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A case of pediatric psoriasis successfully and rapidly treated with ixekizumab
Matteo Megna,Luigi Fornaro,Mario De Lucia,Orsola Rescigno,Elisa Camela,Gabriella Fabbrocini
doi : 10.1111/dth.15108
Volume 34, Issue 6 e15108
Exacerbation of plaque psoriasis after inactivated and BNT162b2 mRNA COVID-19 vaccines: A report of two cases
Ecem Bostan,Leyla Elmas,Beril Yel,Basak Yalici-Armagan
doi : 10.1111/dth.15110
Volume 34, Issue 6 e15110
Safety of omalizumab treatment in patients with chronic spontaneous urticaria and COVID-19
Maria Passante,Maddalena Napolitano,Stefano Dastoli,Luigi Bennardo,Gabriella Fabbrocini,Steven Paul Nisticò,Cataldo Patruno
doi : 10.1111/dth.15111
Volume 34, Issue 6 e15111
Is risankizumab effective in the treatment of pityriasis rubra pilaris?
Riccardo Balestri,Michela Magnano,Carlo René Girardelli,Giulia Rech
doi : 10.1111/dth.15112
Volume 34, Issue 6 e15112
Dupilumab induces a rapid decrease of pruritus in adolescents: A pilot real-life study
Luca Mastorino,Riccardo Viola,Michele Panzone,Gianluca Avallone,Giuseppe Gallo,Michela Ortoncelli,Giovanni Cavaliere,Pietro Quaglino,Simone Ribero
doi : 10.1111/dth.15115
Volume 34, Issue 6 e15115
Risankizumab effectiveness in a recalcitrant case of hidradenitis suppurativa after anti-TNF and anti-interleukin-17 failures
Raffaele Dante Caposiena Caro,Chiara Pensa,Sara Lambiase,Eleonora Candi,Luca Bianchi
doi : 10.1111/dth.15116
Volume 34, Issue 6 e15116
Dupilumab-induced Urticaria
Luca Mastorino,Michela Ortoncelli,Bernardi Virginia,Giovanni Rolla,Gianluca Avallone,Giovanni Cavaliere,Viola Riccardo,Pietro Quaglino,Simone Ribero
doi : 10.1111/dth.15117
Volume 34, Issue 6 e15117
Treatment of cutaneous leiomyomas with botulinum toxin. Case report and review of literature
David Vega-Díez,Ana Rodríguez-Villa Lario,Marta González-Cañete,María Dolores Vélez-Velazquez,Isabel Polo-Rodríguez,Susana Medina
doi : 10.1111/dth.15121
Volume 34, Issue 6 e15121
Cutaneous adverse effects and contraindications to COVID-19 vaccination; four cases and an illustrative review from an Asian country
Ellie Choi,Choon Fong Liew,Hazel H. Oon
doi : 10.1111/dth.15123
Volume 34, Issue 6 e15123
COVID-19 infection risk in patients on immunosuppressive/immunomodulator therapy: A single center study
Maryam Ghiasi,Maryam Nasimi,Narges Ghandi,Vahideh Lajevardi,Robabeh Abedini,Arghavan Azizpour,Mahshid Sadat Ansari,Azita kheiltash,Kamran Balighi
doi : 10.1111/dth.15126
Volume 34, Issue 6 e15126
Treating hard-to-heal skin and nail onychomycosis of diabetic foot with plasma therapy
Yuta Terabe,Nobuhito Kaneko,Hiroshi Ando
doi : 10.1111/dth.15127
Volume 34, Issue 6 e15127
Amelioration of dystrophic epidermolysis bullosa pruriginosa symptoms with dupilumab: A case report
Yangbin Wang,Mingming Zhou,Li Zhang,Song Zheng,Yuxiao Hong,Xing-Hua Gao
doi : 10.1111/dth.15130
Volume 34, Issue 6 e15130
Platelet-rich-plasma: A potential therapeutic tool for nail lichen planus
Sana Mokni,Zied Kenani,Aycha Arousse,Nadia Ghariani Fetoui,Amina Aounallah,Najet Ghariani,Badreddine Sriha,Colandane Belajouza,Mohamed Denguezli
doi : 10.1111/dth.15135
Volume 34, Issue 6 e15135
Combination of debridation, vacuum system, and epidermal micrografting system for the treatment of an Exserohilum rostratum skin infection in a pediatric cancer patient
José Antonio López Martínez MD,Sergio Cánovas Sanchís PhD,María del Mar Bermúdez Cortes PhD,Clemente José Fernández Pascual MD
doi : 10.1111/dth.15145
Volume 34, Issue 6 e15145
Nail bed staining as a guide for taking Mohs layers of the residual tumors
Leonard H. Goldberg,Mehdi Farshchian,Isadore S. Tarantino,Kourosh Beroukhim,Arash Kimyai-Asadi
doi : 10.1111/dth.15149
Volume 34, Issue 6 e15149
Severe and recalcitrant periungual warts in a child successfully treated with cimetidine
Nelson Ramos-Arancibia,Carmen Varas,Eduardo Rozas-Muñoz
doi : 10.1111/dth.15154
Volume 34, Issue 6 e15154
Extensive ecchymosis and edema associated with injection of human hyaluronidase in the periorbital area: A report of three cases
George Kroumpouzos
doi : 10.1111/dth.15155
Volume 34, Issue 6 e15155
Osteonecrosis of the jaw in a pemphigus vulgaris patient induced by long-term use of bisphosphonates: A case report and review of the literature
Kamran Balighi,Arghavan Azizpour,Fateme Shirzad Moghadam,Raana Samiei
doi : 10.1111/dth.15158
Volume 34, Issue 6 e15158
Zoledronate induced urticarial vasculitis
Bhavya Swarnkar,Shreya Biswal,Shipra Agarwal,Somesh Gupta
doi : 10.1111/dth.15164
Volume 34, Issue 6 e15164
Omalizumab, a savior in long term prevention of idiopathic anaphylaxis with urticaria: A case series
Gautam Kumar Singh
doi : 10.1111/dth.15165
Volume 34, Issue 6 e15165
Bullous Sweet syndrome in a patient with acute myeloid leukemia treated with midostaurin: Rapid response to acitretin and colchicine—A case report
Siri Chiewchanvit,Sirinda Jamjanya,Thanawat Rattanathammethee,Pongsak Mahanupab,Napatra Tovanabutra,Mati Chuamanochan
doi : 10.1111/dth.15171
Volume 34, Issue 6 e15171
Generalized dermal hypersensitivity reaction following Moderna COVID-19 vaccination
Caitlyn N. Myrdal,Keliegh S. Culpepper,Sandra Leyo DuPont
doi : 10.1111/dth.15173
Volume 34, Issue 6 e15173
Wood's lamp examination of hair and nails related to COVID-19 treatment
Betul Demir,Demet Cicek,Sedatcan Turkoglu,Neslihan Yuksel Bozdemir,Furkan Sarikurt,Erden Banoglu
doi : 10.1111/dth.15174
Volume 34, Issue 6 e15174
Macrolide/fluoroquinolone-resistant Campylobacter jejuni-induced cellulitis in a patient with X-linked agammaglobulinaemia successfully treated with carbapenem
Joohyung Youh,Keisuke Imafuku,Teruki Yanagi,Sho Nakakubo,Yosuke Mai,Hideyuki Kosumi,Takuya Kawamura,Ken Muramatsu,Chihiro Shiiya,Ayame Kimura,Sota Itamoto,Masafumi Yamada,Hideyuki Ujiie
doi : 10.1111/dth.15176
Volume 34, Issue 6 e15176
Diffuse erythema and peeling during dupilumab therapy in a patient with atopic dermatitis
Bihong Cheng,Mengting Yin,Xia Dou
doi : 10.1111/dth.15183
Volume 34, Issue 6 e15183
Tranexamic acid versus fractional carbon dioxide laser in post-acne hyperpigmentation
Shereen Osama Tawfic,Rania Abdel Hay,Hadeel Salim,Maha Fathy Elmasry
doi : 10.1111/dth.15103
Volume 34, Issue 6 e15103
Post-acne hyperpigmentation is a common undesirable sequela of acne vulgaris that causes distress for many patients. This study's objective was to compare the efficacy of both low-power/low-density fractional carbon dioxide (CO2) laser and tranexamic acid (TXA) microinjection on post-acne hyperpigmentation. Twenty-five post-acne hyperpigmentation patients (resistant to regular treatment for more than 6?months) were enrolled in this randomized split-face study. One side of the face was randomly assigned to low-power fractional CO2 laser every 4?weeks, and the other side was assigned to TXA intradermal-microinjection every 2?weeks for 3?months. Efficacy was evaluated using digital photography, dermoscopy, post-acne hyperpigmentation index (PAHPI), melanin index (MI), and erythema index (EI) at baseline and 4?weeks after the last session. Both fractional CO2 laser and TXA microinjection treatment sides showed a significant reduction in the PAHPI and MI (p <?0.001). There was statistically significant difference with better percentage of improvement regarding total dermoscopic score on the fractional CO2 laser side than the TXA microinjections side (p <?0.009). Both fractional CO2 laser and TXA microinjection are effective and safe treatment options for post-acne hyperpigmentation with potential superiority of fractional CO2 laser. We also believe that dermoscopy could be helpful tool for assessment of pigmentation depth in patients on treatment by analyzing the color pattern.
