to once monthly dosing. Multiple parameters, including PASI 75, PASI 90, PASI 100, Investigator’s Global Assessment scores of 0 or 1, and improved Dermatology Life Quality Index scores were all assessed. Both regimens were well tolerated. Despite more frequent dosing, there was no increase in Candida infections among the every-two-week drug recipients.
TO READ MORE: Augustin M, et al. Secukinumab dosing every two weeks demonstrated superior efficacy compared with dosing every four weeks in patients with psoriasis weighing 90 kg or more: Results of a randomised controlled trial [published online ahead of print, 2022 Jan 4]. Br J Dermatol. 2022;10.1111/bjd.20971. doi:10.1111/bjd.20971.
A prospective Chinese study compared 152 psoriasis only patients to 136 psoriasis plus PSORIATIC ARTHRITIS patients. Those with arthritis had a higher age at disease onset and a greater prevalence of hypertension and hypercholesterolemia. Interestingly, methotrexate therapy was found to lower lipid levels in both groups.
TO READ MORE: Wang B, et al. The difference of lipid profiles between psoriasis with arthritis and psoriasis without arthritis and sex-specific downregulation of methotrexate on the apolipoprotein B/apolipoprotein A-1 ratio. Arthritis Res Ther. 2022;24(1):17. Published 2022 Jan 7. doi:10.1186/s13075-021-02715-4.
An Israeli cohort of 5,275 psoriatic arthritis patients was compared to 21,011 matched controls. The causes of death during a mean follow-up of just over 7 years was the same for both groups. After correcting for comorbid states, the crude hazard ratio for ALL-CAUSE MORTALITY was also the same in both groups.
TO READ MORE: Haddad A, et al. The Association of Psoriatic Arthritis With All-cause Mortality and Leading Causes of Death in Psoriatic Arthritis. J Rheumatol. 2022;49(2):165-170. doi:10.3899/jrheum.210159.
The fourth case of GUTTATE PSORIASIS associated with SARS-CoV-2 infection was reported. The eruption responded to topical corticosteroid administration.
TO READ MORE: Janodia RP, et al. Guttate psoriasis following COVID-19 infection. Cutis. 2022 February;109(2):101-102. doi:10.12788/cutis.0443.
ATOPIC DERMATITIS
A cross-sectional survey of 240 parent-child combinations revealed that ITCHING in the pediatric atopic dermatitis patient occurs in the early evening and at bedtime.
TO READ MORE: Cheng BT, Patel MS, Xu M, et al. Timing of itch among children with atopic dermatitis [published online ahead of print, 2022 Feb 4]. Ann Allergy Asthma Immunol. 2022;S1081-1206(22)00089-8. doi:10.1016/j.anai.2022.01.042.
CONTACT DERMATITIS
Gold thread acupuncture consists of intradermal injection of multiple thin, sterile linear gold particles. This procedure may be used to relieve muscular and articular pain or to reduce wrinkles. The authors report a case reminding us that gold, while considered inert, once put into the tissue is subject to alteration over time turning it into an allergen. The patient reported development of histologically verified FOREIGN BODY REACTIONS at the sites of gold thread implantation. Improvement was obtained by thread removal coupled with intralesional steroid injection.
TO READ MORE: Yook H, et al. A case of foreign body granuloma developing after gold thread acupuncture. Indian J Dermatol Venereol Leprol. 2022;88(2):222-224. doi:10.25259/IJDVL_258_2021.
COSMETIC DERMATOLOGY
A small Egyptian study compared four different techniques (N=10 each) of preparing PLATELET-RICH PLASMA (PRP) for monthly injection as therapy for female pattern hair loss. It was concluded that use of a digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900 rpm) was optimal for PRP preparation.
TO READ MORE: Moftah NH, et al. Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study. J Cosmet Dermatol. 2022; January 2.doi.10.1111/jocd.14648.
A small (N=20, all women, aged 24 to 38) U.S. prospective study of same-visit COMBINATION AESTHETIC TREATMENT disclosed excellent patient satisfaction at 2 months post-therapy session. All patients received multi-site Botox Cosmetic injections, Juvederm Voluma into the midface, and Juvederm Volbella into the lips. Addressing all cosmetic concerns simultaneously led to decreased self-perceived age and improvement in psychosocial functioning.
TO READ MORE: Kurtti A, et al. Combination Facial Aesthetic Treatment in Millennials. J Drugs Dermatol. 2022;21(1):37-42. doi:10.36849/JDD.2022.6425.
