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Cover Image, Volume 34, Issue 5
Jia-Yi Zhuang,Jin-Sheng Li,Yuan-Qiu Zhong,Fang-Fei Zhang,Xin-Ze Li,Hang Su,Ze-Qiao Zhang,Xiao-Hua Wang,Yong-Feng Chen,
doi : 10.1111/dth.15147
Volume 34, Issue 5 e15147
Giant rhinophyma with olfactory and breathing dysfunction successfully treated by shave excision and electrocautery
Giant rhinophyma with olfactory and breathing dysfunction successfully treated by shave excision and electrocautery
doi : 10.1111/dth.15029
Volume 34, Issue 5 e15029
Tildrakizumab: A new therapeutic option for erythrodermic psoriasis?
Matteo Megna,Luca Potestio,Gabriella Fabbrocini,Eleonora Cinelli,
doi : 10.1111/dth.15030
Volume 34, Issue 5 e15030
Systemic hedgehog inhibitors to treat locally advanced basal cell carcinomas of the head–neck region: A retrospective study
Alessia Villani,Claudia Costa,Gabriella Fabbrocini,Massimiliano Scalvenzi,
doi : 10.1111/dth.15036
Volume 34, Issue 5 e15036
Post Covid-19 vaccination papulovesicular pityriasis rosea-like eruption in a young male
Keshavmurthy A. Adya,Arun C. Inamadar,Warood Albadri,
doi : 10.1111/dth.15040
Volume 34, Issue 5 e15040
Radiation-induced morphea – a rare, but not to be dismissed, adverse effect of radiotherapy
Thilo Gambichler,Christina H. Scheel,Stefanie Boms,
doi : 10.1111/dth.15041
Volume 34, Issue 5 e1504
The potential role for topical imiquimod in the treatment of chronic mucocutaneous candidiasis caused by gain-of-function mutation in STAT1: A case-report
Joel Reis,Frank L. van de Veerdonk,Agostinho Carvalho,Alexandre Fernandes,Susana Machado,
doi : 10.1111/dth.15043
Volume 34, Issue 5 e15043
Crab claw island pedicle flap for reconstruction of nasal ala and perialar combined large defects
Giulio Gualdi,Paolo Amerio,Ruggero Moro,
doi : 10.1111/dth.15046
Volume 34, Issue 5 e15046
Psoriasis caused by pembrolizumab treatment in advanced melanoma: A positive prognostic side effect?
Angelo Massimiliano D'Erme,Cristian Fidanzi,Agata Janowska,Giacomo Allegrini,Cecilia Barbara,Samanta Cupini,Paolo Viacava,Giovanni Bagnoni,
doi : 10.1111/dth.15050
Volume 34, Issue 5 e15050
Black dots in trichoscopy after COVID-19. Can it be telogen effluvium?
Maria Vastarella,Mariateresa Cantelli,Paola Nappa,Gabriella Fabbrocini,Sonia Sofía Ocampo-Garza,
doi : 10.1111/dth.15053
Volume 34, Issue 5 e15053
Exacerbation of psoriasis following COVID-19 vaccination in a patient previously treated with PD-1 inhibitor
Karolina Mieczkowska,Andreas Kaubisch,Beth N. McLellan,
doi : 10.1111/dth.15055
Volume 34, Issue 5 e15055
The initial experience of COVID-19 vaccination in autoimmune blistering diseases patients from a reference care center in Italy
Federico Bardazzi,Diego Abbenante,Federica Filippi,Lidia Sacchelli,Camilla Loi,
doi : 10.1111/dth.15057
Volume 34, Issue 5 e15057
Therapy of cutaneous leishmaniasis caused by Leishmania braziliensis with fluconazole
Stefano Veraldi,Maurizio Romagnuolo,Marco Cusini,Carlo Alberto Maronese,
doi : 10.1111/dth.15060
Volume 34, Issue 5 e15060
Less is more? Failure of one JAK inhibitor does not predict failure of another one in a patient with alopecia areata
Danielle Peterson,Mathieu Powell,Brett King,
doi : 10.1111/dth.15062
Volume 34, Issue 5 e15062
Erythema migrans-like rash after Moderna vaccine: An uncommon type of “COVID arm”
Corrado Zengarini,Chiara Artanidi,Cecilia Preci,Valeria Gaspari,
doi : 10.1111/dth.15063
Volume 34, Issue 5 e15063
Alcohol flushing during dupilumab therapy: An emerging adverse event
Maddalena Napolitano,Luca Potestio,Gabriella Fabbrocini,Cataldo Patruno,
doi : 10.1111/dth.15064
Volume 34, Issue 5 e15064
Can secukinumab improve liver fibrosis? A pilot prospective study of 10 psoriatic patients
Jorge Magdaleno-Tapial,Cristina López-Martí,José María Ortiz-Salvador,Pablo Hernández-Bel,Juan José Tamarit-García,Moisés Diago-Madrid,José Luis Sánchez-Carazo,Amparo Pérez-Ferriols,
doi : 10.1111/dth.15065
Volume 34, Issue 5 e15065
A Gianotti-Crosti-like eruption in the setting of SARS-CoV-2 infection
Emilio de Dios Berná-Rico,Claudia Álvarez-Pinheiro,Patricia Burgos-Blasco,Gerald Selda-Enríquez,Carlos Azcárraga-Llobet,Montserrat Fernández-Guarino,Diego Fernández-Nieto,
doi : 10.1111/dth.15071
Volume 34, Issue 5 e15071
Blistering lesions associated with Waldenström macroglobulinemia: New insights into pathogenesis
Simone Garcovich,Dario Didona,Clara De Simone,Valerio De Stefano,Feliciana Mariotti,Giovanni Di Zenzo,
doi : 10.1111/dth.15072
Volume 34, Issue 5 e15072
Cutaneous lymphocytic vasculitis after administration of COVID-19 mRNA vaccine
Camilla Vassallo,Emanuela Boveri,Valeria Brazzelli,Teresa Rampino,Raffaele Bruno,Arturo Bonometti,Marilena Gregorini,
doi : 10.1111/dth.15076
Volume 34, Issue 5 e15076
Paradoxical psoriasis induced by anti-TNF-alpha successfully treated with brodalumab
Giulio Cortonesi,Emanuele Trovato,Corinne Orsini,Elisa Cinotti,Pietro Rubegni,
doi : 10.1111/dth.15084
Volume 34, Issue 5 e15084
Onset/flare of psoriasis following the ChAdOx1 nCoV-19 Corona virus vaccine (Oxford-AstraZeneca/Covishield): Report of two cases
Prateek Nagrani,Rashmi Jindal,Dikshita Goyal,
doi : 10.1111/dth.15085
Volume 34, Issue 5 e15085
COVID-19 vaccine-induced urticarial vasculitis
Siddhartha Dash,Biswanath Behera,Madhusmita Sethy,Jeebanjyoti Mishra,Sonika Garg,
doi : 10.1111/dth.15093
Volume 34, Issue 5 e15093
Neoadjuvant use of methotrexate in eosinophilic angiocentric fibrosis of upper lip and hard palate: A case report
Francesca Nastro,Angelo Ruggiero,Gustavo Spanò,Sara Cacciapuoti,Mariateresa Cantelli,Gabriella Fabbrocini,Claudio Marasca,
doi : 10.1111/dth.15094
Volume 34, Issue 5 e15094
Sonidegib after vismodegib discontinuation in a patient with Gorlin–Goltz syndrome and multiple basal cell carcinomas
Alfredo Piccerillo,Alessandro Di Stefani,Alessio Costantini,Ketty Peris,
doi : 10.1111/dth.15095
Volume 34, Issue 5 e15095
Comorbidities of bullous pemphigoid: A single-center retrospective case–control study from Turkey
S?la K?l?ç Sayar,Gizem P?nar Sun,R?fkiye Küçüko?lu,
doi : 10.1111/dth.15031
Volume 34, Issue 5 e15031
Although significant associations between bullous pemphigoid (BP) and certain comorbidities, primarily subtypes of neurological disorders, have been reported in several populations, it has yet to be demonstrated whether a correlation exists between pre-existing comorbidities and serum titers of anti-BP180 and 230 immunoglobulin G (IgG) antibodies among BP patients. The aim of the current study is to investigate the demographic and clinical features of BP patients in a large series from Turkey, determine the prevalence of pre-existing neurological and systemic disorders, and assess the correlation between the existence of certain comorbidities and basal serum titers of anti-BP180 and 230 IgG autoantibodies. Thus, data from 145 BP patients diagnosed in the study's center between 1987 and 2017 were retrospectively analyzed and compared with 310 age- and sex-matched control subjects. The serum titers of anti-BP 180 and 230 IgG autoantibodies were compared between the patients with and without comorbidities and its subtypes among 55 patients with available serum basal anti-BP levels. Twenty-eight of the BP patients (19.3%) had already been diagnosed with at least one neurological disorder at the onset of BP. According to regression analysis, preexisting neurological disorders (p = 0.017), stroke (p = 0.017), and malignancies (p = 0.005) were found to be higher among the study's BP patients than the controls. The serum titers of anti-BP180 and 230 that were measured at the time of diagnosis were significantly higher in patients with neurological disorders than in patients without neurological disorders (p = 0.042; p = 0.018). Among the pre-existing comorbidities, neurological disorders, particularly stroke, and malignancies were found to be significantly connected to the occurrence of BP in the selected Turkish population. The high titers of serum anti-BP180 and 230 IgG antibodies at the time of BP diagnoses may highlight undiagnosed pre-existing neurological disorders by provoking suspicion.