Three-year U.S. pharmacovigilance report of brodalumab
Mark Lebwohl,Craig Leonardi,April Armstrong,Nicole Rawnsley,Binu Alexander,Earl Goehring Jr,Francisco Kerdel,Abby Jacobson
doi : 10.1111/dth.15105
Volume 34, Issue 6 e15105
Brodalumab, an interleukin-17 receptor A antagonist, is approved for treatment of moderate-to-severe plaque psoriasis in adults without response or with loss of response to other systemic therapies. In the United States, there is a boxed warning for brodalumab regarding suicidal ideation and behavior; however, no causal relationship between brodalumab and suicidality was established during pivotal trials. In the 2-year pharmacovigilance data, no completed suicides or suicide attempts were reported. The most frequent adverse event (AE) was arthralgia. The safety profile of brodalumab is now being updated after 3?years of pharmacovigilance data. Here, we outline pharmacovigilance data reported to Ortho Dermatologics by patients and healthcare professionals in the United States from August 15, 2017, to August 14, 2020. Brodalumab exposure estimates were obtained by calculating the time between first and last prescription-dispensing authorization dates. Data from 1854 patients were collected, and brodalumab exposure was estimated to be 2736 patient-years. The most frequent AE was arthralgia (111 events; 0.04 events per patient-year). One episode of suicide attempt was reported in a patient with a history of depression. No completed suicides were reported. There were 81 serious infections reported, none of which were fungal. Over the 3-year period, 30 malignancies occurred in 25 patients, none of which were determined to be related to brodalumab. Three-year pharmacovigilance data are consistent with the safety profile of brodalumab previously reported in long-term analyses of clinical trials and the 2-year pharmacovigilance data.
Effectiveness of brodalumab after previous treatment failure of interleukin-17A inhibitors in patients with psoriasis
Nikolai Loft,Anne Bregnhøj,Simon Fage,Claus Henrik Nielsen,Christian Enevold,Claus Zachariae,Lars Iversen,Lone Skov
doi : 10.1111/dth.15106
Volume 34, Issue 6 e15106
Studies on switch between interleukin (IL)-17 inhibitors are scarce. We assessed the effectiveness of brodalumab in patients with previous treatment failure of IL-17A inhibitor(s). Patients with psoriasis and previous treatment failure of an IL-17A inhibitor were treated with brodalumab at standard dose. Effectiveness was assessed after 12, 26, and 52?weeks of treatment. The primary outcome was the proportion of patients that had achieved an absolute psoriasis area and severity index (PASI) ?2 and/or a relative reduction of PASI of 75% (PASI75) at week 12. Plasma cytokine levels were measured at baseline and after 12?weeks of treatment. In total, 20 patients were included, seven (35%) were female, the median age was 50?years, and the median baseline PASI was 13.5. Analyzing the data using nonresponder imputation, 14 (70%) patients had achieved either PASI75 and/or PASI ?2, 8 (40%) had achieved PASI90, and three (15%) had achieved PASI100 at week 12. In total, nine patients (45%) completed the 52-weeks trial and seven patients (35%) still had PASI75 throughout 52?weeks. Seventeen out of 20 patients experienced any adverse events (AEs) during 52?weeks with no serious AEs or deaths. Patients responding to treatment had lower levels of tumor necrosis factor (TNF)-? and IL-6 at baseline compared with those who did not respond to treatment (TNF-?, p =?0.041, IL-6, p =?0.0054). In conclusion, treatment with brodalumab despite previous treatment failure with an IL-17A inhibitor can be effective and well-tolerated.
Topical 5% tranexamic acid with 30% glycolic acid peel: An useful combination for accelerating the improvement in melasma
Priyadarshini Sahu,Surabhi Dayal,Neha Bhardwaj
doi : 10.1111/dth.15107
Volume 34, Issue 6 e15107
Recently, topical Tranexamic acid (TXA) has been used in melasma management. On detail search of literature, this may be the first study-assessing efficacy on combining of Topical TXA with GA peel in melasma. The aim of this study is to assess efficacy, safety, and improvement in quality of life index on combining 30% GA peel with 5% TXA solution topically in melasma of epidermal type. Sixty patients of epidermal melasma were included in the study and were categorized into two groups: Combination group was treated with 30% GA peel at 2 weekly intervals with 5% TXA solution applied twice daily and Control group was treated with only 30% GA peel every 2?weeks for 12?weeks. Melasma area severity index (MASI) was used for assessing clinical improvement. Hi-MELASQOL and HRQOL scales were used to measure Melasma related quality of life and were compared between both groups. At each visit, adverse effects were noted. A significantly decreasing trend was seen regarding the MASI score when compared within the group, but the difference was statistically not significant between the two groups at 12?weeks. However, significant reduction in MASI score was attained earlier in the combination group than the control group. Similarly, there was significant improvement in Hi-MELASQOL and HRQOL in both the groups, but the difference between them was statistically not significant. Side effects experienced by patients in both groups were trivial and did not require stoppage of therapy. This study concluded that topical TXA with GA peel has comparable result with GA peel alone, but the therapeutic response was achieved in patients of combination group earlier in comparison to control group patients.
Investigation of relapse rate and factors affecting relapse after oral isotretinoin treatment in patients with acne vulgaris
Elif Demirci Saadet
doi : 10.1111/dth.15109
Volume 34, Issue 6 e15109
Oral isotretinoin is the most effective treatment option used in acne treatment. However, varying rates of relapse have been reported after oral isotretinoin therapy. The aim of this study was to evaluate factors that affect relapse after oral isotretinoin treatment in patients with acne. In this cross-sectional study, 212 patients with acne using 0.3–1 mg/kg/day oral isotretinoin for at least 4 months were analyzed retrospectively regarding relapse frequency and factors that affected relapse. In the study, the female-to-male ratio was 3.15, with a mean age of 23.5 ±?6.2?years. The relapse rate was found as 37.3%. The median time to relapse was 10 months. The relapse rate was higher in younger patients (age???20?years), macrocomedone-type acne, and those with residual lesions at the end of the treatment (p <?0.05 and p <?0.01, respectively). To prevent relapse in patients with acne using oral isotretinoin, it is of great importance to continue the treatment until complete clinical improvement, and extend the treatment for at least one more month regardless of the cumulative dose. Relapse may also occur with younger age and macrocomedone-type acne.
Is the severity of initial sensitization to diphenylcyclopropenone in alopecia areata patients predictive of the final clinical response?
Narges Ghandi,Golnoosh Seifi,Maryam Nasimi,Robabeh Abedini,Soheila Mirabedian,Ifa Etesami,Amirhooshang Ehsani
doi : 10.1111/dth.15118
Volume 34, Issue 6 e15118
Immunotherapy by diphenylcyclopropenone (DPCP) is generally started with 2% DPCP sensitization, however in recent years studies have questioned the necessity of sensitization that may cause patients severe reactions and troubles at the onset of therapy. The purpose of the present study was to evaluate the association between the severity of initial reaction to 2% DPCP sensitization in AA patients and clinical response. In this retrospective study, 110 AA patients who continued therapy for at least 6 months were enrolled. Hair loss and hair regrowth rates were calculated based on the Severity of Alopecia Tool (SALT) scoring system. Initial reaction to 2% DPCP sensitization after 2?weeks was graded as negative reaction (absence of any reaction), doubtful reaction (mild erythema, pruritus, and irritation for minutes after test), weak (erythema, mild edema, and scaling), and strong to extreme reaction (vesicles, bullae, ulcer, and discharge). The degrees of the initial reaction to 2% DPCP after 2?weeks were negative reaction 13 (11.81%), doubtful reaction 40 (36.36%), weak reaction 33 (30%), and strong to extreme reaction 24 (21.81%). Patients were divided into two groups: (A) patients with less than 12-month therapy (75 of 110), (B) patients with more than 12-month therapy (35 of 110). Initial reaction to 2% DPCP sensitization was not correlated with hair regrowth rate in either group (group A: Spearman's rho = 0.194, p?= 0.095; group B: Spearman's rho = 0.063 p?= 0.720). After 12-month treatment with DPCP, hair regrowth rate was significantly greater than 6-months therapy (group A: 17.03?±?37.78, group B: 49.26?±?36.34; p?= 0.003). The severity of hair loss at the onset of treatment was significantly associated with the response rate in both groups (p-value <0.002). Based on our results, it is the initial severity of the disease and not the initial reaction to 2% DPCP sensitization that predicts the clinical response to DPCP immunotherapy.
