Including the latest on general and pediatric dermatology, contact dermatitis, cutaneous oncology, infectious disease, and more.
GENERAL DERMATOLOGY
Though touted as an aid to recovery from severe injury, GLUTAMINE SUPPLEMENTATION (through a feeding tube or orally) failed to reduce either time to discharge alive or mortality rate among 1200 randomized deep second- or third-degree thermal burns. Glutamine or placebo was given until one week following the last skin grafting procedure, discharge from the acute care unit, or three months after admission—whichever came first. The median time to discharge was 40 days in the glutamine recipients versus 38 days in the placebo recipients. Mortality at 6 months was 17.2% in the glutamine recipients compared to 16.2% in the placebo group.
TO READ MORE: Heyland DK, et al. A Randomized Trial of Enteral Glutamine for Treatment of Burn Injuries. N Engl J Med. 2022 Sep 15;387(11):1001-1010. doi: 10.1056/NEJMoa2203364. Epub 2022 Sep 9. PMID: 36082909.
An excellent review noted that, due to protracted immunosuppression, SOLID ORGAN TRANSPLANT PATIENTS are particularly prone to develop cutaneous malignancies: squamous and basal cell carcinoma, malignant melanoma, Kaposi sarcoma, and Merkel Cell carcinoma. Porokeratosis is another potential complication. Dermatophytoses, oral and cutaneous Candidiasis, tinea versicolor and Malassezia folliculitis, widespread or severe warts and molluscum, and herpes virus-related disorders are common infections. Cytomegalovirus and Epstein-Barr virus infections may also be encountered. Scabies may be of the crusted variety. Inflammatory disorders may include eosinophilic folliculitis, nephrogenic systemic fibrosis, and graft versus host disease.
TO READ MORE: Fronek L, et al. A Review of Cutaneous Diseases Observed in Solid Organ Transplant Recipients. J Clin Aesthet Dermatol. 2022 Oct;15(10):21-31. PMID: 36312823; PMCID: PMC9586525.
Daily, occlusive table salt was effective at eliminating a classic DIGITAL PYOGENIC GRANULOMA.
TO READ MORE: Bernales Salinas A, et al. Case report: Pyogenic granuloma-just salt, a simple and pain-free treatment. Dermatol Ther. 2022 Jan;35(1):e15194. doi: 10.1111/dth.15194. Epub 2021 Nov 16. PMID: 34750919.
GLUCOCORTICOID-RELATED OSTEOPOROSIS AND FRACTURE risk are oral or intramuscular steroid dose and treatment duration dependent. Topical and intralesional steroids are not considered a significant risk factor for bone disease. Patients who must receive systemic steroids for more than three months should be placed on calcium (500-2000 mg/day) and Vitamin D (400-800 IU/day) supplementation. There is evidence which suggests that probiotics may also decrease bone disease risk in those receiving prolonged systemic steroids.
TO READ MORE: Chen KL, et al. Glucocorticoid-Induced Bone Loss: Dietary Supplementation Recommendations to Reduce the Risk for Osteoporosis and Osteoporotic Fractures. Cutis. 2022 Oct;110(4):201-206. doi: 10.12788/cutis.0627. PMID: 36446101.
PEDIATRIC DERMATOLOGY
The American Academy of Pediatrics recently published updated guidance on management of HEAD LICE, the first update since 2015. Key points from this article include: It’s no longer recommended to send head lice children home from school and elimination of “no-nit” policy; spread of head lice is almost always by direct head-to-head contact and not by fomites; effectiveness of permethrin and pyrethroids has declined to as low as 25%; and oral ivermectin—although not FDA-approved—can be used to treat head lice (two doses of 200 ug/kg, 7-10 days apart).
TO READ MORE: Nolt D, et al. Head Lice. Pediatrics. 2022 Oct 1;150(4):e2022059282. doi: 10.1542/peds.2022-059282. PMID: 36156158.