Oral cyclosporine is effective in stabilizing active vitiligo: Results of a randomized controlled trial
Hitaishi Mehta,Sheetanshu Kumar,Davinder Parsad,Anuradha Bishnoi,Keshavamurthy Vinay,Muthu Sendhil Kumaran,
doi : 10.1111/dth.15033
Volume 34, Issue 5 e15033
Intrapleural infections in patients with subcutaneous panniculitis-like T-cell lymphoma are susceptible to hemophagocytic lymphohistiocytosis
Ji-Cheng Zhou,Bin-Bin Tan,Yan Huang,Yin-Ying Wu,Zhen-Jie Bai,Min-Lan Liang,
doi : 10.1111/dth.15037
Volume 34, Issue 5 e15037
Superficial cryotherapy using dimethyl ether and propane mixture versus microneedling in the treatment of alopecia areata: A prospective single-blinded randomized clinical trial
Soha Aboeldahab,Essam El-Din Abdel-aziz Nada,Hanan Abd-Elrady Assaf,Zeinab Abu-Elbaha Gouda,Mohammed Abu El-Hamd,
doi : 10.1111/dth.15044
Volume 34, Issue 5 e15044
To verify and compare the therapeutic efficacy and safety of superficial cryotherapy using dimethyl ether and propane (DMEP) mixture vs. microneedling in the treatment of mild scalp alopecia areata (AA). In a prospective randomized single-blinded clinical trial, 80 patients with clinically evident scalp mild AA were randomly assigned into two groups of 40 patients each. Group (1) was treated by superficial cryotherapy using DMEP in three freeze–thaw cycles of 5 s each. Group (2) was treated by microneedling. Both groups were treated every 2?weeks for 6 sessions and followed up for 3 months after the last session. Patients were assessed by photographic documentation, trichoscopic evaluation, severity of alopecia tool (SALT) score, and alopecia areata symptom impact scale (AASIS). An excellent response was achieved in 15 (37.5%) of group (1) compared with 14 (35%) of group (2) patients, while a good response was achieved in 23 (57.5%) of group (1) compared with 21 (52.5%) of group (1) patients, with a statistically insignificant difference. The mean SALT score change percentage was a statistically significantly higher in group (2) patients. The mean AASIS change percentage was higher in group (1) patients, but this was a statistically insignificant. In both groups, the mean numbers of trichoscopic signs of AA significantly decreased from baseline to the end of follow-up period. Both therapeutic modalities were well-tolerated, with no recurrence after the follow-up period. Both superficial cryotherapy using DMEP mixture, and microneedling are simple, effective, and safe therapeutic options for mild scalp AA, however, microneedling showed higher efficacy.
Correction of tear trough deformity by hyaluronic acid soft tissue filler placement inferior to the lateral orbital thickening
Uwe Wollina,Alberto Goldman,
doi : 10.1111/dth.15045
Volume 34, Issue 5 e15045
Tear trough deformities can be a sign of facial aging and exert a negative impact in facial attractiveness. Surgical techniques and adipose tissue transfer have been used to improve tear trough deformity. In recent years, minimal invasive procedures such as soft tissue filler injections became more popular. We report a retrospective evaluation of 45 Caucasian female patients ?40?years (mean age of [58.8?±?8.9] years). Severity of tear trough was classified according to Hirmand: 3 as grade I, 28 as grade II, and 14 grade III tear trough deformities. We used a monophasic hyaluronic acid, low G prime filler placed inferior to the lateral orbital thickening. On average, 0.4 ml of hyaluronic acid (HA) filler were injected per side. The improvement was I grade 29 patients and II grades in 16 patients. The improvement lasted (10.8?±?2.3) months. No severe adverse events were noted. Vascular danger zones can be avoided.
Feasibility of oral tranexamic acid for vitiligo patients with melasma
Pin-Hsuan Chiang,Yu-Jr Lin,Yen-Chuan Chiu,Wen-Hung Chung,Cheng-Lung Ku,Chau Yee Ng,
doi : 10.1111/dth.15047
Volume 34, Issue 5 e15047
Melasma and vitiligo are both common pigmentary disorders, and the treatment is challenging. Oral tranexamic acid (TA) is effective for refractory melasma; however, the feasibility of TA in vitiligo patients with melasma was not studied. To evaluate the treatment outcomes and adverse effects of oral TA in vitiligo patients with melasma. We conducted a retrospective analysis of vitiligo patients who received oral TA for melasma in a tertiary dermatologic center from January 2017 to August 2020. We enrolled 32 patients with concomitant vitiligo and melasma on the face. The mean duration of the improvement of melasma that patients reported is around 1.64?months of treatment. The first sign of repigmentation of the vitiligo lesions occurred at 1?month of treatment. 84.38% of the patients achieved a mild to good degree of improvement of melasma (0%–75% improvement), whereas 81.25% of the patients achieved a moderate to excellent degree of improvement of vitiligo (25%–100% improvement) via physician global assessments. No significant adverse event was noted. No patients experience vitiligo disease deterioration during TA treatment. Oral TA may be a feasible option for melasma in vitiligo patients.
Evaluation of the efficacy and safety of platelet rich plasma injection in treatment of rosacea
Maysa T. Ghoz,Dareen A. Mohamed,Zainab A. Ibrahim,Ghada Fawzy Rezk Hassan,
doi : 10.1111/dth.15049
Volume 34, Issue 5 e15049
Rosacea is a chronic relapsing inflammatory skin disease, with a high prevalence among adults. Treatment of rosacea is difficult, with high rate of recurrence. Due to the strong anti- inflammatory and antibacterial effects of platelet rich plasma (PRP), it was used in the medicine for treating many inflammatory diseases. To evaluate the role of PRP injection in treatment of rosacea. The study was carried on 40 patients with rosacea. They were treated by PRP injection in right side of the face (group A) and platelet poor plasma injection in left side (group B). They underwent one session every 2?weeks for 3 months (6 sessions). The patients were assessed clinically before and after treatment by the rosacea grading scale. Skin biopsies were taken to evaluate the clinical results. There was a statistically significant decrease in rosacea grading scale after treatment with PRP injection, 50% of the patients showed excellent improvement and 50% showed good improvement. The improvement was significantly better in group A than B. There was marked decrease in inflammatory cells by hematoxylin and eosin stain, and decrease in expression of nuclear factor kappa ?eta after treatment with PRP. PRP was effective and safe technique in treatment of rosacea and alternative to other systemic modalities, especially if they are contraindicated.
Real-world evidence on time to relapse of plaque psoriasis after discontinuation of biologic treatment in Poland
Witold Owczarek,Maciej Dzik,Joanna Narbutt,Irena Walecka,Marta Kowalczyk,
doi : 10.1111/dth.15052
Volume 34, Issue 5 e15052
The aim of this study is analysis of time to relapse after discontinuation of biologic treatment and identification of factors associated with risk of relapse. The analysis used real-world data of 705 patients treated with biologic drugs (adalimumab [ADA], ustekinumab, infliximab, and etanercept) in Poland in 2013–2019. Time to relapse was analyzed by Kaplan–Meier estimator. Data was stratified by the number of prior relapses. Determinants of risk to relapse were analyzed with Prentice-Williams-Peterson model. Kaplan–Meier estimate of time to the first relapse was 276?days, to the second relapse was 246?days, to the third relapse was 218?days, and to the fourth relapse was 178?days. In multidimensional analysis statistically significant variables affecting risk of relapse were the following: biologic naivety (hazard ratio [HR] 0.707), ADA (HR 0.787), psoriasis area and severity index at the last follow-up visit (HR 1.049), abnormal hemoglobin level (HR 0.794), and abnormal lymphocyte counts (HR 1.278). The findings of this study suggest that periods to relapse after discontinuation of biologic drugs become shorter with the number of prior relapses experienced by the patient. Ninety-five percentage of observed relapses occurred within 613?days of the end of the first treatment cycle, within 478 of the second cycle and within 351?days of the third cycle.