Efficacy and tolerability of vismodegib treatment in locally advanced and metastatic basal cell carcinoma: Retrospective real-life data
Mustafa Gürbüz,?zzet Do?an,Erman Akku?,Hande Ermi?,Güngör Utkan,Sezai Vatansever,Faruk Ta?
doi : 10.1111/dth.15122
Volume 34, Issue 6 e15122
The study aims to evaluate the vismodegib treatment in local advanced (laBCC) and metastatic (mBCC) basal cell carcinoma. The data of 29 patients were retrospectively reviewed. The clinical and histopathological features of the patients and adverse events of vismodegib were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated with Kaplan–Meier analysis. The median follow-up period was 17?months (range: 1.6–57.3), and the median age at diagnosis 73?years (range: 39–88). The most common disease location was head and neck (86.2%), and the most common non-skin sites of disease were lymph nodes (13.8%), bone (13.8%), lung (6.9%), and brain (6.9%). Three (10.3%) patients had Gorlin's syndrome. The number of metastatic patients was 5 (17.2%). With vismodegib treatment, the complete response rate was 27.6%, partial response 55.2%, and stable response 10.3%. Treatment responses were most frequently seen within 2 months from the beginning of vismodegib. The median OS was 43.3?±?9.0 months (25.6–61.1) for all patients. The median PFS in the laBCC was 15.7?±?1.8 months (12.2–19.3), and 12.1?±?4.6 months (2.9–21.2) in the mBCC. In the univariable analysis for the OS, only the treatment after the vismodegib was statistically significant, showing chemotherapy was better comparing to no treatment or surgery. The most common adverse events were fatigue-58.6%, muscle spasms-48.3%, alopecia-13.8%, and weight loss-13.8%. This real-life data study shows that vismodegib treatment in locally advanced and metastatic BCC was well tolerated and effective.
Satisfactory treatment of mucocutaneous lesions in hereditary hemorrhagic telangiectasia patients with dual pulsed dye laser and neodymium: yttrium–aluminum–garnet
Xavier Cubiró,Cristina Garcia-Melendo,Caridad Elena Morales-Munera,Esther Roé-Crespo,Antoni Riera-Mestre,José María Mora-Luján,Adriana Iriarte,Lluís Puig,Eulàlia Baselga
doi : 10.1111/dth.15124
Volume 34, Issue 6 e15124
Hereditary hemorrhagic telangiectasia (HHT) is characterized by telangiectasia and larger arteriovenous malformations (AVM) in different organs. Mucocutaneous telangiectasia can bleed and cause stigmatization, but the best treatment approach has not been defined yet. The aim of the study was to evaluate the efficacy and safety of dual pulsed dye laser and neodymium: yttrium–aluminum–garnet (PDL-Nd:YAG) laser treatment for mucocutaneous telangiectasia in HHT patients. It is a retrospective case series, where clinical files of all HHT patients treated with PDL-Nd:YAG laser at our Department between December 2010 and July 2019 were reviewed. Demographic, clinical, and treatment characteristics were recorded. The severity and degree of improvement were evaluated by three blinded examiners scoring pretreatment and posttreatment pictures on a 5-point scale. Patient satisfaction and procedure pain were assessed using an ordinal scale (0–10). Forty-three treatment areas from 26 patients were analyzed. Lesions were predominantly located on the lower lip and cheeks. The median number of laser sessions per patient was 3 (interquartile range [IQR] 2–4). The median global severity score at baseline was 2 and became 0 at endpoint (p < 0.0001), with a median improvement rate of 4 (IQR 3–4). All patients reported a high degree of satisfaction (median 9) and tolerable pain (median 5). In conclusion, dual PDL-Nd: YAG laser is a convenient, safe, and effective treatment option for mucocutaneous telangiectasia in HHT patients.
Comparison of the efficacy and safety of minocycline and clofazimine in chronic and recurrent erythema nodosum leprosum—A randomized clinical trial
Vinod Hanumanthu,Vishal Thakur,Tarun Narang,Sunil Dogra
doi : 10.1111/dth.15125
Volume 34, Issue 6 e15125
Management of chronic/recurrent erythema nodosum leprosum (ENL) is challenging. The majority of these patients become steroid-dependent and suffer from the adverse effects of long-term corticosteroid use. Minocycline has shown promising results in a small series of chronic/recurrent ENL patients. The aim of this study was to compare the efficacy and safety of minocycline and clofazimine in patients with chronic/recurrent ENL. In this prospective randomized clinical trial, 60 participants with chronic/recurrent ENL were randomized (1:1) to receive either minocycline 100?mg once daily or clofazimine 100?mg thrice daily for 12?weeks along with prednisolone according to WHO protocol and followed up for 6 months. The outcome measures were mean time for initial control of ENL, proportion of patients having a recurrence of ENL, mean time for recurrence after initial control, additional prednisolone requirement, and frequency of adverse events. Initial control of ENL was achieved earlier in the minocycline group as compared to the clofazimine group (2.97?±?1.9?weeks vs. 4?±?1.96?weeks, respectively; p-0.048). The number of participants having ENL flares/recurrences during the study period was comparable in both groups (71.4% in clofazimine vs. 55.2% in minocycline group; p-0.2). The participants in the minocycline group remained in remission for a longer duration after initial control of ENL as compared to the clofazimine group (p-0.001). Mean additional prednisolone dose required for control of ENL flares/recurrences was also comparable in both groups (p-0.09). The minocycline group had fewer side effects than the clofazimine group (p-0.047). Minocycline led to a rapid and sustained improvement of ENL episodes with fewer adverse events showing a superior efficacy to clofazimine.
A randomized clinical trial on therapeutic effects of 0.25?mg oral minoxidil tablets on treatment of female pattern hair loss
Sadegh Vahabi-Amlashi,Pouran Layegh,Bita Kiafar,Masoumeh Hoseininezhad,Mohammadreza Abbaspour,Saeedeh Hajebi Khaniki,Mehdi Forouzanfar,Vahideh Sabeti
doi : 10.1111/dth.15131
Volume 34, Issue 6 e15131
Topical minoxidil solution is recommended treatment for female pattern hair loss. However, some complications, such as skin allergies, have prevented some patients from completely receiving this treatment. This study intends to evaluate the therapeutic and side effects of oral minoxidil 0.25?mg tablets treatment on FPHL and compare it with conventional treatment of 2% topical minoxidil. This study is a triple-blind randomized clinical trial in which 72 women with FPHL were treated as two separate groups. Group 1 was treated with oral minoxidil 0.25?mg tablets and topical placebo solution, while topical minoxidil solutions and oral placebo tablets were used to treat group 2 patients. In the oral minoxidil group, the average hair diameter and hair density after the 9-month treatment reached from 0.044?mm and 102?per?cm2 to 0.048?mm and 115?per?cm2, respectively. In the topical minoxidil group, the average hair diameter and hair density from initial values of 0.044?mm and 107?per?cm2 increased to 0.047?mm and 113?per?cm2. In both groups, the changes of hair diameter and hair density were significant compared to initial values (p?< 0.001), while the trend of changes was not statically different between the two groups (p?= 0.077, p?= 0.674 for hair diameter and hair density, respectively) and side effects were trivial. In conclusion, oral minoxidil is an effective and new treatment for FPHL, even with a minimal dose, which can be used as an alternative treatment, especially for patients with poor compliance against topical minoxidil.
Flame burns
Yasemin Demir Yi?it,Ebral Yi?it
doi : 10.1111/dth.15133
Volume 34, Issue 6 e15133
Flame burns lead to significant long-term morbidity and functional consequences. This study analyzed the mortality-related factors in patients with flame burns to compare with the existing literature. This retrospective descriptive study was carried out at the General Surgery Clinic, Gazi Ya?argil Training and Research Hospital, Turkey, to include 131 patients admitted and treated with emergency surgery for flame burns between January 2016 and December 2019. Of the patients hospitalized for flame burn, 103 (78.6%) were male and 28 (21.4%) were female (M:F = 3.6) with a mean age of 25.3?±?20.78?years. The 15–34?years age group was the most affected by flame burns. The most frequently affected body areas were the upper extremities and face (n = 68, 51.9%); conjunctivitis developed in 49 (37.4%) patients. The wound infection rate was 34.3%, and Staphylococcus epidermidis had the highest growth rate in wound culture results (24.4%). Flame burns were most common in winter and autumn. The majority of patients (n = 95, 72.5%) were treated with escharectomy and dressing, while grafting was performed in 36 (27.5%) patients. A total of 3 (2.2%) patients died—one died in a suicide attempt, one due to inhalation burn after flame burn, and another died due to sepsis. The average length of hospital stay was 8.0 ±?3.9?days. Flame burns are much more common in young men, causing deeper and wider burns and requiring greater surgical intervention. This leads to frequent wound infections and longer hospital stays.