The rare entity known as JUVENILE GANGRENOUS VASCULITIS OF THE SCROTUM was reviewed. This is seen in adolescents to young adults. It typically presents as the acute onset of multiple, painful, well-defined, round scrotal ulcers. Patients are often febrile and have peripheral leukocytosis. Pathology shows epidermal necrosis and a dense, mostly neutrophilic perivascular infiltrate. There is no standard therapy identified, and most cases resolve in a few days to a month.
TO READ MORE: Bazzi N, et al. Juvenile gangrenous vasculitis of the scrotum: systematic review. Int J Dermatol. 2022 Nov;61(11):1364-1371. doi: 10.1111/ijd.16066. Epub 2022 Mar 24. PMID: 35323998.
ACNE
Despite the inherent problems with online surveys, this retrospective review of a number of such studies allows some important generalizations. TRUNCAL ACNE is more frequent in the 21 to 29 age group than in the 14 to 20 age category. Individuals with self-assessed “mild” acne were less likely to have truncal involvement than those with self-assessed “moderate to severe” acne. Individuals with both facial and truncal disease tend to have an earlier onset of acne. Truncal acne is associated with a large negative impact on quality of life.
TO READ MORE: Tan J, et al. Prevalence and Demographics of Truncal Involvement Among Acne Patients: Survey Data and a Review of the Literature. J Clin Aesthet Dermatol. 2022 Oct;15(10):62-67. PMID: 36312821; PMCID: PMC9586532.
A small (N=60) Egyptian study demonstrated equivalent efficacy of low-dose ISOTRETINOIN (0.25 MG/KG/DAY) IN COMBINATION WITH ORAL ZINC SULFATE (1 MG/KG/DAY) when compared to isotretinoin monotherapy at a higher dose (0.5 mg/kg/day). The frequency of treatment-related adverse events was much higher in the isotretinoin only recipients.
TO READ MORE: Salah E. Oral Zinc as a Novel Adjuvant and Sparing Therapy for Systemic Isotretinoin in Acne Vulgaris: A Preliminary Comparative Study. J Clin Aesthet Dermatol. 2022 Oct;15(10):58-61. PMID: 36312827; PMCID: PMC9586528.
A systematic review attempted to define how efficacious TOPICAL DAPSONE actually is. Based upon review of 14 key articles, a designation of “clear” or “almost clear” was achieved in 40.1% to 69.4% of patients treated with 5% dapsone gel, and 29.8% to 47.0 with 7.5% dapsone gel for 12 to 16 weeks. Adverse events were uncommon.
TO READ MORE: Nickles MA, et al. Topical dapsone in the treatment of acne: a systematic review. Int J Dermatol. 2022 Nov;61(11):1412-1421. doi: 10.1111/ijd.16074. Epub 2022 Feb 7. PMID: 35132625.
A small systematic review based on limited data concluded that silicone ENCAPSULATED TRETINOIN-BENZOYL PEROXIDE was a safe and effective addition to the acne armamentarium. Since poor adherence is an issue in treating acne, this combination of two critical ingredients into one product may help in that regard.
TO READ MORE: Singh R, et al. Review of Tretinoin-Benzoyl Peroxide in The Treatment of Acne Vulgaris. J Drugs Dermatol. 2022 Oct 1;21(10):1098-1103. doi: 10.36849/JDD.6808. PMID: 36219052.
ATOPIC DERMATITIS
A single center retrospective review was conducted of atopic dermatitis patients who either failed to respond or had incomplete response to DUPILUMAB. The review suggested that among those who experience suboptimal dupilumab response, the clinician should search diligently for either concomitant allergic contact dermatitis or concurrent photosensitivity. These two factors might perpetuate a portion of dermatitis which does not necessarily respond to dupilumab.
TO READ MORE: Bai H, et al. Diagnostic testing of eczematous dermatitis with incomplete response to dupilumab. J Am Acad Dermatol. 2022 Sep;87(3):692-695. doi: 10.1016/j.jaad.2022.03.047. Epub 2022 Mar 31. PMID: 35367296.
