Including the latest on general and pediatric dermatology, contact dermatitis, cutaneous oncology, infectious disease, and more.
GENERAL DERMATOLOGY
Chronic hand eczema, including cases in individuals with no prior history of atopic dermatitis, may respond to dupilumab therapy according to a small (N=19) retrospective Danish study. Dosage regimen was identical to that used for adult atopic dermatitis.
TO READ MORE: Olesen CM, et al. Treatment of chronic hand eczema with dupilumab-A retrospective follow-up study. J Eur Acad Dermatol Venereol. 2023;37(4):e557-e559. doi:10.1111/jdv.18805.
A nationwide survey disclosed that only about 4% of long-term hydroxychloroquine users are undergoing periodic ophthalmologic examinations. As a consequence, about 40% of those diagnosed with hydroxychloroquine retinopathy are already symptomatic at the time of diagnosis. Looking at it another way, during this one-year study, 0.03% to 0.06% of long-term hydroxychloroquine patients were diagnosed with retinopathy secondary to chronic hydroxychloroquine use.
TO READ MORE: Yusuf IH, et al. A nationwide survey of hydroxychloroquine retinopathy presenting to the hospital eye service in the United Kingdom [published online ahead of print, 2022 Nov 15]. Eye (Lond). 2022;10.1038/s41433-022-02291-0. doi:10.1038/s41433-022-02291-0.
Editor’s note: this was a British study, so applicability to the United States is unknown.
Hypertrophic lichen planus and cutaneous squamous cell carcinoma occur concurrently, mostly on the forelegs in older women. The squamous cell carcinoma lesions followed a relatively non-aggressive course. Mild cytologic atypia and psoriasiform hyperplasia favor lichen planus, whereas severe cytologic atypia and deep extension favor squamous cell carcinoma.
TO READ MORE: Idriss MH, et al. Concomitant hypertrophic lichen planus and squamous cell carcinoma: Clinical features and treatment outcomes. Int J Dermatol. 2022;61(12):1527-1531. doi:10.1111/ijd.16321.
Although dapsone may be considered the treatment of choice, a case of linear IgA bullous dermatosis was successfully managed with sulfasalazine (1gm BID). This is a useful alternative when dapsone may be contraindicated.
TO READ MORE: Ashraf S, et al. A Case of Successful Management of Adult-Onset Linear IgA Bullous Disease With Sulfasalazine During the COVID-19 Pandemic. J Drugs Dermatol. 2022;21(12):1355-1357. doi:10.36849/JDD.6717.
PEDIATRIC DERMATOLOGY
An excellent comprehensive review of pediatric mycosis fungoides (4-5% of all mycosis fungoides cases) disclosed a slight predilection for male children. The disease most often presents with hypopigmented, scaly patches (55-100% of pediatric mycosis fungoides cases) in an early stage (IA, IB, and IIA). There is a delay from onset to diagnosis of 1 to 5 years, on average. Pediatric mycosis fungoides runs an indolent course, with a typically good response to phototherapy. However, relapse occurs when treatment is discontinued.
TO READ MORE: Kothari R, et al. Mycosis fungoides in pediatric population: comprehensive review on epidemiology, clinical presentation, and management. Int J Dermatol. 2022;61(12):1458-1466. doi:10.1111/ijd.16098.
ATOPIC DERMATITIS
Analysis of patients enrolled in a tralokinumab clinical trial did not display increased risk of COVID-19 infection. Perhaps, more importantly, among those patients receiving tralokinumab who did develop COVID-19, 98% had mild to moderate disease.
TO READ MORE: Blauvelt A, et al. Outcomes of COVID-19 and Vaccination in Patients With Moderate to Severe Atopic Dermatitis Treated With Tralokinumab. JAMA Dermatol. 2022;158(11):1327-1330. doi:10.1001/jamadermatol.2022.3488.
A systematic review and meta-analysis compared the risk of venous thromboembolic events (VTEs) noted in phase 2 and 3 randomized clinical trials involving oral JAK inhibitors versus a control group receiving either placebo or dupilumab. There was no significant difference seen in the risk for incident VTEs between the two groups. These findings were similar across all four JAK inhibitors analyzed.
TO READ MORE: Chen TL, et al. Association of Risk of Incident Venous Thromboembolism With Atopic Dermatitis and Treatment With Janus Kinase Inhibitors: A Systematic Review and Meta-analysis. JAMA Dermatol.2022;158(11):1254-1261. doi:10.1001/jamadermatol.2022.3516.
A Korean study involving over 1 million person-years showed that there is a higher risk of atopic dermatitis wherever there are high concentrations of particulate matter, nitrogen dioxide, sulfur dioxide, and carbon monoxide. In other words, pollution facilitates atopy development.