An anti-hair loss treatment in the management of mild androgenetic alopecia: Results from a large, international observational study
Pascal Reygagne,Victor Desmond Mandel,Catherine Delva MSc,Michaela Havlí?ková MD,Kamila Padlewska MD,Rose Khalil,Veronique Meuleman MD,Gilberto Adame Miranda MD,Mariya Nevskaya MD,Jean-Francois Michelet PhD,Florence Pouradier PhD,Sergio Vano-Galvan,Delphine Kerob MD
doi : 10.1111/dth.15134
Volume 34, Issue 6 e15134
Androgenic alopecia (AGA) is a common and chronic condition. It may impact self-esteem, self-image and quality of life. Benefit, tolerability, cosmetic acceptance and patient satisfaction are key to ensure good treatment outcome. Hair loss improvement and hair quality with AC5 (2,4-Diamino-Pyrimidine-N-Oxyde, arginine, 6-O glucose linoleate (SP94), piroctone olamine and Vichy mineralizing water) once daily was assessed in 527 subjects with mild AGA in an open-label, observational, international real-life study. After 3 months, investigators evaluated the impact of AC5 on hair loss, product satisfaction and asked subjects about local tolerance; subjects assessed hair growth and quality and satisfaction. Data from 357 subjects were evaluable for the benefit analysis; 59.9% of subjects were female; the mean age was 33.6±8.7 years. Duration of hair loss was 1.62±2.24 years. 71.3% of women had a Ludwig score of 1 and 40.8% of men had a Hamilton Norwood score of 2. At the end of study, hair loss was reduced in 89.0% of subjects; it was slightly higher in women (92.5%) than in men (83.8%). Subject satisfaction on a scale from 0 (not satisfied at all) to 10 (completely satisfied) was 7.9±1.7. Tolerance was rated good to very good by 98.6% of all subjects. In conclusion, AC5 reduces mild AGA in both men and women with a pleasant texture. AC5 was well tolerated and highly appreciated.
Debulking followed by intralesional 5-fluorouracil for the treatment of cutaneous squamous cell carcinoma and keratoacanthoma: A retrospective analysis
Judy Hamad,Puneet S. Jolly
doi : 10.1111/dth.15139
Volume 34, Issue 6 e15139
Debulking followed by intralesional 5-fluorouracil (deb-IL5FU) is a nonsurgical modality which has been used to treat skin cancer anecdotally for many years. There are few in depth studies examining this technique and success rate of intralesional 5-fluorouracil (IL5FU) for the treatment of cutaneous squamous cell carcinoma (cSCC). To evaluate the response rate of deb-IL5FU for the treatment of cSCC and to determine which patient factors were associated with tumor clearance or treatment failure. A retrospective chart analysis of patients with the diagnosis of cSCC or keratoacanthoma (KA) and subsequent deb-IL5FU treatment. Sixty-one patients with a total of 315 tumors (cSCC and KA), were treated using deb-IL5FU. The overall tumor clearance rate was 89%. This was highest for well-differentiated SCC, SCC, KA-type SCC, and KA. Tumors on the trunk and extremities showed high clearance rates while tumors on the scalp/face/neck/ears showed lower clearance rates. Immunocompetent patients cleared more tumors compared to immunocompromised patients. Limitations included the retrospective nature of this analysis as well as a small sample size. Treatment of cSCC and KA with deb-IL5FU demonstrated high tumor clearance rates. Lower rates of clearance were seen in males, immunosuppressed patients, tumors located on the scalp and face/neck/ears.
Treatment of nevus of Ota with 1064?nm picosecond Nd:YAG laser: A retrospective study
Hedan Yang,Lifang Guo,Gaorong Jia,Xiangdong Gong,Qiuju Wu,Rong Zeng,Mengli Zhang,Hui Ding,Fumin Fang,Huiying Zheng,Xing Liu,Yiping Ge,Yin Yang,Tong Lin
doi : 10.1111/dth.15152
Volume 34, Issue 6 e15152
Nevus of Ota has been successfully treated by lasers. Currently, 1064?nm picosecond Nd:YAG lasers have become available for the treatment of pigmented disorders. However, there are few studies concerning the application of 1064?nm picosecond Nd:YAG laser in nevus of Ota. This study aimed to evaluate the efficacy and safety of a 1064?nm picosecond Nd:YAG laser for the treatment of nevus of Ota. We conducted a retrospective analysis of Chinese patients with nevus of Ota who had been treated with a 1064?nm picosecond Nd:YAG laser. Those who had any other laser treatment during the period of picosecond laser treatment were excluded. Via a visual analog scale for percentage of pigmentary clearance in standard photographs, the treatment efficacy was assessed by three blinded physician evaluators. A total of 16 subjects were included in this retrospective study. The average age at the beginning of treatment was 16.87?years old (range of 4 months to 59?years), and all patients were of Fitzpatrick skin type IV. Total treatment ranged from 1 to 5 sessions. A 1064?nm picosecond Nd:YAG laser with a mean fluence of 1.8–4.3 J/cm2 was used at 3–12?month intervals. The mean efficacy score for all 16 patients was 2.56 after one session, and the mean efficacy score of 13 patients who completed two sessions and nine patients who completed three sessions were 3.15 and 3.51, respectively. Postinflammatory hyperpigmentation after treatment was only observed in 1 (1/16, 6.25%) patient. The 1064?nm picosecond Nd:YAG laser is an effective and safe approach for treating nevus of Ota.
Dapsone in hidradenitis suppurativa: A case series of 56 patients
Cristina López-Llunell,Núria Riera-Martí,Marta Gamissans,Jorge Romaní
doi : 10.1111/dth.15161
Volume 34, Issue 6 e15161
Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a challenging treatment. Current guidelines reserve dapsone as a third line agent for patients with mild to moderate HS. To our knowledge, only four small case series have been reported. The objective of this study was to assess the effectiveness and safety of dapsone in our clinical practice. A retrospective observational single-center study of 56 HS patients who underwent treatment with dapsone from May 1, 2015, to June 1, 2021, was performed. The Hidradenitis Suppurativa Clinical Response (HiSCR) scale was used to evaluate the response to treatment. Fifty-six patients were included, 66% of which were men, with a median age of 33?years. Most of them had mild or moderate disease and belonged to LC2 follicular phenotype. All patients had been refractory to first-line treatments. Dapsone was prescribed at doses of 50–150?mg/day. 62.5% of the patients achieved HiSCR after 12?weeks of treatment. No serious adverse reactions were detected. The median duration of treatment was 8 months. After multivariate analysis, an association was found between the presence of fistulous tracts and the risk of non-response to the drug. In four of the dapsone responders, oral retinoids were added to achieve a sustained response. Limitations include the retrospective and non-controlled nature of this study. In conclusion, dapsone is an effective and well-tolerated option for long-term HS treatment, and in this series, it was mainly chosen for patients with LC2 phenotype. It would be interesting to study combination with retinoids and other management options.
The evaluation of efficacy of atmospheric pressure plasma in diabetic ulcers healing: A randomized clinical trial
Shirin Samsavar,HamidReza Mahmoudi,Reza Shakouri,Mohammad Reza Khani,Behnam Molavi,Jamal Moosavi,Maryam Daneshpazhooh,Ifa Etesami,Babak Shokri
doi : 10.1111/dth.15169
Volume 34, Issue 6 e15169
The aim of this study is to evaluate the efficacy and safety of cold atmospheric plasma (CAP) as a novel therapy for diabetic foot ulcers. This was an investigator-blinded, randomized controlled trial of 14?weeks (6?weeks of treatment and 8?weeks of follow-up). Twenty patients with diabetic foot ulcers were divided into two groups: the control group receiving standard wound care and the plasma group, which received CAP twice a week for six consecutive weeks in addition to standard wound care. The ulcer size, amount of exudate, and wound grading were determined weekly. Cold plasma was produced by applying a high voltage (4.5 kV) and a high frequency (22?kHz) to helium gas. Exudate from wounds treated with CAP showed a significant reduction in the third week after complete treatment (p =?0.039). The wound grading of the ulcers improved by the sixth week (p =?0.019), and the sizes of ulcers significantly decreased in the plasma group at the end of the treatment period (p =?0.007). In this randomized clinical trial, CAP was an effective treatment option for diabetic foot ulcers in terms of wound surface reduction and antibacterial effects.