Evaluation of short-term (16-week) effectiveness and safety of guselkumab in patients with psoriasis: A prospective real-life study on the Chinese population
Jia-Yi Zhuang,Jin-Sheng Li,Yuan-Qiu Zhong,Fang-Fei Zhang,Xin-Ze Li,Hang Su,Ze-Qiao Zhang,Xiao-Hua Wang,Yong-Feng Chen,
doi : 10.1111/dth.15054
Volume 34, Issue 5 e15054
Real-life data on guselkumab in psoriasis are limited and not available in China hitherto. This study aimed to evaluate the short-term effectiveness and safety of guselkumab in patients with psoriasis under Chinese real-life conditions and to explore the effect of guselkumab on CD4+CD25+Foxp3+ regulatory T cells (Tregs). A Chinese prospective and real-life study involving patients with psoriasis in Dermatology Hospital of Southern Medical University, Guangzhou, China from April to September 2020 was conducted. A total of 45 patients with psoriasis were finally enrolled in the study. Psoriasis Area Severity Index (PASI) 90 and 100 responses at week 16 were achieved by 88.6% and 45.5% of patients, respectively. The analysis of PASI response in different subgroups showed no statistically significant difference. Univariate logistic regression analysis revealed that at week 16, none of the variables were associated with decreasing PASI 90 response, whereas age at onset of disease was a predictor of PASI 100 response. Dynamic detection of CD4+CD25+Foxp3+ Tregs frequency from peripheral blood suggested a stable maintained trend in terms of guselkumab treatment duration. No severe adverse events occurred during the follow-up period. This study confirmed the short-term effectiveness and safety of guselkumab, as well as its good tolerance against psoriasis, in the Chinese population. Guselkumab treatment maintains levels of Tregs in patients with psoriasis.
Is targeted UVB as effective as excimer light phototherapy in treatment of vitiligo?
Hera Tabassum,Imran Majid,Saher Imran,
doi : 10.1111/dth.15058
Volume 34, Issue 5 e15058
Excimer light (EL) and targeted UVB (TUVB) devices have been used successfully in repigmenting vitiligo. To compare the repigmenting efficacy and safety of EL with TUVB device in vitiligo. The study was conducted retrospectively on patients of vitiligo who had received either EL (Group A) or TUVB (Group B) from year 2015 to 2020. Data pertaining to 40 such age and sex matched patients from each group was retrieved with almost similar sites of involvement. Only patients whose phototherapy sessions had been given twice weekly for minimum of 30 sessions or until 90%–100% repigmentation were included in the study. The study was retrospective in nature and the principles outlined in the Declaration of Helsinki were followed during the study. The primary endpoint compared between the two groups was the extent of repigmentation achieved on different sites of body and adverse effects from treatment. Secondary endpoints compared included total number of doses, cumulative dose needed for complete repigmentation and number of doses needed for onset of repigmentation. There were 82.6% responders in Group A and 76.3% in Group B who had achieved at least 50% repigmentation. Excellent response (75%–100% repigmentation) was achieved in 68.1% lesions in Group A and 46.4% lesions in Group B. Patients in Group A needed less number of doses (13.75 vs. 19.37) and less cumulative dose (6.14 vs. 7.69?J/cm2) to achieve complete or near complete repigmentation. Adverse effects were negligible in both groups. Targeted phototherapy with EL demonstrated better repigmenting efficacy than TUVB in vitiligo.
Efficacy of combined treatment with intense pulsed light and fractional erbium:YAG Laser in scar prevention: A randomized split wound trial
Jin Cheol Kim,Seok Young Kang,Hye One Kim,Chun Wook Park,Ohseong Kwon,Bo Young Chung,
doi : 10.1111/dth.15061
Volume 34, Issue 5 e15061
Various methods have been used for scar prevention; however, the optimal method remains unclear. We investigated the efficacy of combinational intense pulsed light (IPL)/fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser treatment in early wound healing. This was a prospective, randomized, controlled split wound trial. Scars were divided into three sites: the combined IPL/fractional Er:YAG treatment, fractional Er:YAG laser treatment, and untreated control sites. Treatment was conducted in three sessions: at removal of stitches and after 4 and 8?weeks. Treatment efficacy was evaluated using the Patient Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores. The erythema index (EI) and melanin index (MI) were measured. In the total POSAS score, the IPL/fractional Er:YAG site showed steady and significant improvement, in contrast to the other sites. At week 8, the combined treatment sites had better POSAS scores than the fractional Er:YAG laser alone sites (p = 0.001) and the control sites (p = 0.000). The effect of combinational treatment was maintained until the follow-up period by comparing the Er:YAG (p = 0.015) and control sites (p = 0.007). In terms of VSS scores, the IPL/fractional Er:YAG combined treatment sites had consistent improvement at week 8 (p = 0.005) and week 20 (p = 0.02) compared to that at week 4, while the other sites showed no such improvement. In conclusion, the combination of IPL and Er:YAG showed more favorable effects on scar prevention than Er:YAG or no treatment. IPL/Er:YAG therapy could be an effective and safe strategy in the early wound healing process for reducing scar formation.
Dimethyl fumarate treatment for psoriasis in a real-life setting: A multicentric retrospective study
Monica Corazza,Giulia Odorici,Andrea Conti,Vito Di Lernia,Alberico Motolese,Federico Bardazzi,Sergio Di Nuzzo,Alberto Monti,Federica Arginelli,Federica Filippi,Giorgia Valpiani,Chiara Morotti,Alessandro Borghi,
doi : 10.1111/dth.15066
Volume 34, Issue 5 e15066
Dimethyl fumarate (DMF) is a fumaric acid esters derivate approved for plaque psoriasis as first-line systemic therapy. It has been available in Italy since 2017 and an increasing number of patients are treated with this drug. To evaluate DMF effectiveness, side effects and drug survival in a dermatological real-life setting. We performed a retrospective multi-center study in five dermatologic clinics in Emilia-Romagna, Northern Italy, which included all consecutive patients affected by moderate–severe psoriasis treated with DMF. We assessed effectiveness (in terms of PASI50 and PASI75 in an intention to treat observation) and safety (occurrence of side effects) of DMF and their association with demographic and disease characteristics, mean daily dose taken and treatment discontinuation. We included 103 patients, 78 (75.72%) had at least one comorbidity including 19 (18.44%) with a history of cancer; the mean treatment duration was 23.61?±?17.99?weeks (min 4, max 130) and the mean daily dose was 262.13?±?190.94?mg. Twenty-four patients (23.30%) reached PASI75 at week 12, while a further 18 patients (17.47%) reached it at week 26. Side effects occurred in 63 patients (61.16%), the most frequent were diarrhea, epigastric discomfort, nausea, and flushing. Sixteen patients (15.53%) showed an alteration of laboratory tests. In some cases side effects were transitory, while in 53 patients (51.45%) they led to cessation of therapy. The median daily dose showed a direct association with PASI50 achievement and an indirect association with treatment discontinuation. Our study shows the peculiarities of DMF in a real-world setting: effectiveness is often reached after 12?weeks of treatment and side effects could limit the continuation of the therapy but, at the same time, DMF has no major contraindications and, due to the wide range of dosage, it can allow both to manage side effects and to personalize the prescription for each patient.
Adjuvant PD-1 inhibitor versus high-dose interferon ?-2b for Chinese patients with cutaneous and acral melanoma: A retrospective cohort analysis
Jingjing Li,Jiuhong Wang,Dandan Li,Xizhi Wen,Ya Ding,Xing Liu,Hang Jiang,Fuxue Huang,Xiaoshi Zhang,
doi : 10.1111/dth.15067
Volume 34, Issue 5 e15067
The clinical efficacy of PD-1 inhibitors as an adjuvant treatment for Asian melanoma patients has not yet been determined. This retrospective study analyzed the clinical data of 90 Chinese patients with completely resected, stage III cutaneous or acral melanoma who received either adjuvant PD-1 inhibitor or high-dose interferon ?-2b (HDI). Anti-PD-1 treatment resulted in significantly longer RFS and DMFS than HDI in cutaneous melanoma patients, with hazard ratios (HRs) (anti-PD-1 versus HDI) of 0.402 (95% CI, 0.183–0.886) and 0.324 (95%CI, 0.122 to 0.861) for RFS and DMFS, respectively. However, adjuvant anti-PD-1 treatment had no advantage over HDI in acral melanoma patients with HRs (anti-PD-1 versus HDI) of 1.204 (95% CI, 0.521 to 2.781) and 1.968(95% CI, 0.744–5.209) for RFS and DMFS, respectively. Adjuvant anti-PD-1 treatment yielded a significantly better prognosis than HDI in Chinese patients with stage IIIB/C cutaneous melanoma, but a significant difference was not observed in those with acral melanoma.
Ultrasound-guided injection of intralesional steroids in acute hidradenitis suppurativa lesions: A prospective study
Michela Iannone,Agata Janowska,Teresa Oranges,Lorenzo Balderi,Bianca Benedetta Benincasa,Saverio Vitali,Giulia Tonini,Riccardo Morganti,Marco Romanelli,Valentina Dini,
doi : 10.1111/dth.15068
Volume 34, Issue 5 e15068
The management of hidradenitis suppurativa (HS) flares with intralesional steroids lacks strong scientific evidence but limited data suggest that it may be useful. The objective of this study is to assess the clinical and ultrasound responses of HS flares to ultrasound-guided injections of intralesional triamcinolone (40?mg/ml) with a dilution 1:4 versus 1:2 at 30-day (t1), 60-day (t2), and 90-day (t3) follow-up. We recruited patients with ?3 acute lesions, unresponsive to topical therapy. At baseline we assessed lesions clinically and by ultra-high frequency ultrasound (48 or 70?MHz) and randomly performed an ultrasound-guided injection of triamcinolone. Assessments were repeated at t1, t2, and t3 follow-up, re-injecting the lesion in the case of no or partial response. We treated 49 lesions: 38.8% showed improvements at t1; 46.9% at t2; 6% at t3; and 8.3% showed no clinical and ultrasound improvements. Long-term follow-up data confirmed a statistically significant reduction in Visual Analogue Scale (VAS)-pain, Dermatology Life Quality Index (DLQI), and HS-Physician Global Assessment (HS-PGA), as well as edema and vascular signals. No adverse effects were reported. Our study suggests that ultrasound-injections with a 1:2 dilution are beneficial for HS flares that do not respond to topical treatment and should be included in the therapeutic algorithm.