Between their ability to reduce cutaneous fungal load and a modicum of inherent anti-inflammatory effect, it is reasonable to wonder whether TOPICAL ANTIFUNGAL AGENTS might be beneficial in the management of atopic dermatitis. This analysis, involving 9 randomized and controlled studies and 785 patients attempted to answer that question. Unfortunately, the studies were of low quality and the data often incomplete or expressed in an unusual manner. Therefore, the safety and efficacy of topical antifungal agents in atopic dermatitis simply could not be accurately assessed.
TO READ MORE: He D, et al. Treatment of atopic dermatitis using topical antifungal drugs: A meta-analysis. Dermatol Ther. 2022 Dec;35(12):e15930. doi: 10.1111/dth.15930. Epub 2022 Oct 27. PMID: 36258284.
Utilizing sophisticated genetic analysis (whole blood, lymphocytes, and cutaneous fibroblasts) from about 840,000 individuals, investigators identified 19 GENES which appear closely related to atopic dermatitis.
TO READ MORE: Wu H, et al. Multitissue Integrative Analysis Identifies Susceptibility Genes for Atopic Dermatitis. J Invest Dermatol. 2022 Sep 23:S0022-202X(22)01940-6. doi: 10.1016/j.jid.2022.09.006. Epub ahead of print. PMID: 36155055.
A prospective Dutch study involving 295 adult patients with atopic dermatitis failed to find a correlation between SERUM DUPILUMAB levels and likelihood of response or likelihood of adverse events.
TO READ MORE: Spekhorst LS, et al. Association of Serum Dupilumab Levels at 16 Weeks With Treatment Response and Adverse Effects in Patients With Atopic Dermatitis: A Prospective Clinical Cohort Study From the BioDay Registry. JAMA Dermatol. 2022 Dec 1;158(12):1409-1413. doi: 10.1001/jamadermatol.2022.4639. PMID: 36322072; PMCID: PMC9631227.
CONTACT DERMATITIS
HAIRDRESSERS AND BARBERS are at high risk for developing occupationally related contact dermatitis. One potential source of contact dermatitis would be nickel derived from tools used in this trade. Researchers tested 192 metal tools from 12 barbershops in Minnesota for nickel release using dimethylglyoxime. Only 10 of the tools (5.2%) demonstrated nickel release. Interestingly, the barbershop chair and cape clips were more common sources of nickel than handheld tools, such as clippers and scissors.
TO READ MORE: Peterson MY, et al. Nickel release from metal tools in United States barbershops. Int J Dermatol.2022 Nov;61(11):1405-1408. doi: 10.1111/ijd.16161. Epub 2022 Mar 18. PMID: 35304753; PMCID: PMC9790711.
INFECTIOUS DISEASES
Although a survey of members of the Association of Professors of Dermatology disclosed that 93.8% of respondents were aware of HIV PRE-EXPOSURE PROPHYLAXIS (PrEP), only 4.9% were actual prescribers. A major impediment was that only 42% were familiar with indications for PrEP. Moreover, 72.8% felt uncomfortable with a discussion of potential risks of various PrEP regimens and 84% were unfamiliar with recommended laboratory monitoring.
TO READ MORE: Gutierrez D, et al. HIV Pre-exposure Prophylaxis (PrEP): A Survey of Dermatologists’ Knowledge and Practice Patterns. Cutis. 2022 Oct;110(4):220-225. doi: 10.12788/cutis.0620. PMID: 36446102.
Editor’s note: Of the estimated 1.1 million Americans eligible for PrEP, only 400,000 receive it.
Berdazimer gel 10.3% is a NOVEL NITRIC OXIDE RELEASING AGENT BEING DEVELOPED FOR TREATMENT OF MOLLUSCUM CONTAGIOSUM. This early phase study revealed good tolerability–38.2% application site pain and 17.6% application site erythema, with minimal systemic absorption.