COVID-19 induced telogen effluvium
Hasan Aksoy,Umut Mert Y?ld?r?m,P?nar Ergen,Mehmet Salih Gürel
doi : 10.1111/dth.15175
Volume 34, Issue 6 e15175
COVID-19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID-19. To assess the frequency of TE in post-COVID-19 patients and the correlation between the development of TE and the severity of COVID-19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS-CoV-2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID-19 and whose hair loss started after COVID-19 were considered as “COVID-19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (±?23.772) days after COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p?<?0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID-19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p?<?0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID-19, compared to those without. TE developed in approximately one-quarter of people who have had COVID-19, and our study is the first to detect it. The time to onset of CATE, which was 7–8?weeks after the SARS-CoV-2 RT-PCR positivity, was not much different from post-infectious TE. Patients with severe COVID-19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID-19. During the pandemic, clinicians should consider a previous SARS-CoV-2 infection in patients presenting with hair loss.
Long-term efficacy and safety of apremilast in the treatment of plaques psoriasis: A real-world, single-center experience
Giulia Radi,Anna Campanati,Federico Diotallevi,Giulio Rizzetto,Emanuela Martina,Ivan Bobyr,Melania Giannoni,Annamaria Offidani
doi : 10.1111/dth.15179
Volume 34, Issue 6 e15179
Apremilast is a small molecule approved for the treatment of plaques psoriasis and adult psoriatic arthritis. Pivotal studies have demonstrated short and long term efficacy and safety of apremilast but few data in real life are still available. The aim of this study is to report the efficacy and safety results of apremilast in clinical practice in patients with moderate-to-severe plaque psoriasis, focusing on therapeutic results obtained after 24 and 52?weeks of treatment. From May 2018 to December 2018, 40 patients with plaques psoriasis have been enrolled. Psoriasis Area Severity Index (PASI), body surface area, Physician Global Assessment, and Dermatology Life Quality Index (DLQI) were performed at baseline at 24 (W24) and 52 (W52) weeks after treatment initiation. Primary endpoint was to evaluate the percentage of patient that achieved PASI 75, PASI 90 and PASI 100 at week 24 and 52 of treatment. Additional measure of efficacy was percentage of patients reaching the minimal disease activity (MDA = PGA0/1 and DLQI 0/1) after 24 and 52?weeks of treatment. As secondary endpoint, we evaluated the percentage of patient that achieved DLQI 0–1 at W24 and W52, and long-term safety of apremilast. The percentage of patients who achieved PASI75, PASI90 and PASI100 was 47.5%, 30% and 10% and 25%, 35% and 10% at W24 and W52 respectively. About the half of the reported patients reached MDA at W24 (n = 21) and at W52 (n = 20). The 60% of patients achieved and maintained DLQI 0–1 at W24 until W52. Diarrhea, nausea, headache, insomnia, and other AEs have been reported by 28 patients. Apremilast in real life experience confirmed the levels of efficacy and safety obtained in pivotal trials. In particular, the good initial response to the treatment is predictive of the maintenance or improvement of the outcome over W52. The efficacy is supported by an excellent safety profile even in frail patients.
Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review
Kim A. Papp,Gurbir Dhadwal,Melinda Gooderham,Lyn Guenther,Irina Turchin,Marni Wiseman,Jensen Yeung
doi : 10.1111/dth.15104
Volume 34, Issue 6 e15104
Psoriasis (PsO) requires safe and effective long-term management to reduce the risk of recurrence and decrease the frequency of relapse. Topical PsO therapies are a cornerstone in the management of PsO though safety concerns limit the chronic, continuous use of topical corticosteroids and/or vitamin D3 analogs. Evidence-based guidelines on optimal treatment targets and maintenance therapy regimens are currently lacking. This review explores the evidence supporting approaches to maintenance topical therapy for PsO including continuous long-term therapy, chronic intermittent use, step-down therapy, sequential or pulse therapy regimens, and proactive maintenance therapy. Several unaddressed questions are discussed including how and when to transition from acute to maintenance therapy, strategies for monitoring long-term treatment, the role of topical maintenance therapy in the context of systemic and biologic therapies, risks of maintenance therapy, prescribing a topical preparation suitable for patients' preferences and skin type, and key concepts for patient education to maximize long-term outcomes. Overall, emerging evidence supports a paradigm shift toward proactive treatment once skin is completely clear as a strategy to enhance disease control without compromising safety.
Pityriasis rosea-like cutaneous eruption as a possible dermatological manifestation after Oxford-AstraZeneca vaccine: Case report and brief literature review
Maria Cristina Pedrazini,Mariliza Henrique da Silva
doi : 10.1111/dth.15129
Volume 34, Issue 6 e15129
Pityriasis rosea (PR) has been manifested in patients suffering from COVID-19 as well as after vaccine protocols against SARS-CoV-2. It has a possible association with the HHV-6B virus (roseola infantum) and can be controlled by antivirals such as acyclovir as well as by the amino acid l-Lysine that showed a positive result in reducing the number of lesions and healing time. The aim of this study was to report a case of PR after a second dose of Oxford-AstraZeneca, the adopted therapy and a brief literature review. A 53-year-old woman, phototype II, presented an erythematous lesion in the posterior right thigh 15?days after the second dose of Oxford-AstraZeneca vaccine. Eight days after the initial injury, new injuries appeared in the calf, buttocks and thighs. The diagnosis was PR with a 5-week eruption cycle. The treatment consisted of the use of l-Lysine, 3 grams loading dose and 500?mg for 30?days and moisturizing/healing lotion, starting 14?days after the herald patch. After the 5th week of the disease cycle, there were no new eruptions and the repair cycle continued for up to 8?weeks leaving some residual skin spots. It is concluded that the patient may be a carrier a latent virus, HHV-6, and the vaccine administration with immune system stimulation, would have activated the possible virus causing PR. l-Lysine helped to control the manifestation by limiting the number of lesions and their location, which were restricted to the legs, thighs and buttocks.
How to prevent skin damage from air pollution part 2: Current treatment options
Katerina Damevska,Viktor Simeonovski,Razvigor Darlenski,Stefana Damevska
doi : 10.1111/dth.15132
Volume 34, Issue 6 e15132
In the first part of this review, we have summarized the methods used to examine skin exposure to air pollution and the fundamental concept of skin-exposome interactions. Part 2 of this review focuses on dermatoses, whose aggravation or initiation by air pollution has been confirmed in evidence based medicine manner. Based on the model of photodermatology and photodermatoses, we propose a new concept of “polludermatoses.” A key feature of this concept is identifying patients at risk, which will reveal the noxious effects of air pollutants on skin health. Identifying clinical signs of pollution-damaged skin could be beneficial in categorizing conditions caused or exacerbated by exposure to air pollution. Finally, we discuss the current treatment options and the pathogenetic processes targeted by these therapeutics or the development of novel treatment modalities.
The effects of CO2 laser and topical agent combination therapy for onychomycosis: A meta-analysis
Yang Han,Yi Wang,Xin-rui Zhang,Juan Chen,Xiao-dong Li
doi : 10.1111/dth.15136
Volume 34, Issue 6 e15136
The routine options for onychomycosis are oral, topical, and device-based therapies which are often limited in terms of efficacy and unsatisfactory side effects. Topical agents such as luliconazole, tioconazole, terbinafine, and tazarotene can be more effective when combined with laser therapies. Our aim was to compare the efficacy and satisfaction rates of CO2 laser therapy with topical agents in patients with onychomycosis. PubMed, the Cochrane Library, Embase, and Ovid databases were searched to identify randomized controlled trials (RCTs) evaluating the effects of combined therapies. Selected study data were analyzed for differences expressed as odds ratio (OR) and relative ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes. Efficacy and satisfaction outcomes were assessed using quantitative methods. Our investigations showed that combined CO2 laser and topical treatments significantly increased efficacy 5.38-fold when compared with topical agents alone (OR 5.38; 95% CI; 3.20–9.04; p?<?0.00001), with low heterogeneity observed among studies (I2 = 38%). Mycological clearance comparison rates were also improved by combined treatments. The higher satisfaction of the combined group was assessed by pooled effect (OR 4.56; 95% CI; 2.78–7.49; p?<?0.00001). Our evidence suggests combined therapy may exert positive effects and satisfactory safety for patients with moderate to severe onychomycosis, however, optimal combination options and appropriate dosages require more comprehensive RCTs.