TO READ MORE: Park SK, et al. Exposure to air pollution and incidence of atopic dermatitis in the general population: A national population-based retrospective cohort study. J Am Acad Dermatol. 2022;87(6):1321-1327. doi:10.1016/j.jaad.2021.05.061.
CONTACT DERMATITIS
A systematic literature review disclosed that patch testing may well help identify allergens responsible for allergic vulvar contact dermatitis. Commonly implicated agents include metals, topical medications, fragrances, preservatives, cosmetic ingredients, and rubber-related antigens. However, caution was urged in that not all positive tests have clinical relevance.
TO READ MORE: Vandeweege S, et al. A systematic review of allergic and irritant contact dermatitis of the vulva: The most important allergens/irritants and the role of patch testing. Contact Dermatitis. 2023;88(4):249-262. doi:10.1111/cod.14258.
INFECTIOUS DISEASES
Although practitioners of dermatology rarely administer antiretroviral therapy (ART), this paper presents an excellent, detailed summary of current recommendations. Key take-aways for dermatologists include: Initiation of ART is recommended as soon as possible after HIV diagnosis; ART may be delayed for several weeks if serious opportunistic infection is diagnosed (e.g. Cryptococcal meningitis, active tuberculosis); initial therapy generally should be based on integrase strand transfer inhibition (bictegravir or dolutegravir); all persons with HIV who are pregnant should receive ART for their own health and to prevent transmission to the fetus, although pregnancy requires alteration in ART choice; pre-exposure prophylaxis can be accomplished by both oral and injectable regimens; and weight gain and metabolic complications (e.g. diabetes) have been linked to certain ART agents and should be monitored. Immediate institution of ART is associated with both a decreased risk of transmission to others and a greater likelihood of and decreased time to viral suppression.
TO READ MORE: Gandhi RT, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2023;329(1):63-84. doi:10.1001/jama.2022.22246.
Pfizer and BioNTech have initiated a phase 1 trial to investigate the immunogenicity and safety of a combination vaccine which includes modified for Omicron bivalent COVID-19 and influenza. The U.S.-based study will include 180 healthy adult participants, 18 to 64 years of age.
FOR MORE INFORMATION: ClinicalTrials.gov Identifier: NCT05596734. A Study to Evaluate the Safety, Tolerability, and Immunogenicity of Combined Modified RNA Vaccine Candidates Against COVID-19 and Influenza – Full Text View – ClinicalTrials.gov
Control of a monkeypox outbreak during the summer of 2022 required dialogue and cooperation between the at-risk population, clinicians, and public health authorities. The main factor in controlling the outbreak was rapid, targeted administration of a suitable vaccine to those at highest risk. The other effective intervention was timely symptom recognition, presentation, diagnosis, and isolation, requiring a rapid and targeted educational campaign.
TO READ MORE: Harrison LB, et al. Monkeypox in Montréal: Epidemiology, Phylogenomics, and Public Health Response to a Large North American Outbreak. Ann Intern Med. 2023;176(1):67-76. doi:10.7326/M22-2699.
During a literature review of the benefit of antifungal susceptibility testing for dermatophytosis, it was noted that 40% of the cases of resistant dermatophyte infections had a history of travel to India or contact with individuals from India. It was also noted that the most common dermatophytes to show resistance to typical antifungal medication were T. rubrum, followed by T. mentagrophytes/interdigitale and T. tonsurans.
TO READ MORE: Khan SS, et al. A Review of Antifungal Susceptibility Testing for Dermatophyte Fungi and It’s Correlation with Previous Exposure and Clinical Responses. J Fungi (Basel). 2022;8(12):1290. Published 2022 Dec 9. doi:10.3390/jof8121290.
Erythrasma in skin of color may uniquely present as dark red-brown hyperpigmented plaques covered with fine scale and manifesting little central clearing, or as a hypopigmented patch with a sharply marginated hyperpigmented border.
TO READ MORE: Masood M, et al. Erythrasma. Cutis. 2022;110(6):338-339. doi:10.12788/cutis.0662.
A comprehensive systematic literature review of intralesional therapies for plantar warts found that, among easily accessible agents, Candida antigen and bleomycin were the best. Administration of commercially available HPV vaccine may also lead to resolution of recalcitrant plantar warts. None of these modalities is guaranteed to be successful.
TO READ MORE: Martin A, et al. Emerging Intralesional Treatments for Plantar Warts: A Systematic Review. J Drugs Dermatol. 2022;21(12):1322-1329. doi:10.36849/JDD.6735.