Treatment of donor site wounds using facial skin remaining in the scar area
Shao-hai Chang,Zhuo-shan Huang,Wei-liang Chen,
doi : 10.1111/dth.15070
Volume 34, Issue 5 e15070
Reconstruction of cheek skin defects is surgically challenging. We evaluated the outcomes of using cheek skin remaining in the scar area for treating donor site wounds following the repair of cheek skin defects using full-thickness skin. We conducted a retrospective case series study that included 12 patients with a scar of the cheek. The patients included seven females and five males. The donor site was treated using the cheek skin remaining in the scar area following repair of the cheek skin defect with a full-thickness skin graft from the inner side of the upper arm. Minor flap necrosis of the full-thickness skin graft in the cheek developed in one patient. The postoperative esthetic results were excellent and satisfactory in 11 and 1 patient, respectively. Patients were followed up for 18–32?months; no lagophthalmos or ectropion was noted. However, there were two cases of hyperpigmentation in cheek grafts, and two of graft hypertrophy in the arm. The facial skin remaining in the scar area can be used to treat donor site wounds following a full-thickness skin graft from the inner side of the upper arm to repair a large cheek skin defect.
Therapeutic efficacy and safety of three different modalities in pediatric patients with plantar warts
Emine Müge Acar,Belk?z Uyar,Ömer Faruk Elmas,Kemal Özyurt,Mustafa Atasoy,Ümit Türsen,Torello Lotti,
doi : 10.1111/dth.15073
Volume 34, Issue 5 e15073
Human papillomavirus infection is relatively common in communities. Thus, determining an effective and painless treatment method, especially in pediatric patients is of utmost importance. This study aimed to compare the outcomes of three different methods of treating plantar warts in pediatric patients. Children with verruca plantaris treated with a salicylic acid–lactic acid combination once daily (SA/LA 1), a salicylic acid–lactic acid combination applied in three to seven layers under occlusion every 3?days (SA/LA 2), or a combination of 5-fluorouracil (0.5%) and salicylic acid (10%) (SA/5-FU) were evaluated retrospectively. Treatment responses and recurrence rates were also evaluated after a minimum of 4 months. Among the 98 children with verruca plantaris, 19 were treated with SA/LA 1, 53 were treated with SA/LA 2, and 18 were treated with SA/5-FU; the eight patients who received cryotherapy were excluded. The mean treatment duration was significantly shorter in the SA/LA 2 group than in the SA/LA 1 group and the SA/5-FU group. (p?= 0.000 for both) Application of a salicylic acid–lactic acid combination in multiple layers under occlusion is a safe, painless, and effective treatment method for plantar warts in children.
Characteristics of mucocutaneous vascular malformations drawn from a decade of a multidisciplinary committee experience
Andrea Estébanez,Miguel Puche-Torres,Juan Manuel Sanchis García,Alberto Cuñat,Maria Isabel Pinazo Canales,María Francisca Rausell Félix,Salvador Campos,Juan Márquez Cañada,Jose María Martín Hernández
doi : 10.1111/dth.15074
Volume 34, Issue 5 e15074
Vascular malformations (VM) are congenital, benign, and relatively frequent lesions. Scant data have been published about the epidemiology, clinical presentation, and treatment of VM from a dermatologist's perspective. The substantial differences between subtypes, broad range of specialists consulted and confusing nomenclature used over previous years may hamper a correct diagnosis. The main objective of this study is to describe VM epidemiology. As a secondary endpoint we evaluate clinical characteristics, clinical-radiological correlation and treatment approaches. We carried out an observational, descriptive, retrospective study. Cases presented to the multidisciplinary committee of our hospital from 2009 to 2019 were retrieved. Electronic medical records, monthly committee reports and the iconographic archive were reviewed and statistically analyzed. Overall, venous malformations (VeM) are the most frequent VM, followed by capillary malformations (CM), arterioVeM and lymphatic malformations (LM). Considering only patients under 16, CMs are the most frequent ones. Capillary and LMs are larger than venous or arteriovenous. While CMs are usually asymptomatic, symptomatic cases are threefold more frequent in the other subtypes. Decisions on active or conservative management depend on VM size but not location or patient age. CMs are mainly treated with laser therapy; venous with sclerotherapy or surgery; arteriovenous with surgery and lymphatic with surgery or sirolimus. Dermatologists play an important role in VM diagnosis and management. Our 10-year multidisciplinary experience should contribute to the literature and represent a practical resource for clinicians and researchers.
Oral simvastatin combined with narrowband UVB for the treatment of psoriasis: A randomized controlled trial
Mohammad Al Salman,Maryam Ghiasi,Ali Salehi Farid,Mohammad Taraz,Arghavan Azizpour,Hamidreza Mahmoudi,
doi : 10.1111/dth.15075
Volume 34, Issue 5 e15075
Psoriasis is a common chronic skin condition, which is an immune-related hyperproliferative disorder. Among the different treatments for psoriasis, statins have been found to reduce the severity of the disease. Accordingly, fluvastatin and simvastatin are known to have anti-inflammatory effects by inhibiting inflammatory cytokines and lymphocyte function. Narrowband ultraviolet B (NB-UVB) is known as an effective and safe modality for psoriasis treatment. In this double blind, randomized controlled trial, we investigated the efficacy and safety of adding simvastatin to NB-UVB phototherapy in patients with psoriasis. Forty-eight patients with psoriasis undergoing NB-UVB phototherapy were randomly divided into placebo groups; one received oral simvastatin, and the other received a placebo for 12?weeks. Psoriasis severity was assessed with the Psoriasis Area and Severity Index (PASI) and Dermatology Life and Quality Index (DLQI). Both groups showed a significant decline in PASI score after 6 and 12?weeks compared to the baseline. The differences in reducing PASI score and DLQI between the two groups were not significant neither at week sixth nor 12th. In addition, DLQI decreased significantly in the placebo group at week 12th. In contrast with previous studies, we did not find any additional effects for oral simvastatin5 in treating psoriasis with NB-UVB. Also, an insignificant difference in the improvement of quality of life between both groups was ascertained.
Patient satisfaction with calcipotriol/betamethasone dipropionate cutaneous foam for the treatment of plaque psoriasis: The LION real-life multicenter prospective observational cohort study
Anna Campanati,Laura Atzori,Concetta Potenza,Giovanni Damiani,Luca Bianchi,Monica Corazza,Rossana Tiberio,Francesca Prignano,Giuseppe Argenziano,Maria Concetta Fargnoli,Luca Stingeni,Annamaria Mazzotta,Ornella De Pità,Carlo Mazzatenta,Claudio Feliciani,Massimo Donini,Annamaria Offidani,Ketty Peris,LION study group
doi : 10.1111/dth.15077
Volume 34, Issue 5 e15077
Topical treatment is the mainstay for mild or moderate psoriasis, but patients are generally little satisfied. Calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam has shown to improve signs and symptoms in plaque psoriasis patients. This study assessed patient's satisfaction with Cal/BD foam in a real-life Italian dermatological clinical practice. A multicenter, 4-week observational prospective cohort study enrolled, in 17 Italian dermatology clinics, adult patients with plaque psoriasis on the body and/or scalp. Treatment satisfaction was assessed by 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9), preference over previous treatments by Patient Preference Questionnaire (PPQ), and change in disease state by Psoriasis Area Severity Index (PASI). Overall 256 patients were eligible, with a mean (SD) age of 55.6 (15.4) years, 59.4% were males. Psoriasis severity was mild in 52.0% of patients, moderate in 43.3%, and severe in 4.7%. Scalp involvement was present in 36.7% of patients. Previous antipsoriatic treatments had been received by 80.5% of patients. TSQM-9 median (25th–75th percentile) scores were 83.3 (66.7–88.9) for effectiveness, 77.8 (66.7–88.9) for convenience, and 78.6 (64.3–92.9) for global satisfaction. Mean (SD) PASI value decreased from 7.3 (4.8) to 2.1 (2.7) after 4?weeks. More than 90% of patients previously treated for psoriasis evaluated the Cal/BD foam more effective, easier to use and better tolerated compared to previous topical treatments at PPQ. This observational study provides real-life evidence of a high level of satisfaction with effectiveness and convenience of the Cal/BD foam in a cohort of plaque psoriasis patients, with an objective improvement in PASI.