Ocular involvement and complications of lichen planus, lichen planus pigmentosus, and lichen planopilaris: A comprehensive review
Raul E. Ruiz-Lozano,Julio C. Hernández-Camarena,Jorge E. Valdez-Garcia,Mariana Roman-Zamudio,Monica I. Herrera-Rodriguez,Daniela Andrade-Carrillo,Lucas A. Garza-Garza,Jesus A. Cardenas-de la Garza
doi : 10.1111/dth.15137
Volume 34, Issue 6 e15137
Ocular involvement of lichenoid dermatoses, such as lichen planus (LP), lichen planus pigmentosus (LPP), and lichen planopilaris (LPL), although uncommon, is associated with skin manifestations. Isolated ocular involvement is very rare. When lesions are confined to the skin, the dermatologist inquires and evaluates for oral and genital symptoms and lesions, respectively; hence, eye manifestations are commonly neglected by the non-ophthalmologist. Ocular involvement in LP, LPP, and LPL may result in significant morbidity. An ophthalmic interrogatory and a gross ophthalmic evaluation performed by the dermatologist may unravel ocular signs and symptoms that require evaluation by an eye specialist. Ocular surface inflammation and scarring, when untreated, results in serious complications such as corneal perforation and permanent vision loss. This review aims to present an up-to-date overview for the dermatologist of the ocular involvement and complications of LP, LPP, and LPL, and when to refer to the ophthalmologist to prevent blinding complications.
A narrative review of therapies for scalp dermatomyositis
Avani M. Kolla,Lynn Liu,Katharina Shaw,Jerry Shapiro,Alisa Femia,Kristen Lo Sicco
doi : 10.1111/dth.15138
Volume 34, Issue 6 e15138
Cutaneous involvement of the scalp is a common manifestation of dermatomyositis (DM), occurring in up to 82% of adults with DM. Scalp DM predominantly affects women and is characterized by dermatitis, alopecia, pruritus, and/or burning. While cutaneous DM negatively impacts quality-of-life, scalp symptoms in particular are often severe, debilitating, and recalcitrant to standard DM therapies. Currently, there is a paucity of guidelines to inform management of scalp symptoms in patients with cutaneous DM. In this narrative review, we summarize the treatments utilized to manage scalp DM and highlight potential areas for future research. We identified eight studies that reported on 27 treatments focused on cutaneous DM and described outcomes on scalp symptoms. A majority of the treatments were standard therapies for cutaneous DM and resulted in no or minimal improvement in scalp symptoms. Five therapies did result in complete resolution of scalp symptoms and were recommended as potential areas of future research. These included low-dose naltrexone and platelet-rich plasma, as well as two frequent and one less common therapy for cutaneous DM respectively: intravenous immunoglobulin, rituximab, and apremilast. Though the literature was not systematically assessed in this review, these findings illustrate not only that strategies for refractory scalp DM are lacking, but also that those demonstrating potential efficacy are limited by low levels of evidence. Additional studies, especially randomized controlled trials, are needed to better inform management of scalp DM.
Topical opioid use in dermatologic disease: A systematic review
Yasmin Gutierrez,Sarah P. Pourali,Alison H. Kohn,Madison E. Jones,Jeffrey R. Rajkumar,April W. Armstrong
doi : 10.1111/dth.15150
Volume 34, Issue 6 e15150
Topical opioid formulations offer a potential solution to manage pain and decrease the use of systemic opioids. Synthesis of use and efficacy of topical opioids in dermatological conditions has not been well characterized. We conducted a systematic search of the PubMed, Embase, and Cochrane databases from 1980 to February 2021. This study analyzed data from 14 articles and 263 patients on the use of topical opioids for pain related to chronic ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts. Topical opioids included in this review were topical morphine and diamorphine. Common formulations consisted of 0.2–10 mg of opioid compounded with hydrogel or IntraSite gel. Topical opioids were variably effective in the use for pain control related to chronic ulcers and other dermatologic conditions. For example, the use of topical opioids appears to be effective in the reduction of pain related to pressure ulcers. Topical opioids were generally well tolerated. Insufficient data exist to adequately evaluate the efficacy and safety of topical opioid use in the context of nonpressure ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts.
New onset inflammatory bowel disease in patient treated with secukinumab: Case report and review of literature
Ailia K. Ali,Arman Torosian,Caroline Porter,Richard S. Bloomfeld,Steven R. Feldman
doi : 10.1111/dth.15151
Volume 34, Issue 6 e15151
Psoriasis is a chronic autoimmune skin disorder that can vary in severity and extent of disease. While localized disease can be managed with topical medications, widespread disease often requires systemic therapy including biologics. This medication class targets different components of the immune system and thus modulates disease activity. The biologic secukinumab is a human monoclonal antibody against interleukin-17A used for the treatment of psoriasis and psoriatic arthritis; cases of inflammatory bowel disease (IBD) have been observed in clinical trials to be associated with this medication. This review aims to provide evidence for the relationships between secukinumab treatment and the development of IBD. We have examined review articles and original research papers, published between 2010 and 2020, using the following keywords: psoriasis, psoriatic arthritis, secukinumab, IBD, Crohn's disease, ulcerative colitis, interleukin-17, IL-17, IL-17 inhibitor. Case reports have noted an association between secukinumab use and IBD and have called for IBD pre-screening in patients who will be prescribed this medication. Clinical trials concluded that secukinumab was associated with IBD, while retrospective studies have had mixed results, with most studies showing no statistical significance between secukinumab and IBD but having seen patients with history of IBD or family histories experience new-onset IBD or flare-ups. Given the utilization of secukinumab as a therapy for psoriasis and psoriatic arthritis, appropriate screening and risk stratification could help limit morbidity and mortality that can be associated with secukinumab-induced IBD.
Top 10 acral skin manifestations associated with COVID-19: A scoping review
Saeedeh Farajzadeh,Maryam Khalili,Shakiba Dehghani,Sharareh Babaie,Mahdi Fattah,Bahareh Abtahi-Naeini
doi : 10.1111/dth.15157
Volume 34, Issue 6 e15157
COVID-19-associated cutaneous manifestations are one of the most important and relatively common extra-respiratory presentations of SARS-COV-2 infection. The exact identification and classification of these lesions can facilitate the accurate diagnosis and treatment. There are several case reports and small case series which describe cutaneous lesions in hands and feet. Currently, there is no scoping review about acral skin manifestations associated with COVID-19. This paper covers the COVID-related acral skin manifestations in 10 entities including acral papulo-vesicular eruption, acral urticarial lesion, acral non-inflammatory purpura and necrosis, acro-ischemia associated COVID-19, acral vasculitis, chilblain-like lesion (COVID Toe), acral erythema multiform (EM) like lesion, hand and foot skin lesions associated with multisystem inflammatory syndrome in children (MISC), acral peeling conditions and red half-moon nail sign. Future studies should focus on exact investigation of etiologies of these lesions including role of immune senescence, environment, gender, immunogenetics and relation of these lesion with major organ involvements.
Applications of microneedling for various dermatologic indications with a special focus on pigmentary disorders: A comprehensive review study
Elham Ziaeifar,Fatemeh Ziaeifar,Samaneh Mozafarpoor,Azadeh Goodarzi
doi : 10.1111/dth.15159
Volume 34, Issue 6 e15159
Microneedling can accelerate skin repair through numerous complex processes triggered by micro-injuries it produces on the skin surface with very thin needles. The current growth in the application of microneedling in the treatment of cutaneous diseases can be explained by its numerous effects on the skin as reported in the literature. Despite the numerous studies conducted on the application of microneedling in the treatment of skin lesions, its effects on pigmented skin lesions have remained relatively unexplored. The present review comprises an examination of the evidence for the application of microneedling in skin diseases in general and a comprehensive review of the applications of microneedling in pigmentation disorders. The review involved a search of all clinical studies, including trials, case reports, and case series, in the databases MEDLINE/PubMed and Google Scholar using the following keywords: “microneedling,” “dermal needling,” “percutaneous collagen induction,” “skin needling,” “dermaroller,” and “dermatology disorder.” Pertinent data were extracted from all relevant articles published from 1990 to April 2021, and focused on the application of microneedling in the treatment of pigmented skin lesions. Despite the limited number of available studies, evidence suggests the effectiveness and safety of microneedling in treating vitiligo, melasma, and periorbital hypermelanosis. It is noteworthy that the combination of any type of non-aggressive needing technique with other effective therapies (especially topical agents and mesotherapy) yields more promising therapeutic results than single therapy for melasma, dark cycles, and vitiligo as the prototype of pigmentary disorders. However, single needling therapy is significantly effective, too.
Vitamin E supplementation in inflammatory skin diseases
Enzo Berardesca,Norma Cameli
doi : 10.1111/dth.15160
Volume 34, Issue 6 e15160
Vitamin E is a powerful lipophilic antioxidant that protects membranes from lipid peroxidation, and consequently, oxidative damage. Oxidative stress plays a role in the development of neurodegenerative diseases. Vitamin E supplementation is recommended in patients with vitamin E deficiency due to fat malabsorption. The addition of vitamin E to the diet slows Alzheimer's disease progression and protects older patients against respiratory infections. Recent studies also point to the involvement of oxidative stress in the pathology of immune-mediated skin diseases, such as atopic dermatitis and psoriasis. We reviewed the available clinical trials that investigated the role of vitamin E supplementation in preventing and treating atopic dermatitis and psoriasis. Data from these studies point to a positive role of vitamin E supplementation in these diseases. Still, due to limitations in study design, further evidence is needed to reach a definite conclusion.