A small (N=15) U.S. open-label, single-arm, single center prospective study investigated injection of DEOXYCHOLIC ACID (Kybella) in the fat of upper, inner thighs. Two to four injection sessions, given 5 to 7 weeks apart, were performed. Patients received at total of 40 injections of 0.2ml at each session. At the end of a 12-week follow-up period, thigh circumference decreased an average of 2.2cm and the “thigh gap” increased by an average of 1.6cm. Overall, 13 of 15 subjects (86%) were satisfied and 11 of 15 (73%) indicated that they would undergo the treatment again.
TO READ MORE: Yuan J, et al. Safety and Efficacy of Deoxycholic Acid for Reduction of Upper Inner Thigh Fat. J Drugs Dermatol. 2022;21(1):66-70. doi:10.36849/JDD.2022.5919.
(Editor’s note: Kybella (Allergan Aesthetics) is the only FDA approved injectable treatment for reduction of submental fat.)
Analysis of a large U.S. database showed reduced prevalence of ANXIETY among those who received botulinum toxin injections for cosmetic purposes (mostly glabellar rhytid reduction), for migraine management, improvement in spasticity of upper and lower limbs, and torticollis and neck pain. One theory for this finding is that relaxing facial and neck muscles, which are utilized to express negative emotions, reduces the intensity of those emotions.
TO READ MORE: Wollmer MA, et al. Postmarketing safety surveillance data reveals protective effects of botulinum toxin injections against incident anxiety. Sci Rep. 2021;11(1):24173. Published 2021 Dec 21. doi:10.1038/s41598-021-03713-x.
HIDRADENITIS SUPPURATIVA
Despite pain being a major feature of hidradenitis, there is no widely accepted algorithm for PAIN MANAGEMENT in this disorder. The authors point out the multifactorial nature of HS pain, which is worsened by underlying anxiety and depression. If oral NSAIDS, acetaminophen, and topical analgesics (such as liposomal lidocaine cream) fail, prudent use of oral opiates may be considered. Intralesional triamcinolone may relieve pain of acutely inflammatory abscesses.
TO READ MORE: Jeha GM, et al. Management of Acute and Chronic Pain Associated With Hidradenitis Suppurativa: A Comprehensive Review of Pharmacologic and Therapeutic Considerations in Clinical Practice. Cutis. 2021 November;108(5):281-286,E4 | doi:10.12788/cutis.0383.
A retrospective cross-sectional analysis was done using data derived from the largest managed care organization in Israel. There was an increased risk of both HEPATITIS B AND HEPATITIS C infection among those carrying aa dermatologist-verified diagnosis of hidradenitis suppurativa. This may relate to elevated levels of IL-17.
TO READ MORE: Cohen JM, et al. Hepatitis B and C among patients with hidradenitis suppurativa: a population-based study. Int J Dermatol. 2022;61(1):84-88. doi:10.1111/ijd.15578.
Although self-reported postoperative recurrence occurred in 41%, patients who underwent outpatient SURGICAL INTERVENTION for HS were generally satisfied with the outcome. De-roofing and local tissue excision were the primary interventions done in the clinic setting at a single American academic institution.
TO READ MORE: Ravi S, Miles JA, Steele C, Christiansen MK, Sayed CJ. Patient Impressions and Outcomes After Clinic-Based Hidradenitis Suppurativa Surgery. JAMA Dermatol. 2022;158(2):132-141. doi:10.1001/jamadermatol.2021.4741.
CUTANEOUS ONCOLOGY, SURGERY, AND LASERS
A systematic review and meta-analysis disclosed that smoking is not a risk factor FOR BASAL CELL CARCINOMA. In fact, smoking was found to be somewhat protective. This may relate to nicotine release, which reduces prostaglandin metabolism, thereby altering the cutaneous inflammatory response to UV irradiation.
TO READ MORE: Wu PC, et al. Smoking and the risk of basal cell carcinoma: a systematic review and meta-analysis. Int J Dermatol. 2022;61(1):e33-e37. doi:10.1111/ijd.15607.
A prospective cohort study of 618 patients with MERKEL CELL CARCINOMA demonstrated a higher recurrence rate (40%) following ostensibly definitive excision than that expected for both melanoma and non-melanoma skin cancer. Over 90% of the recurrences occurred within three years following treatment. Factors favoring recurrence included higher pathologic stage, male gender, older age and clinically detectable nodal disease.