HAIR AND NAILS
The third case of extensive alopecia areata with at least partial response (eyelashes, eyebrows, and beard area) following dupilumab administration for atopic dermatitis is reported. This report suggests that a more systematic study should be conducted of dupilumab for alopecia areata.
TO READ MORE: Visconti MJ, et al. Dupilumab as a Therapeutic Approach in Alopecia Universalis. Cutis.2022;110(5):E7-E8. doi:10.12788/cutis.0659.
Regular use of a special razor designed for individuals with pseudofolliculitis barbae resulted in improved skin appearance, better shave satisfaction, and improved quality of life after 12 weeks of use. The novel razor technology (Skin Guard, Proctor & Gamble) consisted of two low force cutting blades separated by a bridge.
TO READ MORE: Moran E, et al. New Razor Technology Improves Appearance and Quality of Life in Men With Pseudofolliculitis Barbae. Cutis. 2022;110(6):329-334. doi:10.12788/cutis.0669.
CUTANEOUS ONCOLOGY, SURGERY, AND LASERS
A retrospective Australian study (N=646) disclosed that high risk or advanced melanoma patients who were treated with immune checkpoint inhibitors were at increased risk for major atherosclerotic cardiovascular events, including myocardial infarction, stroke, and acute limb ischemia. After adjusting for age, gender, smoking history, and prior treatments, the immune checkpoint inhibitor recipients were at 2.8 times the risk than comparable patients who did not receive these drugs.
TO READ MORE: Wang C, et al. Immune checkpoint inhibitors and the risk of major atherosclerotic cardiovascular events in patients with high-risk or advanced melanoma: a retrospective cohort study. Cardiooncology. 2022;8(1):23. Published 2022 Dec 2. doi:10.1186/s40959-022-00149-8.
A pooled Australian and Dutch cohort of children and adolescents with melanoma were studied. Of the 514 patients in the final analysis, 397 were Dutch and 117 were Australian. There were 62 children and 452 adolescents included. At 10 years, overall survival rates were 100% for children and 92.7 for adolescents. Recurrence free survival was lower, but still quite good: 91.5% for children and 86.4% for adolescents.
TO READ MORE: El Sharouni MA, et al. Melanomas in children and adolescents: Clinicopathologic features and survival outcomes. J Am Acad Dermatol. 2023;88(3):609-616. doi:10.1016/j.jaad.2022.08.067.
A Chinese study of 853 patients with no clinical adenopathy and acral malignant melanoma showed that while lesions <2mm thickness have better melanoma-specific survival, there was no difference in melanoma specific survival in lesions > 2mm thickness regardless of Breslow level.
TO READ MORE: Wei X, et al. Prognostic impact of Breslow thickness in acral melanoma: A retrospective analysis. J Am Acad Dermatol. 2022;87(6):1287-1294. doi:10.1016/j.jaad.2022.08.052.
HIDRADENITIS SUPPURATIVA
In this retrospective study involving 1160 patients with hidradenitis suppurativa (HS) from a single county in Minnesota, as might be expected, HS patients compared to age/gender matched controls had higher frequency of anxiety, depression, and substance abuse. As also expected, HS patients have a higher frequency of pilonidal cysts, dissecting cellulitis, and acne conglobate. Other comorbid conditions discovered included hyperlipidemia, psoriasis, atopic dermatitis, diabetes, and chronic kidney disease.
TO READ MORE: Sokumbi O, et al. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol. 2022;61(11):1372-1379. doi:10.1111/ijd.16228.
Aside from about a 4% to 5% prevalence of squamous cell carcinoma in association with hidradenitis suppurativa, there is also a 2 to 4 times greater risk of developing lymphoma. This case report highlighted the occurrence of plasmablastic lymphoma in association with hidradenitis.
TO READ MORE: Preis S, et al. Plasmablastic lymphoma masked by hidradenitis suppurativa. JAAD Case Rep. 2022;27:13-15. Published 2022 Jul 3. doi:10.1016/j.jdcr.2022.06.016.
DRUGS AND DEVICES
In-vivo experimentation revealed that the order of application (emollient and topical corticosteroid) did not affect efficacy. However, applying the emollient first and allowing several minutes for it to dry before applying topical corticosteroid prevents unintended spread of the steroid.
TO READ MORE: Surber C, et al. Topical corticosteroid or emollient product: Which to apply first? J Eur Acad Dermatol Venereol. 2023;37(5):e646-e647. doi:10.1111/jdv.18797.