TO READ MORE: Cartwright M, et al. Pharmacokinetic Profile, Safety, and Tolerability of Topical Berdazimer Gel, 10.3% in Patients With Molluscum Contagiosum. J Drugs Dermatol. 2022 Oct 1;21(10):1104-1110. doi: 10.36849/JDD.6938. PMID: 36219053.
A double-blind, placebo (vehicle) controlled study of BERDAZIMER GEL 10.3% found that 32.4% of patients who received active gel versus 19.7% of patients who received vehicle experienced complete resolution of molluscum lesions. The product was found to be well tolerated.
TO READ MORE: Browning JC, et al. Efficacy and Safety of Topical Nitric Oxide-Releasing Berdazimer Gel in Patients With Molluscum Contagiosum: A Phase 3 Randomized Clinical Trial. JAMA Dermatol. 2022 Aug 1;158(8):871-878. doi: 10.1001/jamadermatol.2022.2721. PMID: 35830173; PMCID: PMC9280611.
Using several validated modeling methods on 2746 individuals, British investigators presented fairly conclusive evidence that MONKEYPOX can be transmitted before the appearance or detection of signs and symptoms. In fact, it was estimated that 53% of monkeypox infections occur pre-symptomatically.
TO READ MORE: Ward T, et al. Transmission dynamics of monkeypox in the United Kingdom: contact tracing study. BMJ. 2022 Nov 2;379:e073153. doi: 10.1136/bmj-2022-073153. PMID: 36323407; PMCID: PMC9627597.
Although optimum protection against monkeypox requires 2 vaccinations given 4 weeks apart, a CDC study investigated if even a single vaccination offered any benefit. This study involved 5402 individuals who had verified monkeypox. Bottom line: for every infection occurring in a single-vaccinated individual, there were 14 infections in individuals who had not received even one JYNNEOS VACCINE dose. Among 32 U.S. jurisdictions, monkeypox incidence was higher among unvaccinated persons compared with those who had received a first vaccine dose ≥14 days earlier.
TO READ MORE: Payne AB, et al. Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose – 32 U.S. Jurisdictions, July 31-September 3, 2022. MMWR Morb Mortal Wkly Rep. 2022 Oct 7;71(40):1278-1282. doi: 10.15585/mmwr.mm7140e3. PMID: 36201401; PMCID: PMC9541026.
HAIR AND NAILS
Especially outside the United States, antihistamines are often used as either monotherapy or adjunctive therapy for ALOPECIA AREATA. This study reviewed 42 articles, including 395 patients with alopecia areata who were managed—at least in part—with oral antihistamines. One of the most widely used and ostensibly effective regimens is fexofenadine 60 mg to 120 mg daily.
TO READ MORE: Pham C, et al. The Role of Antihistamines and Dupilumab in the Management of Alopecia Areata: A Systematic Review. J Drugs Dermatol. 2022 Oct 1;21(10):1070-1083. doi: 10.36849/JDD.6553. PMID: 36219058.
CUTANEOUS ONCOLOGY, SURGERY AND LASERS
An open-label, single arm phase 2 study demonstrated that first-line use of NIVOLUMAB for locally advanced or metastatic cutaneous squamous cell carcinoma led to over half (58.3%) of patients experiencing an objective response. Nivolumab was administered every two weeks (dose: 3mg/kg) until disease progression, unacceptable toxicity, or 12 months of treatment. Twenty-four patients with a median age of 74 participated in this trial. Although there were no complete responses (cures), progression-free survival was 12.7 months and overall survival was 20.7 months. Grade 3 or greater adverse events occurred in 25% of trial subjects, but only one subject discontinued nivolumab due to toxicity.
TO READ MORE: Munhoz RR, et al. A phase 2 study of first-line nivolumab in patients with locally advanced or metastatic cutaneous squamous-cell carcinoma. Cancer. 2022 Dec 15;128(24):4223-4231. doi: 10.1002/cncr.34463. Epub 2022 Oct 24. PMID: 36274573.