A randomized prospective study of different dose regimens using the 308-nm excimer laser in the treatment of palmoplantar pustulosis
Chen Peng,Yifan Hu,Wenjuan Chen,Yangfeng Ding,Xingzi Li,Ning Yu,Jiajing Lu,Yuling Shi,
doi : 10.1111/dth.15079
Volume 34, Issue 5 e15079
The objective of this study was to evaluate optimal treatment regimen of 308-nm excimer laser for palmoplantar pustulosis (PPP). 77 patients with PPP were randomly assigned to receive low dose (2-fold of MED as initial dose), medium dose (4-fold of MED as initial dose) and high dose group (6-fold of MED as initial dose) and the MED of each patient depended on the ultraviolet light sensitivity of individual's skin which ranged from 0.1 to 0.25?J/cm2. All group received 308-nm excimer laser treatment three times weekly for 8?weeks. Clinical evaluation based on the Palmoplantar Pustular Psoriasis Area and Severity Index (PP-PASI) and Dermatology Life Quality Index (DLQI) score. All treatment groups achieved satisfied efficacy at the end of the treatment period with more obvious reduction of PP-PASI score in high dose group (16.05?±?4.26) than low and medium dose group (23.67?±?7.16, p?< 0.01; 22.04?±?5.74, p?< 0.01). Improvement of DLQI score was greatest at week 4 for all patients in each group, while DLQI improved more quickly in high/medium dose group than low dose group. Adverse effects of erythema, blistering and erosions were more common with the higher dose regimen. High dose of 308-nm excimer laser could achieve a better efficacy in PPP treatment, reduce the severity of the disease in patients and improve the life quality of patients. Meantime, the incidence of adverse reactions should be aware of and it's necessary to evaluate the skin and lesion type before the dose selection.
Efficacy and safety of intralesional tuberculin purified protein derivative versus cryotherapy in the treatment of warts: An assessor-blinded, randomized controlled trial
Wan Syazween Lyana Wan Ahmad Kammal,Adawiyah Jamil,Norazirah Md Nor,
doi : 10.1111/dth.15080
Volume 34, Issue 5 e15080
Cryotherapy is a standard treatment for warts. Tuberculin immunotherapy is a novel therapeutic option. We compared the efficacy and safety of cryotherapy versus tuberculin immunotherapy in a randomized, assessor-blinded study. 15 patients were treated with intralesional tuberculin and 15 patients received cryotherapy every 2?weeks until complete wart resolution or a maximum of six sessions. Wart diameter, total number of warts and adverse effects were documented. Complete clearance of treated warts was achieved in 13(86.7%) and 11(73.3%) of patients with immunotherapy and cryotherapy respectively. Immunotherapy showed greater wart size reduction (51.88?±?89.36?mm) than cryotherapy (32.99?±?36.19?mm), (p = 0.46). Immunotherapy resulted in 64% reduction in total number of warts compared to 23.2% with cryotherapy, p?<?0.01. More blisters developed with cryotherapy (46.7%) than immunotherapy (6.7%), (p = 0.01). Compartment syndrome-like features complicate immunotherapy in 1 patient. Tuberculin immunotherapy and cryotherapy are equally effective in treating warts. Immunotherapy has added benefit with resolution of distant warts. Safety profiles were similar except for blisters which were more common with cryotherapy.
Efficacy and safety of cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in the treatment of seborrheic keratosis
Shirin Zaresharifi,Reza M. Robati,Sahar Dadkhahfar,Mohammad-Mehdi Forouzanfar,Nooshin Zaresharifi,
doi : 10.1111/dth.15083
Volume 34, Issue 5 e15083
Seborrheic keratosis (SK) is a common benign skin epidermal lesion. Different treatment modalities have been proposed for this lesion. This study aimed to compare the efficacy and safety of electrodesiccation, cryotherapy, CO2 laser, and Er:YAG laser in the treatment of SK. The study was carried out on 30 patients each with four similar facial SKs. Each lesion was assigned to be treated with cryotherapy, electrodesiccation, CO2 laser, and Er:YAG laser in a random fashion. Therapeutic results were evaluated 8?weeks after the interventions through clinical and dermatoscopic assessment. Treatment improvement criteria for each lesion included the texture of the lesion, severity of the pigmentation, and an overall assessment of the healing. The severity of burning, pain, erythema, and the duration of the erythema after the procedures were documented. A survey of the patients' satisfaction with the treatments was also performed. In the assessment of overall lesion healing by two dermatologists, the improvement rate was significantly higher in the CO2, Er:YAG lasers and electrodesiccation group compared to the cryotherapy (p <?0.001). However, the CO2 and Er:YAG laser and the electrodesiccation groups showed no significant difference (p >?0.05). Moreover, no significant difference was observed in posttreatment pigmentation and texture between the groups (p >?0.05). The pain and burning severity after the interventions were negligible in all four groups. Prolonged erythema was not observed in any of the cases; however, the duration of erythema in the Er:YAG laser group was significantly longer (p <?0.001). Patient satisfaction in the cryotherapy group was significantly lower than the other three groups (p <?0.001). The efficacy of treatment and patient satisfaction rate is highly comparable between electrodesiccation, CO2 laser, and Er:YAG laser but significantly higher than cryotherapy.
Tanshinone IIA alleviates vitiligo by suppressing AKT mediated CD8+ T cells activation in a mouse model
Diancai Zhang,Yujie Wang,Guangzhi Li,Baoxiang Zhang,
doi : 10.1111/dth.15086
Volume 34, Issue 5 e15086
Tanshinone IIA has been reported to exhibit anti-inflammatory effects, while it is not clear whether Tanshinone IIA has protective role in vitiligo. Premelanosome (PMEL) CD8+ T cells were adoptive transferred into Krt14- Kitl* mice with Kit ligand (KITL) over-expressed, to construct the vitiligo model. Pdk1fl/fl and Stat3fl/fl mice were crossed with Cd8cre mice to establish Pdk1TKO and Stat3TKO mice. Tanshinone IIA (200??g) was intravenous injected to treat vitiligo in mice every 3?days. The accumulation of macrophages and CD8+ T cells in the ear skin was assayed by flow cytometry. Bone marrow-derived macrophages (BMDMs) were induced and stimulated with lipopolysaccharides (LPS) and IL-4. It was found that Tanshinone IIA alleviated the development of vitiligo, impaired PMEL CD8+ T cells accumulation in the ear skin, and inhibited LPS-induced TNF-?, IL-6, and IL-1? expression and secretion in BMDMs, which could also inhibit IL-4-induced Arg-1 and Mrc-1 expression in BMDMs. In addition, Tanshinone IIA could inhibit the proliferation and cytotoxic function of CD8+ T cells indicated by the expression of Perforin, Granzymeb, and IFN-?. Furthermore, Tanshinone IIA treated Pdk1TKO mice, not Stat3TKO mice, showed impaired PMEL CD8+ T cells accumulation in the ear skin. In summary, Tanshinone IIA alleviates vitiligo development with impaired CD8+ T cells accumulation and activation of Pdk1-Akt pathway.
Hyperdiluted calcium hydroxylapatite for the treatment of skin laxity of the neck
Stefania Guida,Sabrina Longhitano,Marco Spadafora,Andrea Lazzarotto,Francesca Farnetani,Nicola Zerbinati,Giovanni Pellacani,Hassan Galadari,
doi : 10.1111/dth.15090
Volume 34, Issue 5 e15090
Despite being a common concern, there are very few minimally invasive treatments targeting neck skin laxity (NSL) reported in the literature. To assess the efficacy of hyperdiluted calcium hydroxyapatite (hy-CaHA) for the treatment of NSL, according to the NSL scale, and to estimate safety. Twenty patients showing NSL were treated with hy-CaHA 1:2. To evaluate the efficacy of hy-CaHA treatment for NSL, pictures of treated subjects were collected before and 3 months after treatment and graded according to the NSL scale, and T-student's test was applied to estimate differences. Hy-CaHA for the neck was effective according to the previously unreported NSL scale (p?<?0.001) and safe. There were no major adverse events reported. This study supports the efficacy (according to the NSL scale) and safety of hy-CaHA (1:2) for NSL. Our results also highlight the utility of the newly developed NSL scale, being a useful tool to evaluate the level of NSL before treatment and to measure the outcome.