The Ellacor, a new aesthetic micro-coring device manufactured by Cytrellis recently became available. This device removes “cores” of skin about 5mm deep and about the width of a 22-gauge needle. In a single session, 24,000 such cores are removed–about the equivalent of two inches of skin, leading to a reduction in fine lines and wrinkling. The procedure is especially useful for the lower cheek and jawline but does require local anesthesia or nerve blocks. A clinical study revealed that, up to 180 days following treatment, an objective wrinkle severity score had improved, and participants reported satisfaction with 85.6% of treatment sites.
TO READ MORE: Gfrerer L, et al. Dermal Micro-coring for the Treatment of Moderate to Severe Facial Wrinkles. Plast Reconstr Surg Glob Open. 2022;10(10):e4547. Published 2022 Oct 17. doi:10.1097/GOX.0000000000004547.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome associated with vancomycin carries a high mortality rate. This investigation attempted to identify risk factors. Younger age (< age 50) and high vancomycin trough levels (>30 ug/ml) were associated with increased risk of severe vancomycin reactions.
TO READ MORE: Blumenthal KG, et al. Risk Factors for Vancomycin Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome. JAMA Dermatol. 2022;158(12):1449-1453. doi:10.1001/jamadermatol.2022.3541.
RHEUMATOLOGIC DISEASES
A small French cohort (N=16) of dermatomyositis patients were retrospectively studied for response to oral Janus kinase (JAK) inhibition. Eighty-eight percent had active skin disease, 56% had active muscle disease, and 44% had both. Baricitinib (2 and 4 mg daily) and ruxolitinib (20 and 30 mg daily) were utilized. Thirteen of 16 patients benefited and remained on JAK inhibitor therapy. By study’s end, 67% of patients were able to decrease prednisone dose to 5 mg or less per day and 4 of the 5 intravenous immunoglobulin recipients had discontinued treatment.
TO READ MORE: Landon-Cardinal O, et al. JAK inhibitors for the treatment of adult dermatomyositis: A pilot study. J Am Acad Dermatol. 2023;88(4):924-926. doi:10.1016/j.jaad.2022.10.055
COVID-19
A relatively small (N=47) group of pregnant women who received Paxlovid responded well to the drug and experienced no gestational complications.
TO READ MORE: Garneau WM, et al. Analysis of Clinical Outcomes of Pregnant Patients Treated With Nirmatrelvir and Ritonavir for Acute SARS-CoV-2 Infection. JAMA Netw Open. 2022;5(11):e2244141. Published 2022 Nov 1. doi:10.1001/jamanetworkopen.2022.44141.
The longer COVID has gone on, the greater the risk of health care provider burnout and intent to leave medicine. This relates to the “chaos” and “loss of autonomy” the pandemic has infused into the health care system.
TO READ MORE: Linzer M, et al. Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic [published correction appears in JAMA Health Forum. 2023 Feb 3;4(2):e230002]. JAMA Health Forum. 2022;3(11):e224163. Published 2022 Nov 4. doi:10.1001/jamahealthforum.2022.4163
A new technology utilizing a dye, rhodamine R18, linked to a virus (in this case COVID-19) can demonstrate where the virus is trapped in a mask and also when the organism is non-viable. Tests using inactivated COVID-19 show that some viral particles do make it past the inner mask layer, but then are trapped and die in the middle of multilayer surgical and N95 masks.
TO READ MORE: Furer LA, et al. A novel inactivated virus system (InViS) for a fast and inexpensive assessment of viral disintegration. Sci Rep. 2022;12(1):11583. Published 2022 Jul 8. doi:10.1038/s41598-022-15471-5.
Does COVID-19 infection aggravate pre-existing skin conditions? Pre-existing telogen effluvium worsens. Also, about 45% of those with pre-existing psoriasis will flare during and up to 4 months after active COVID-19. There is some evidence to support the hypotheses that stress, the SARS-C0V-2 virus itself, and/or the therapeutic interventions utilized may be responsible for psoriatic flares.
TO READ MORE: Chularojanamontri L, et al. New-onset and exacerbated skin diseases after COVID-19 infection: A systematic review. J Dermatol. 2022;49(11):e419-e421. doi:10.1111/1346-8138.16501.
A retrospective systematic review from the end of 2019 until May 2022 disclosed only 25 articles involving 26 patients linking lichen planus to either COVID-19 infection or vaccination. Nearly 85% of the reported cases occurred in association with vaccination, rather than following active viral infection, and nearly 81% were de novo lichen planus (as compared to flare of prior disease).
TO READ MORE: Nguyen B, et al. Lichen planus after COVID-19 infection and vaccination: A systematic review. J Eur Acad Dermatol Venereol. 2023;37(3):e278-e281. doi:10.1111/jdv.18752.