A single-center, retrospective analysis compared the time to re-epithelialization when MOHS SURGERY WOUNDS on the lower extremity were allowed to heal by secondary intent. Three groups were considered: A. younger, healthier patients (N=32); B. patients over 65 with one or more factors which could impair healing (such as smoking, diabetes, peripheral vascular disease) managed with petroleum jelly and non-adherent gauze (N=25); and C. patients similar to the previous group whose post-op regimen also included 1 to 2 drops daily of 0.5% timolol maleate ophthalmic solution (N=18). There was a significant delay in wound healing between groups A and B. However, there was no significant delay in would healing between groups A and C. This suggests that, at least in older patients with surgical wounds on the lower extremities, the use of topical timolol may enhance and facilitate the healing process.
TO READ MORE: Manci R, et al. Topical timolol enhances surgical wound healing in the lower portion of the leg in older patients with comorbidities: A retrospective review. J Am Acad Dermatol. 2022 Sep;87(3):661-663. doi: 10.1016/j.jaad.2022.02.021. Epub 2022 Feb 17. PMID: 35183658.
Solid ORGAN TRANSPLANT RECIPIENTS who have already developed skin cancer do not face an increased risk of second and subsequent skin cancers based upon the type of organ which was transplanted. However, increasing age at time of transplantation increases the risk for multiple skin cancers. These conclusions were based on a single-center retrospective analysis of 5129 white adult patients.
TO READ MORE: Wheless L, et al. Differences in Skin Cancer Rates by Transplanted Organ Type and Patient Age After Organ Transplant in White Patients. JAMA Dermatol. 2022 Nov 1;158(11):1287-1292. doi: 10.1001/jamadermatol.2022.3878. PMID: 36169974; PMCID: PMC9520444.
Nine-hundred-sixty-five patients from 5 centers with pathologic stage T1a melanomas (non-ulcerated and <0.8 mm thick) had a very low rate of SENTINEL LYMPH NODE POSITIVITY (4.4%). Key risk factors for sentinel lymph node involvement in this type of melanoma included younger age (42 or younger), head and neck primary tumor, and lymphovascular invasion.
TO READ MORE: Shannon AB, et al. Sentinel lymph node biopsy in patients with T1a cutaneous malignant melanoma: A multicenter cohort study. J Am Acad Dermatol. 2023 Jan;88(1):52-59. doi: 10.1016/j.jaad.2022.09.040. Epub 2022 Sep 30. PMID: 36184008.
Although we have long preached this, evidence from the prospective Norwegian Women and Cancer Study now confirms that SUNBURNS IN CHILDHOOD are a critical factor for development of melanoma or cutaneous squamous cell carcinoma later in life.
TO READ MORE: Lergenmuller S, et al. Lifetime Sunburn Trajectories and Associated Risks of Cutaneous Melanoma and Squamous Cell Carcinoma Among a Cohort of Norwegian Women. JAMA Dermatol. 2022 Dec 1;158(12):1367-1377. doi: 10.1001/jamadermatol.2022.4053. PMID: 36197657; PMCID: PMC9535508.
HIDRADENITIS SUPPURATIVA
A European alternative method of assessing benefits of therapy for hidradenitis suppurativa (HS) has been developed and validated. This is the IHS4—the INTERNATIONAL HIDRADENITIS SUPPURATIVA SEVERITY SCORE SYSTEM. The authors believe this instrument is superior (greater sensitivity and accuracy) than the widely utilized HiSCR (Hidradenitis Suppurativa Clinical Response).
TO READ MORE: Tzellos T, et al. Development and validation of IHS4-55, an IHS4 dichotomous outcome to assess treatment effect for hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2023 Feb;37(2):395-401. doi: 10.1111/jdv.18632. Epub 2022 Oct 19. PMID: 36184889.