Therapeutic approach with squaric acid dibutylester for steroid resistant-alopecia areata incognita: A pilot study of a single center
Michela Starace,Roberta Vezzoni,Aurora Alessandrini,Francesca Bruni,Miriam Anna Carpanese,Cosimo Misciali,Andrea Sechi,Bianca Maria Piraccini,
doi : 10.1111/dth.15096
Volume 34, Issue 5 e15096
Topical immunotherapy is widely used in the treatment of alopecia areata (AA). Alopecia areata incognita (AAI) is a relatively common disorder, predominantly affecting females, characterized by widespread hair thinning in the absence of typical alopecic patches. AAI can have a chronic relapsing course and in some cases can be resistant to current standard treatments. Topical immunotherapy has been used in the management of AA with encouraging results, but to date there are no literature studies reporting the efficacy of topical immunotherapy with squaric acid dibutylester (SADBE) in AAI. The aim of our study is to evaluate the efficacy and tolerance of topical immunotherapy with SADBE in AAI not responding to conventional steroid therapy. A total of 12 patients were enrolled in our Hair Disease Outpatient Service, with a proved histological diagnosis of AAI, and resistant to classical steroid therapy. Each patient underwent global photography, pull test, and trichoscopy at beginning and during the follow-ups. The efficacy of topical immunotherapy with SADBE was assessed by evaluating the changes of clinical and trichoscopic signs. Complete regrowth was achieved in 66.7% of cases (8/12), three patients remained unchanged on clinical evaluation but showed subclinical improvement on trichoscopy, whereas one patient progressed and worsened both on clinical and trichoscopic examination. All patients reported scalp diffuse mild erythema and itching the day after the application of SADBE, which were well tolerated. Three patients developed reactive cervical lymphoadenomegaly. No other side effects were observed. Topical immunotherapy with SADBE is widely used in the management of patchy AA and can be considered an effective alternative in resistant AAI, providing visible clinical and trichoscopic improvement in the majority of cases. Further studies are warranted to confirm and validate our findings.
The efficacy of Janus kinase inhibitors in patients with atopic dermatitis: A systematic review and network meta-analysis
Lu Zhang,Lian Wang,Xian Jiang,
doi : 10.1111/dth.15098
Volume 34, Issue 5 e15098
Janus kinase (JAK) inhibitors are novel treatment approaches for atopic dermatitis (AD). This study was aimed to compare the efficacy of JAK inhibitors for AD treatment. The database of PubMed, EMBASE, Web of Science, and Cochrane Library were searched until March 28, 2021, for randomized control trials (RCTs) of AD patients treated with JAK inhibitors. Baseline and follow-up data were extracted. Efficacy of JAK inhibitors was evaluated using 50% improvement in Eczema Area and Severity Index (EASI-50). A Bayesian multiple treatment network meta-analysis with fixed effects was performed. Odds ratio (OR) with 95% credibility interval (CrI) were used for comparing the efficacy of JAK inhibitors with placebo for AD. A total of seven RCTs of JAK inhibitors with 2530 patients were included for analysis. After excluded one study with high risk of bias, a total of six JAK inhibitors with 17 different formulations and doses were analyzed. The severity of atopic dermatitis of included patients was almost moderate to severe (93.4%). Compared with placebo, all JAK inhibitors had higher EASI-50 at 4?weeks of treatment, except for baricitinib with 1 mg once daily (QD) (OR: 1.4, 95% Crl: 0.9–2.1), ruxolitinib with 0.15% QD (OR: 2.3, 95% Crl: 0.8–11.4), and ruxolitinib with 0.5% QD (OR: 3.4, 95% Crl: 0.9–18.1). Among all included, upadacitinib had the highest probability of being the best treatment (SUCRA value of 0.936). In topical JAK inhibitors, delgocitinib 3% twice a day (BID) had the highest probability of being the best treatment (SUCRA value of 0.849). JAK inhibitors had promising treatment efficacy for AD patients. Upadacitinib with 30?mg QD had the best efficacy among all included JAK inhibitors, and delgocitinib 3% BID showed superior efficacy over other topical JAK inhibitors for AD treatment.
A novel nonfocused pulsed ultrasound technology for noninvasive circumference reduction
Ines Verner
doi : 10.1111/dth.15101
Volume 34, Issue 5 e15101
There is a continuously growing demand for circumference reduction and body shaping technologies, with an overwhelming preference for non-invasive, pain-free procedures. This paper presents a novel body contouring device which uses pulsed, vacuum-assisted non-focused ultrasound. To evaluate the clinical safety and efficacy of the vacuum-assisted acoustic wave technology for circumference reduction of the abdominal region. Eighteen healthy women with a body mass index under 25 underwent four 20-min fat reduction treatments in the abdominal region, at 1-week intervals. Efficacy was evaluated by the change in abdominal circumference up to 12?weeks post treatment relative to baseline and by comparison of before and after photos by two blinded evaluators. Subjects rated their satisfaction with the treatment procedure and outcomes. Safety was evaluated by adverse events, local skin reaction, and pain assessments. 1?week after the final session, the mean reductions in abdominal circumference measured 5.4 ±?2.6 cm. At 1 month after the last session, the cumulative reduction in circumference was 5.8 ±?3.2 cm. Measurements take at 3 months after the last treatment showed abdominal circumferences decrease of an average 5.2 ±?3.1 cm relative to baseline measures. All patients reported a painless procedure and there were no treatment-induced severe adverse events. Most patients reported a positive change in body contour, with all subjects saying they would highly recommend the treatment to others. Assessments performed by blinded evaluators ranked six cases as very to extremely improved and an additional seven cases as somewhat improved. No dramatic weight fluctuations were recorded. This study demonstrates that a four-treatment course with an acoustic wave ultrasound applicator with 1-week intervals, leads to a significant reduction in abdominal circumference, lasting up to at least 3 months with no pain or side effects reported.
Therapeutic approaches and targets for treatment of autoimmune bullous diseases
Federico Bardazzi,Camilla Loi,Adriano Chessa Marco,Ambra Di Altobrando,Federica Filippi,Rossella Lacava,Filippo Viviani,Riccardo Balestri,Miriam Leuzzi,Lidia Sacchelli,
doi : 10.1111/dth.15032
Volume 34, Issue 5 e15032
Autoimmune bullous diseases are a heterogeneous group of diseases characterized by the development of cutaneous and mucosal vesicles, blisters, and finally erosions. The common pathogenetic mechanism is the presence of autoantibodies targeting structural proteins of the skin and mucous membranes (demosomes and hemidesmosomes): in the case of pemphigus, the antigens are intraepidermal, whereas in the case of pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa acquisita they are subepidermal. Mucosal involvement typically affects the oral and ocular mucosa, but in some cases, the upper airways or the upper digestive tract are affected. The burden on patients' lives could be severe due to the impairment of normal feeding or breathing. In other cases, they may represent paraneoplastic syndromes. Since autoimmune bullous diseases may result in significant morbidity and mortality, depending on the grade of cutaneous and mucosal involvement, a prompt therapeutic approach is mandatory and, in recalcitrant cases, may be challenging. The first line therapy consists of corticosteroids, both topical and systemic. Once remission or control of the acute phase is obtained, adjuvant therapies need to be introduced in order to spare the corticosteroid load and minimize side effects such as iatrogenic diabetes or osteoporosis. Herein, we describe all current therapeutic approaches to autoimmune bullous diseases, also including emerging therapies.
Treatments for disease damage in cutaneous lupus erythematosus: A narrative review
Adrienne K. Joseph,Laila F. Abbas,Benjamin F. Chong,
doi : 10.1111/dth.15034
Volume 34, Issue 5 e15034
Cutaneous lupus erythematosus (CLE) is an autoimmune photosensitive disorder that affects the skin. CLE lesions can have signs of skin damage including dyspigmentation, scarring, atrophy and/or alopecia. Disease damage secondary to CLE can be cosmetically disfiguring and causes patients significant distress. While many current treatments for CLE focus primarily on reducing inflammation, there are few options for managing disease damage. Providers currently lack strong guidance on managing CLE damage due to the paucity of literature on this topic. Because of this knowledge gap, we aim to provide an overview of what is currently known about the pathogenesis and management of signs of disease damage in CLE. In this narrative review, Pubmed, Ovid Medline, and Google scholar were searched for relevant articles assessing pathogenesis and treatment of disease damage. Therapeutic options for CLE damage, including hyperpigmentation (laser and camouflage), hypopigmentation (melanocyte grafting and camouflage), scarring (laser, dermabrasion, and camouflage), atrophy (filler, fat transplantation, and flap procedures), and scarring alopecia (hair transplantation and camouflage) were identified. We found that investigations of therapeutics for CLE disease damage primarily consist of case reports and small case series. Reported adverse events due to treatment for CLE disease damage range from temporary erythema and discomfort to disease reactivation and pigmentary defects. There are various treatments for disease damage for each sign of disease damage. However, more robust investigations are needed to assess disease pathogenesis and improve treatments of disease damage due to CLE.
Rivaroxaban for treatment of livedoid vasculopathy: A systematic review
Yimeng Gao,Hongzhong Jin,
doi : 10.1111/dth.15051
Volume 34, Issue 5 e15051
Rivaroxaban is a direct inhibitor of activated coagulation factor X and competitively targets factor Xa via reversible binding. We conducted a systematic review of the efficacy and safety of rivaroxaban for treatment of livedoid vasculopathy (LV) by searching the PubMed, Cochrane and Embase databases. A total of 22 articles and 1 registered clinical trial were identified in the search of which 13 were included. The studies included 73 LV patients receiving rivaroxaban therapy (10–20?mg per day). Overall, 60 patients (82.2%) had responses to therapy, achieving remission of both pain and ulceration. Few adverse effects were observed. Thus, the consensus of the clinical evidence is that rivaroxaban is a well-tolerated and effective treatment for LV. However, this still needs to be confirmed by large prospective and/or case control studies.
COVID-19 vaccines: What dermatologists should know?