Cannabinoids interaction with transient receptor potential family and implications in the treatment of rosacea
Kieran B. Garbutcheon-Singh,Saxon D. Smith
doi : 10.1111/dth.15162
Volume 34, Issue 6 e15162
With the recent interest in medical marijuana, research into cannabinoids is regaining wider attention. Cannabinoids are collectively a group of active compounds that can be produced by animals (endocannabinoids), plants (phytocannabinoids), or synthetically. By acting on a number of different receptors like cannabinoids receptors and transient receptor potential ion channel family, cannabinoids are known to modulate cutaneous inflammation, pain, and itch. Rosacea is a highly prevalent disease and can be associated with a significant degree of morbidity associated with its symptom. Transient receptor potential ion channels are known to be triggered in rosacea and may underlie a portion of rosacea's pathophysiology. This article aims to detail the transient receptor potential channel pathways in rosacea and the known effects of cannabinoids on these pathways and further discussing the potential role of cannabinoids in treating rosacea.
Immunopathogenesis and management of polymorphic light eruption
Miroslava Kadurina,Jana Kazandjieva,Georgeta Bocheva
doi : 10.1111/dth.15167
Volume 34, Issue 6 e15167
Polymorphic light eruption (PLE) is the most common immunologically mediated photodermatosis, demonstrating many abnormalities caused by critical failure of ultraviolet (UV)-induced immunosuppression. The unique expression of antimicrobial peptides in PLE, which is most likely determined by alteration of microbiome components upon UV exposure, implicates their possible triggering role and pathogenic significance in the eruption. The review aims to clarify current knowledge regarding the immunological disturbances correlated with PLE that serve a base for better understanding of molecular pathogenesis of the disease and the development of new therapeutic strategies. Preventive treatment with broad-spectrum suncreens and sunscreens containing DNA repair enzymes, as well as natural photohardening with graduate exposure to sunlight in early spring could be sufficient in milder cases. Antioxidants and topical calcipotriol are promising approach for adjuvant prevention. Phototherapy, mainly with narrow band UVB rays, is more appropriate method in severe cases of the disease. The established treatment options for PLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in the refractory cases. Like medical photohardening, afamelanotide has the potential of photoprotection by inducing a melanization of the skin. Afamelanotide is believed to be a possible new treatment option for very severe and refractory cases of PLE. Targeting the main pruritogenic cytokine, IL-31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PLE with intense pruritus.
Outcomes of adjunctive therapies post hedgehog inhibitors in the management of locally advanced basal cell carcinoma: A systematic review and pooled analysis
Arsh Patel,Jane S. Kim,Jason Liss,Lauren Howard,Sin-Ho Jung,Meenal Kheterpal
doi : 10.1111/dth.15172
Volume 34, Issue 6 e15172
Management of patients with locally advanced basal cell carcinoma (laBCC) with traditional strategies has yielded suboptimal outcomes. Targeted treatments including hedgehog inhibitor therapy (HHIT) present limitations when utilized as monotherapy. Herein, we report evidence-based outcomes from available literature on multimodality treatments adjuvant to HHIT in laBCC management. Utilizing a systematic search strategy in PubMed, we identified studies published from inception to April 15, 2020, screened for definitive inclusion/exclusion criteria, and performed individual study quality assessment and pooled analysis to assess impact of adjunctive treatment-based responses post-HHIT on clinical response and recurrence outcomes. Twenty-nine studies (n = 103) were included. Primary findings include a complete response (CR) rate of 90.5%, the median follow-up of 12?months post-HHIT completion. The recurrence rate was 10.8% with 12-month median time to recurrence. Mohs micrographic surgery (MMS) had 100% CR post-HHIT, while no difference was observed between surgery and radiation therapy (RT). MMS and surgery had comparable 2-year recurrence free rates (RFR) at 87% and 86% respectively, while RT had the lower 2-year RFR at 67%. Male gender portended a more advanced stage at diagnosis and worse outcomes. In a subset analysis, periorbital laBCCs with orbital involvement had a CR rate of 81.8% versus 100% in those without orbital involvement, with similar rates of recurrence. Limited available quantitative data and possible publication bias were limitations. Pooled analysis of observational data supports use of adjunctive therapies post-HHIT to improve treatment response in patients with laBCC. Longer-term follow-up is needed to study recurrence rates after combination therapy.
Cemiplimab in advanced cutaneous squamous cell carcinoma
Piyu Parth Naik
doi : 10.1111/dth.15184
Volume 34, Issue 6 e15184
Cemiplimab, a high-affinity, highly potent human monoclonal antibody that binds to the programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) receptor, is the only drug to attain Food and Drug Administration (FDA) approval and marketing authorization from the European Commission for use in patients with metastatic and locally advanced cutaneous squamous cell carcinoma (CSCC) who are not candidates for curative surgery or curative radiation therapy as a first- or later-line treatment. In pivotal phase II clinical testing, cemiplimab showed rapid and substantial antitumor efficacy and acceptable safety. This systematic review was aimed at evaluating the efficacy and safety of cemiplimab in patients with advanced CSCC. To this end, I reviewed EMBASE, MEDLINE, PubMed, and clinical trial registries/databases by using the following keywords alone or in combination: “cemiplimab,” “Libtayo,” “cutaneous squamous cell carcinoma,” “REGN2810,” and “SER439684.” Cemiplimab showed clinical efficacy and considerable safety and was associated with low rates of treatment discontinuation (7%) and death (3%). However, the current recommendation is primarily based on only phase II clinical testing due to the absence of an approved comparator agent.
COVID-19 and exacerbation of dermatological diseases: A review of the available literature
Khashayar Aram,Anant Patil,Mohamad Goldust,Fateme Rajabi
doi : 10.1111/dth.15113
Volume 34, Issue 6 e15113
Since the emergence of the new coronavirus disease 19 (COVID-19) pandemic, there has been a concern for the patients with chronic autoimmune diseases including dermatological conditions over the potential exacerbation of these underlying conditions after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV2). We performed a systematic review to evaluate presentations, postinfection change in the manifestation, diagnosis, and management of flare-ups of underlying dermatologic disease in patients with COVID-19. A total of 17 articles were recovered reporting on flare-ups of dermatological disease including pemphigus vulgaris, psoriasis, subacute cutaneous lupus erythematosus, acrodermatitis continua of Hallopeau, systemic sclerosis sine scleroderma, and Sézary syndrome (SS). Out of these, psoriasis and alopecia areata were the most common conditions. However, most cases of psoriasis could have been attributed to either antimalarial agents that were initially used for the treatment of COVID-19 or discontinuation of treatment following SARS-CoV2 infection.
Subacute cutaneous lupus erythematosus flare triggered by COVID-19 vaccine
Adrienne K. Joseph,Benjamin F. Chong
doi : 10.1111/dth.15114
Volume 34, Issue 6 e15114
Efficacy of the colchicine add-on therapy in patients with autoimmune chronic urticaria
Sayed Hesamedin Nabavizadeh,Masroor Babaeian,Hossein Esmaeilzadeh,Nasrin Mortazavifar,Soheila Alyasin
doi : 10.1111/dth.15119
Volume 34, Issue 6 e15119
Chronic urticaria is in some cases very difficult to treat, we aimed to evaluate the effect of colchicine on chronic urticaria management. Fifty-five euthyroid patients with chronic urticaria were examined based on UQL and UAS7 questionnaires. The overall UQL-Q score after 3?months has not any statistical difference between groups. The overall UQL-Q score changes between groups was not statistically different. However, the UQL-Q score significantly reduces during study period in each group. In conclusion, colchicine can manage the sign and symptoms of chronic urticaria, which improve the patients' quality of life.
Dupilumab effectiveness for the treatment of patients with concomitant atopic dermatitis and chronic rhinosinusitis with nasal polyposis
Maddalena Napolitano,Marianna Maffei,Cataldo Patruno,Carlo Antonio Leone,Adriana Di Guida,Luca Potestio,Massimiliano Scalvenzi,Gabriella Fabbrocini
doi : 10.1111/dth.15120
Volume 34, Issue 6 e15120
Dupilumab is a fully human monoclonal antibody targeting interleukin (IL) 4 and IL13 pathways. We performed a retrospective observational study to evaluate the efficacy of dupilumab for the treatment of adult patients referred to our department, from January 2019 to May 2021, with a diagnosis of moderate to severe atopic dermatitis (AD) and concomitant chronic rhinosinusitis with nasal polyps (CRSwNP), with a clinical indication for dupilumab treatment. Skin disease activity was assessed using EASI, Numerical Rating Scale (NRS) for pruritus (P-NRS) and sleep (S-NRS), and Dermatology Life Quality Index (DLQI). The CRSwNP activity was evaluated using 22-item Sino-Nasal Outcome Test (SNOT-22), endoscopic nasal polyp score (ENPS), nasal congestion or obstruction score (scale 0–3), loss-of-smell score (scale 0–3), and rhinosinusitis disease severity (visual analog scale 0–10 cm). A significant improvement of all the score values was recorded assessing patients at baseline, week (W)16, and W24. In particular, concerning the CRSwNP, a reduction of ENPS score (baseline: 4.9?±?1.85; W16: 2.49?±?1.42, p?<?0.01; W24: 1.68?±?1.25, p?<?0.01) and SNOT-22 (baseline: 35.9?±?19.11; W16: 12.85?±?6.31, p?<?0.01; W24: 10.71?±?7.29, p?<?0.01) was observed. Furthermore, dupilumab is a labeled drug for the treatment of both AD and CRSwNP. The use of a single drug to obtain the improvement up to the near remission of AD and CRSwNP increases not only patient's compliance with the treatment, but also the benefits in terms of health cost related to these chronic diseases.