TO READ MORE: McEvoy AM, Lachance K, Hippe DS, et al. Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis [published online ahead of print, 2022 Feb 23]. JAMA Dermatol. 2022;e216096. doi:10.1001/jamadermatol.2021.6096.
DRUGS AND DEVICES
A device emitting 20 MHz of HIGH INTENSITY FOCUSED ULTRASOUND was safe and effective at eliminating seborrheic keratosis.
On a 10-point analog scale, treatment-related pain was generally judged a 2, with an occasional 4. There was a chance of residual telangiectasia and 11% had residual mild scarring. Commercial development of this device is planned.
TO READ MORE: Calik J, Migdal M, Zawada T, Bove T. Treatment of Seborrheic Keratosis by High Frequency Focused Ultrasound – An Early Experience with 11 Consecutive Cases. Clin Cosmet Investig Dermatol. 2022;15:145-156. Published 2022 Jan 28. doi:10.2147/CCID.S348106.
GENERAL DERMATOLOGY
A 10-year retrospective review from a single academic center revealed VULVOVAGINAL INVOLVEMENT in 12.7% of women with Stevens-Johnson syndrome or toxic epidermal necrolysis. To both hasten lesion involution as well as prevent long-term sequelae (mostly scarring), early intervention is recommended. Therapy may include ultrapotent topical steroids, topical estrogen-containing cream, and menstrual suppression with oral progesterone. The latter prevents the formation of premalignant vaginal adenosis. Vaginal dilation may be required.
TO READ MORE: Crowder CA, et al. Vulvovaginal involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis: management and techniques used to reduce gynecologic sequelae. Int J Dermatol. 2022;61(2):158-163. doi:10.1111/ijd.15676.
A large survey disclosed that 70% of dermatologists predict that TELEDERMATOLOGY use will continue after the COVID-19 pandemic subsides, but only 58% are planning on personally utilizing this modality. The viability of teledermatology will depend largely on fair reimbursement and continued relaxation of Federal rules. Respondents felt teledermatology was most appropriate for acne and rosacea, medication monitoring, routine follow-ups, and a small number of inflammatory conditions.
TO READ MORE: Hopkins ZH, et al. Teledermatology During the COVID-19 Pandemic: Lessons Learned and Future Directions. Cutis. 2022;109(1):12-13. doi:10.12788/cutis.0431.
English-speaking adults at a single New York institution were surveyed regarding their SATISFACTION WITH TELEDERMATOLOGY care, a modality widely expanded during the COVID-19 pandemic. It is worth noting that patients over age 55 were less satisfied than those younger, and that African-Americans expressed concerns over confidentiality. All participants preferred teledermatology for follow-up visits rather than for initial consultation.
TO READ MORE: Chang LJ, et al. Disparities in telemedicine satisfaction among older and non-white dermatology patients. J Drugs Dermatol 2022;21:210-214
ACNE
Although the quality of the evidence was viewed as low, yet another systematic review and meta-analysis failed to show a link between SPIRONOLACTONE use and risk of cancer of any kind.
TO READ MORE: Bommareddy K, et al. Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis. JAMA Dermatol. 2022;158(3):275-282. doi:10.1001/jamadermatol.2021.5866.
Using data from the Global Burden of Disease Study, investigators ascertained that incident cases of ACNE VULGARIS increased by 48% from 1990 to 2019. The age-standardized incidence rate of acne vulgaris increased from 13.5 to 15.9 per 1000 person years. Excluded from this increase in acne were the United States, Germany, Poland and New Zealand.
TO READ MORE: Chen H, et al. Magnitude and temporal trend of acne vulgaris burden in 204 countries and territories from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019 [published online ahead of print, 2021 Nov 10]. Br J Dermatol. 2021;10.1111/bjd.20882. doi:10.1111/bjd.20882.
ADAPALENE has differences in basic pharmacology compared to other retinoids, likely accounting for its high degree of safety as an OTC agent. A maximal usage trial demonstrated relatively low systemic exposure. Analysis of pregnancy outcomes following known drug exposure failed to show increases in miscarriage, fetal death, or neonatal structural abnormalities.
TO READ MORE: Weiss J, et al. Safe Use of Adapalene 0.1 % Gel in a non-Prescription Environment. J Drugs Dermatol. 2021;20(12):1330-1335. doi:10.36849/jdd.6527.