Azin Ayatollahi,Hamed Hosseini,Rojin Firooz,Alireza Firooz,
doi : 10.1111/dth.15056
Volume 34, Issue 5 e15056
As COVID-19 vaccination has started worldwide to control this pandemic, dermatologists may face various challenges with these new vaccines. In this manuscript, we review different types of available COVID-19 vaccines and their various production platforms. Vaccination considerations in patients with skin diseases, especially those using immunomodulatory drugs will be presented. Finally, adverse cutaneous reactions of COVID-19 vaccines will be reviewed.
Ostomy 101 for dermatologists: Managing peristomal skin diseases
Peyton C. Morss-Walton,Julie Z. Yi,Mary-Ellen Gunning,Jean S. McGee,
doi : 10.1111/dth.15069
Volume 34, Issue 5 e15069
An estimated 1 million North Americans live with ostomies, with up to 80% of ostomy patients developing stoma-related skin morbidities. While ostomy nurses are often the first line of management, dermatologists may be involved in the care of ostomy patients with complex or persistent peristomal skin complications. Therefore, an understanding of the ostomy apparatus and possible peristomal skin conditions that may arise allows dermatologists to identify skin complications early and work effectively with a multidisciplinary team. In this article, we aim to review the ostomy apparatus, discuss the differential diagnoses, and provide practical guidelines for the management of peristomal skin conditions. Pubmed, Ovid Medline, and Google Scholar were searched for relevant articles assessing peristomal skin complications and their management. Peristomal skin complications may be local (e.g., contact dermatitis, infection, fistula, and mechanical trauma) or secondary to systemic disease (e.g., inflammatory bowel disease, pyoderma gangrenosum, and psoriasis). Ensuring appropriate ostomy fit and proper use of ostomy accessory products helps to reduce effluent leakage and prevent damage to the peristomal skin. For persistent peristomal skin conditions, corticosteroid sprays, systemic therapies, and surgical interventions may be warranted.
Acute localized exanthematous pustulosis: Clinical features, pathophysiology, and therapy
Idoudi Safa,Lahouel Ines,Litaiem Noureddine,Jones Meriem,Njima Manel,Hichem Belhajali,Zeglaoui Faten,Jameleddine Zili,
doi : 10.1111/dth.15087
Volume 34, Issue 5 e15087
Acute localized exanthematous pustulosis (ALEP) is a rare disease characterized by the acute onset of multiple localized non-follicular, pinhead-sized pustules. ALEP is considered a localized form of acute generalized exanthematous pustulosis but its pathogeny is not well identified. We performed a systematic review of the literature of all publications regarding ALEP cases using the term “acute localized exanthematous pustulosis,” to provide an update on this disease and its management. Results and conclusion ALEP is an uncommon skin condition attributed primarily to a hypersensitivity reaction to a systemic drug (classical or herbal); though a contact mechanism has been reported. It may be misdiagnosed as infectious or inflammatory disease but the clinico-pathological correlation in addition to the rapid response to withdrawal of the culprit agent supports this diagnosis. The pathogenesis of ALEP is still unclear, and there are no standardized treatment guidelines to manage this disease. Both AGEP and ALEP have a good prognosis if an early diagnosis is made.
Nails and COVID-19 – A comprehensive review of clinical findings and treatment
Uwe Wollina,Jean Kanitakis,Robert Baran,
doi : 10.1111/dth.15100
Volume 34, Issue 5 e15100
The SARS-CoV-2 infection, responsible for COVID-19, has raised the interest for infection-associated muco-cutaneous symptoms. While dermatologic symptoms in general gained an increasing awareness, affection of the nail organ has been mentioned only recently. We provide a narrative review on COVID-19 manifestation on the nail organ and add symptoms induced by personal protective measures and SARS-CoV-2 vaccination. Available treatment options are discussed.
Atopic dermatitis in adolescents: Effectiveness and safety of dupilumab in a 16-week real-life experience during the COVID-19 pandemic in Italy
Luca Stingeni,Katharina Hansel,Elettra Antonelli,Giacomo Dal Bello,Cataldo Patruno,Maddalena Napolitano,Gabriella Fabbrocini,Teresa Grieco,Giovanni Pellacani,Maria Concetta Fargnoli,Maria Esposito,Viviana Piras,Myriam Zucca,Giampiero Girolomoni,
doi : 10.1111/dth.15035
Volume 34, Issue 5 e15035
Dupilumab showed significant improvement of adolescent atopic dermatitis (AD) signs and symptoms in clinical trials, with a good safety profile. Herein we report the real-word effectiveness and safety of dupilumab in adolescents with moderate to severe AD from January to October 2020, during the COVID-19 pandemic in Italy. All patients had a diagnosis of AD for a mean [SD] 12.8 [3.1] years. Baseline demographics, AD characteristics (EASI, cDLQI, NRS itch score, NRS sleep loss score) at baseline and week 16, and safety data were collected. Nineteen patients (52.6% men; mean [SD] age, 15.6 [1.4] years [range, 13–17?years]) were included in the analysis. All patients reached EASI-50 and 78.9% EASI-75, especially in those with EASI?30 and BMI?<?25 at baseline, with marked reduction for cDLQI (77.4%), NRS itch score (5.9 point), and NRS sleep loss score (87.5%). One patient contracted asymptomatic SARS-CoV-2 infection and 1 developed mild conjuntivitis, without stopping dupilumab. In this real-word experience the effectiveness of dupilumab was excellent and resulted higher than that observed in clinical trials, with a good safety profile during COVID-19 pandemic.
Secukinumab-induced multiple lentigines in areas of resolved psoriatic plaques: A case report and literature review
Sanquan Zhang,Jingyao Liang,Xin Tian,Xin Zhou,Weiyu Liu,Xiaoyin Chen,Xibao Zhang,
doi : 10.1111/dth.15048
Volume 34, Issue 5 e15048
Psoriasis is a systemic inflammatory disease commonly associated with postinflammatory hyper- and hypo-pigmentation. Psoriasis-related cytokines such as IL-17 and TNF can contribute to these pigmentation changes by regulating both the growth and pigment production of melanocytes. Here, we present the first reported the case of a patient with a 10-year history of severe psoriasis vulgaris, who developed multiple lentigines in areas of resolved psoriatic plaques during anti-IL-17A antibody secukinumab.
Ocular adverse events in patients with atopic dermatitis undergoing treatment with dupilumab: An Italian single-center experience
Maddalena Napolitano,Adriana Di Guida,Gabriella Fabbrocini,Cataldo Patruno,
doi : 10.1111/dth.15059
Volume 34, Issue 5 e15059
Ocular comorbidities are more frequent in patients with severe atopic dermatitis (AD) compared to general population. Dupilumab, a fully human monoclonal antibody that prevents the signaling of interleukin (IL)-4 and IL-13, is reported to be efficacious and safe for the treatment of moderate-to-severe AD, asthma, and chronic sinusitis. However, conjunctivitis was the most common side effect observed both in clinical trials and real-life studies in atopic patients. In our experience, among all patients treated with dupilumab from June 2018 to February 2021, we observed a total of 42 cases (10.42%) of conjunctivitis, appearing approximately 13.8?weeks after initiating treatment. Thirty-five patients (8.68%) developed mild-to-moderate conjunctivitis, and 7 (1.74%) severe conjunctivitis. The drug was discontinued in all 7 patients with severe conjunctivitis.
Successful treatment of tinea capitis caused by Microsporum canis in a 23-day-old newborn with itraconazole pulse therapy and a review of the literature
Yuan Yuan Xiao,Ya Bin Zhou,Jin Jing Chao,Lin Ma,
doi : 10.1111/dth.15078
Volume 34, Issue 5 e15078
Although tinea capitis is common in children, but it is rare in newborns. It should be differentiated with neonatal lupus erythematosus, nummular eczema, psoriasis, seborrheic dermatitis, erythema annular centrifugum, annular urticaria, and annular erythema of infancy. Tinea capitis usually needs oral antifungal therapy, but the data of use in newborn is limited. Here, we report a case of tinea capitis caused by Microsporum canis in a 23-day-old female newborn. The patient was given itraconazole oral solution pulse therapy with an excellent outcome. Itraconazole oral solution pulse therapy may be a promising therapy for tinea capitis in infants, especially in newborns.
A retrospective study to assess the efficacy, safety, and drug survival of secukinumab in plaque psoriasis patients in China
Yu Wang,Xiaohua Wang,Yixin Yu,Liyan Yuan,Xiaoling Yu,Bin Yang,
doi : 10.1111/dth.15081
Volume 34, Issue 5 e15081
Secukinumab, a full human immunoglobulin G1? monoclonal antibody that targets interleukin-17A, has demonstrated remarkable efficacy and appreciable tolerance in patients with moderate-to-severe psoriasis. However, data on its real-life performance, particularly on drug survival in China are limited. To investigate the efficacy, safety, and drug survival of secukinumab in Chinese patients with psoriasis, we conducted a monocentric retrospective study of 66 patients with moderate-to-severe psoriasis to followed-up for 52?weeks. At week 12, 86.4%, 57.6%, and 10.6% of the patients attained 75% improvement in psoriasis area and severity Index (PASI) score from baseline (PASI 75), PASI 90, and PASI 100 responses, respectively. The quality of life of patients markedly improved. The overall survival rate was 74.2%. Adverse events occurred in 30 patients (45.5%). The results revealed favorable efficacy, safety, and tolerability of secukinumab in the treatment of patients with psoriasis and provided data on drug survival in real-life clinical setting in China for the first time.