DRUGS AND DEVICES
A case report highlighted the development of BLACK HAIRY TONGUE associated with ingestion of linezolid. About 0.2% of patients who receive this antibiotic develop black hairy tongue. As is typical, linezolid discontinuation resulted in resolution.
TO READ MORE: Mannu A, et al. Linezolid-induced lingua villosa nigra. Indian J Dermatol Venereol Leprol. 2022 Oct 17:1. doi: 10.25259/IJDVL_560_2022. Epub ahead of print. PMID: 36331833.
RHEUMATOLOGIC DISEASES
A bidirectional RELATIONSHIP BETWEEN SYSTEMIC SCLEROSIS AND VITILIGO was discovered. New onset systemic scleroderma had an incidence of 2.4 cases per 10,000 patient-years among those who had vitiligo compared to 0.4 cases per 10,000 person-years among controls. Conversely, those with systemic sclerosis had a twice greater likelihood of eventually developing vitiligo compared to matched controls. Concurrent vitiligo and systemic sclerosis was associated with a higher prevalence of ischemic heart disease, hyperlipidemia, and hypertension.
TO READ MORE: Kridin K, et al. Vitiligo and systemic sclerosis: Are they associated?- Lessons from a population-based study. Australas J Dermatol. 2022 Nov 3. doi: 10.1111/ajd.13942. Epub ahead of print. PMID: 36326157.
A small (N=8) study showed that the majority of patients with RECALCITRANT CUTANEOUS DERMATOMYOSITIS improved when apremilast (30mg BID) was added to ongoing systemic drug therapy. Improvement was judged objectively by cutaneous disease activity severity index (CDASI) decrease of 4 points or more within 3 months of starting apremilast.
TO READ MORE: Bitar C, et al. Apremilast in Recalcitrant Cutaneous Dermatomyositis: A Nonrandomized Controlled Trial. JAMA Dermatol. 2022 Dec 1;158(12):1357-1366. doi: 10.1001/jamadermatol.2022.3917. PMID: 36197661; PMCID: PMC9535502.
COVID-19
Those who experience fever, chills, and/or myalgia following either the Moderna or Pfizer COViD-19 mRNA vaccines develop a greater ANTIBODY RESPONSE compared to those who have no reaction or only injection site pain and erythema.
TO READ MORE: Hermann EA, et al. Association of Symptoms After COVID-19 Vaccination With Anti-SARS-CoV-2 Antibody Response in the Framingham Heart Study. JAMA Netw Open. 2022 Oct 3;5(10):e2237908. doi: 10.1001/jamanetworkopen.2022.37908. Erratum in: JAMA Netw Open. 2022 Nov 1;5(11):e2247057. PMID: 36269359; PMCID: PMC9587476.
In a Canadian population-based study of 11,810,255 adults, death due to COVID-19 occurred in 0.03%. Higher risk of COVID-19 MORTALITY was found in those with lower income, lower educational level, racial minority, domicile in an apartment, and large family size.
TO READ MORE: Wang L, et al. Differential patterns by area-level social determinants of health in COVID-19 related mortality and non-COVID-19 mortality: a population-based study of 11.8 million people in Ontario, Canada. Clin Infect Dis. 2022 Oct 28:ciac850. doi: 10.1093/cid/ciac850. Epub ahead of print. PMID: 36303410; PMCID: PMC9620355.
Regardless of vaccination status, including receipt of boosters, COVID-19 REINFECTION can carry serious consequences. Specifically, reinfected individuals have a doubled risk of death and a more than tripled risk of hospitalization compared with those who were infected with COVID just a single time. Moreover, those who experience reinfection have elevated risks for pulmonary, cardiac, renal, and neurologic problems, as well as new onset diabetes.
TO READ MORE: Bowe B, et al. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. 2022 Nov;28(11):2398-2405. doi: 10.1038/s41591-022-02051-3. Epub 2022 Nov 10. PMID: 36357676; PMCID: PMC9671810.