H syndrome: A review of treatment options and a hypothesis of phenotypic variability
Hagar Nofal,Rania AlAkad,Ahmad Nofal,Eman Rabie,Thithiwat Chaikul,Frank Po-Chao Chiu,Rashida Pramanik,Ahmad Alabdulkareem,Alexandros Onoufriadis,
doi : 10.1111/dth.15082
Volume 34, Issue 5 e15082
H syndrome is a rare autosomal recessive disorder with clinical features comprising: hyperpigmentation, hypertrichosis, hearing loss, heart anomalies, low height, hypogonadism and hepatosplenomegaly. H syndrome results from loss-of-function mutations in SLC29A3 which leads to abnormal proliferation and function of histiocytes. Herein, we discuss the considerable phenotypic heterogeneity detected in a consanguineous Egyptian family comprising of four affected siblings, two of which are monozygotic twin and the possible therapeutics. The phenotypic variability may be attributed to the role of histiocytes in the tissue response to injury. Such variable expressivity of H syndrome renders the diagnosis challenging and delays the management. The different treatment approaches used for this rare entity are reviewed.
Switching infliximab in psoriatic patients during COVID-19 pandemics: A real-life retrospective study comparing intra-versus interclass switching strategies
Andrea Conti,Giovanni Damiani,Roberta Ruggeri,Giulia Odorici,Francesca Farnetani,Paolo Daniele Maria Pigatto,Giovanni Pellacani,
doi : 10.1111/dth.15088
Volume 34, Issue 5 e15088
During this pandemic, dermatological infusion centers were partially unavailable, suspended or even reconverted to guest COVID-19 patients, consequently infliximab (IFX) infusions became challenging for their both logistic arrangement and also for patients' COVID-19 phobia. This 48?weeks follow-up retrospective observational study included 37 PsO patients that underwent IFX SB2 during pandemic in two primary dermatological referral centers. In 23 (62.1%) we had to switch from IFX to other biologics, not motivated by adverse reactions, contraindication or even loss of response but only to pandemic related conditions. Nine patients underwent interclass switching and 15 underwent intraclass switching; interestingly 2 patients that underwent adalimumab SB-5 switched back to IFX. Interclass switching was privileged in elder patients and smokers. All patients at week 48 achieved PASI 100. Intra- and interclass switchings are both safe and effective strategies in psoriatic patients with COVID-19 phobia and/or difficulties to undergo infliximab infusions.
Combination of hyaluronic acid fillers and personalized skincare as a perfect tool in aesthetic medicine
Wioletta Bara?ska-Rybak,Magdalena Antoszewska,
doi : 10.1111/dth.15092
Volume 34, Issue 5 e15092
Nowadays the desire to look younger has increased. The most popular noninvasive rejuvenation method is hyaluronic acid (HA) filler injection. However, aging of the skin involves multiple pathological processes, which can be managed by using topical formulations with sophisticated active agents addressing problems such as extracellular matrix degradation, textural variances, and dyschromias. A single site experience trial was conducted to assess the efficacy of HA dermal filler injections combined with personally prepared, bespoke formulations on epidermis and dermis condition. A total of 15 female participated in the study. Mid and lower face were treated with Saypha® HA fillers injection with volume chosen by the investigator performed with 25G/50mm cannula. The formulations for topical skincare consisted of substances chosen from 19 active agents, which were scientifically proven. The subjects were supposed to use them for 6?weeks. Fourteen subjects completed the study, and one subject was lost to follow-up. The age of the study population ranged from 36 to 58?years. The average amounts of Saypha volume plus, Saypha volume, and Saypha filler used per subject were 2.8 ml, 2.25?ml and 1.7 ml, respectively. The most typical skin dysfunctions were loss of elasticity (12 subjects), hyperpigmentation (nine subjects), erythema (eight subjects), and hyperseborrhea with enlarged pores (five subjects). After completing the study all subjects were satisfied. Combined therapies based on HA fillers and personalized skincare with Universkin™ products show promising results in patients with skin problems due to aging.
Efficacy and safety of hydrogen peroxide topical solution in treating actinic keratosis: A randomized controlled trial
Ali Sadeghinia,Delara Amir Dastmalchi,Nika Kianfar,Shayan Dasdar,Hamidreza Mahmoudi,Soheila Dabiran,Vahideh Lajevardi,Maryam Daneshpazhooh,
doi : 10.1111/dth.15097
Volume 34, Issue 5 e15097
Actinic keratosis (AK) is a precancerous skin lesion associated with the development of squamous cell carcinoma. Approved topical treatments for AK are unmet needs. To evaluate the safety and efficacy of hydrogen peroxide topical solution 35% (H2O2) with cryosurgery for the treatment of AKs. Eligible subjects were randomly assigned to receive H2O2 and cryosurgery on each side of their scalp/face. Patients were assessed at baseline and after 3 months of follow-up. Efficacy was evaluated based on the Actinic Keratosis Area and Severity Index (AKASI) and dermoscopic assessments. Fifteen patients with 98 lesions completed the study. At the follow-up visit, the mean improvement of AKASI from baseline was 1.7?±?0.9 for H2O2 and 1.7?±?0.8 for cryosurgery (p?<?0.001, both). Both treatments significantly improved dermoscopic features of yellow scale, white scale, linear-wavy vessels, pigmented dots, and rosette at the end of the 3-month follow-up. Complete dermoscopic response occurred in 57.7% and 73.9% of lesions treated with H2O2 and cryosurgery, respectively (p?>?0.05). Regarding safety, hypopigmentation occurred more frequently in the cryosurgery group (28.3% vs. 9.6%; p = 0.017). Moreover, patients endured more pain with cryosurgery application than H2O2 (p?<?0.001). The effect of H2O2 solution was comparable to cryosurgery. This treatment was well tolerated and had a favorable safety in patients with AKs.
Dermatoscopic assessment of treatment response in patients undergoing autologous non-cultured epidermal cell suspension for the treatment of stable vitiligo: A prospective study
Anubha Dev,Keshavamurthy Vinay,Anuradha Bishnoi,Muthu Sendhil Kumaran,Sunil Dogra,Davinder Parsad,
doi : 10.1111/dth.15099
Volume 34, Issue 5 e15099
There is lack of literature on serial dermatoscopic assessment in patients undergoing non-cultured epidermal cell suspension (NCES) for treatment of stable vitiligo. This prospective study was conducted to evaluate the role of serial dermatoscopy in assessing disease stability and predicting repigmentation rates in vitiligo patients undergoing NCES. Dermatoscopic assessment of target lesions were done at baseline and post-NCES at week 4, 8, 12, 16, and 24. Patches obtaining >90% repigmentation at 24?weeks were categorized to have obtained excellent repigmentation. The dermatoscopic features of target lesions that showed clinical signs of disease activity anytime during the follow-up period were compared to those maintaining clinical stability throughout. Twenty-six vitiligo patients with 52 patches, clinically stable for atleast 1 year were recruited. At follow-up, six patches showed clinical signs of instability. Five patches in the unstable group developed satellite lesions by week 16, compared to none in the stable group (p?< 0.05). Excellent repigmentation was achieved in 29 out of 52 patches. Appearance of normal reticular pigment network at 8?weeks was a positive predictor of excellent response (OR = 10.5, CI 1.2–89.7), whereas, altered pigment network at 12, 16, and 24?weeks and telangiectasias at 12 and 16?weeks significantly reduced the odds of excellent repigmentation.
Onset of vitiligo in a psoriasis patient on ixekizumab
Claudio Marasca,Luigi Fornaro,Fabrizio Martora,Vincenzo Picone,Gabriella Fabbrocini,Matteo Megna,
doi : 10.1111/dth.15102
Volume 34, Issue 5 e15102
Vitiligo is an acquired skin disorder clinically characterized by hypopigmentated macules and patches. Psoriasis is a chronic-inflammatory-skin-condition characterized by erythematous-plaques covered with scales particularly over the extensor-surfaces, scalp, and lumbosacral region. Recent major-researches-advancements have significantly expanded our understanding of psoriasis-pathophysiology, resulting in the development of highly effective targeted-therapies, such as anti TNF?, IL-12/23-inhibitors, IL-17-inhibitors, or IL-23-inhibitors. Particularly, ixekizumab, a humanized-monoclonal immunoglobulin-G 4 antibody, specifically binding IL-17A, demonstrated strong efficacy in threating recalcitrant psoriasis. Nevertheless, paradoxical reactions due to IL-17 inhibitors have been described.
Italian guidelines for therapy of atopic dermatitis—Adapted from consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis)
doi : 10.1111/dth.15091
Volume 34, Issue 5 e15091