Pityriasis rubra pilaris treatment options: A retrospective case series from a tertiary hospital
Sarah Ringin,Christopher S. Baker,Peter Foley,Benjamin S. Daniel
doi : 10.1111/dth.15128
Volume 34, Issue 6 e15128
Pityriasis rubra pilaris (PRP) is a group of uncommon chronic inflammatory skin conditions with unclear pathophysiology and etiology. To date there is limited published literature and no clinical guidelines for the management of PRP. Infliximab, alone or in combination, is the most widely published successful treatment for adults and etanercept for pediatric populations. We present a case series of patients diagnosed with PRP. Retrospective data were collected from a tertiary Australian dermatology department between January 2010 and December 2019 on patients with PRP. Electronic medical records and pathology database were searched. A total of 13 patients were included. Twelve of the 13 patients used topical agents and three patients attempted narrow-band ultraviolet B phototherapy. All patients received acitretin as first line systemic agent with the dose varying from 10 to 50?mg daily. Six patients treated with acitretin reported adverse events, requiring dose reduction or cessation. Of the nine patients who did not receive a biologic agent, complete clearance of PRP was achieved in five cases. At least one biologic agent was used in four cases with two experiencing a marked improvement. Overall, complete clearance was achieved in six patients. PRP continues to be a challenge to treat with many treatment options used with variable efficacy.
Dupilumab facial redness: Clinical characteristics and proposed treatment in a cohort
María Fernanda Ordóñez-Rubiano,Mirian Casas,Valentina Balaguera-Orjuela
doi : 10.1111/dth.15140
Volume 34, Issue 6 e15140
In this case series, we report for the first time in the literature in a cohort, the positive response to oral or topical antifungals for atopic dermatitis patients treated with Dupilumab that developed Dupilumab facial redness, supporting the Malassezia hypersensitivity theory.
Leukocytoclastic vasculitis as a cutaneous manifestation of ChAdOx1 nCoV-19 corona virus vaccine (recombinant)
Sunmeet Sandhu,Anuj Bhatnagar,Harish Kumar,Prashant Kumar Dixit,Gourang Paliwal,Devinder Kumar Suhag,Chetan Patil,Debdeep Mitra
doi : 10.1111/dth.15141
Volume 34, Issue 6 e15141
With the present COVID-19 vaccination drive across the world, adverse skin reactions post COVID-19 vaccine is expected. Majority of these reactions seen were transient or local injection site reactions. However, as the larger population is being vaccinated, certain uncommon dermatological presentations including leukocytoclastic vasculitis, pityriasis rosea, and exacerbation of pre-existing autoimmune diseases are now being reported. Among all the COVID-19 vaccines, most of these reactions are seen with messenger ribonucleic acid-based Pfizer/BioNTech (BNT162b2) and Moderna (mRNA-1273) vaccine. We report two cases of leukocytoclastic vasculitis following ChAdOx1 nCoV-19 corona virus vaccine (recombinant) that bring out potential new dermatological manifestations of recombinant corona virus vaccine being administered across the European, South American, and Asian countries. It is important for all health care workers and patients to be aware of the corona virus vaccine associated adverse cutaneous reactions.
No antibody response in cutaneous manifestations associated with COVID-19: An observational study of 64 cases with microbiological and clinical characterization
Miguel Fernando García-Gil MD,Juan Monte-Serrano MD,Alejandro Lapeña-Casado MD,Pablo Villagrasa-Boli MD,Mar Ramírez-Lluch MD,Isabel Martínez-Pallás MD,Aura Bularca MD,Beatriz Aldea-Manrique MD,Rafael Benito-Ruesca MD, PhD,María Purificación Ventura-Faci MD, PhD,Mariano Ara-Martín MD, PhD
doi : 10.1111/dth.15142
Volume 34, Issue 6 e15142
The microbiological diagnosis of skin lesions related to COVID-19 is not well known.
Clinico-epidemiological profile and long term follow up in melasma
Muthu Sendhil Kumaran,Vignesh Narayan R,Akanksha Kaushik,Anuradha Bishnoi,Keshavamurthy Vinay,Davinder Parsad
doi : 10.1111/dth.15143
Volume 34, Issue 6 e15143
Melasma is a disorder of hyperpigmentation that is frustratingly resistant to therapy with a high recurrence rate on treatment discontinuation. With the scarcity of melasma epidemiological studies from India, we conducted this study to see clinico-epidemiological trends and therapeutic response. Totally 957 melasma patients were studied during the 5-year period between October 2014 and September 2019. A female preponderance was seen. Patients were classified as early, moderate, and late responders if they had more than 80% clinical improvement within 8, 8–12, and 12–16?weeks rest classified as nonresponders. Six hundred and forty-eight patients with mMASI of ?5 had been prescribed non-hydroquinone-based therapies who had overall response rate of 40.9% by end of 16?weeks, 309 with mMASI >5 received hydroquinone based triple combination with a response rate of 33.6% at end of 16?weeks. A total of 33.65% responded to triple combination compared to 40.1% in the non-hydroquinone group. All nonresponders received oral tranexamic acid 250?mg twice daily. Most patients on oral tranexamic acid group developed recurrence by 6?weeks post discontinuation, compared with triple combination therapy group who had relapsed by 2?months post discontinuation and 4?months to relapse with non-hydroquinone-based therapies. Side effects experienced were 0.83% in hydroquinone group reporting erythema and burning. 0.57% in non-hydroquinone group perceived stinging sensation and none from tranexamic acid group. The longest follow up available in our study was for 18?months. The emergent need of the hour is a long, safe, and effective therapy for melasma.
Therapy of paraneoplastic pemphigus with Rituximab: A case report
Hongmei Zhang,Bin Hu,Hui Chen,Li Wan,Jinbo Chen,Xiaoyong Zhou,Liuqing Chen
doi : 10.1111/dth.15144
Volume 34, Issue 6 e15144
We report a case of 39-year-old female patient with paraneoplastic pemphigus (PNP) associated with thymoma treated with rituximab plus corticosteroids and methotrexate. After rituximab therapy for 8?weeks, oral ulcerations had cured, lesions on the trunk and limbs improved. Rituximab may be useful for PNP therapy, but further studies are necessary to confirm this hypothesis.
Sweet syndrome after Oxford-AstraZeneca COVID-19 vaccine (AZD1222) in an elderly female
Imran Majid,Samia Mearaj
doi : 10.1111/dth.15146
Volume 34, Issue 6 e15146
Vaccination for COVID19 infection is in full swing all around the world and while the vaccines are considered overall safe, many cutaneous and extracutaneous adverse effects have been reported after their use. Local injection-site reactions are the commonest adverse effect described with the use of these vaccines. We describe a case of Sweet syndrome in an elderly female after the first dose of Oxford-AstraZeneca COVID-19 vaccine (AZD1222).
Cutaneous adverse reactions after COVID-19 vaccines in a cohort of 2740 Italian subjects: An observational study
Teresa Grieco,Patrizia Maddalena,Alvise Sernicola,Rovena Muharremi,Stefania Basili,Domenico Alvaro,Roberto Cangemi,Alfredo Rossi,Giovanni Pellacani
doi : 10.1111/dth.15153
Volume 34, Issue 6 e15153
An in-depth characterization of the incidence, morphology, and onset of COVID-19-vaccines cutaneous adverse reactions is currently lacking. The existing literature on COVID-19 vaccination-related cutaneous adverse reactions largely focused on messenger RNA vaccines and mainly included type 1 hypersensitivity reactions, such as urticaria and angioedema. Other cutaneous manifestations are still poorly characterized and have been classified as delayed hypersensitivity rash. Our prospective observational study on a sample of 2740 subjects who underwent the COVID-19 vaccination aimed at defining the prevalence of cutaneous adverse reactions and at identifying their timing of onset and their correlation with the administered dose. Vaccine-related cutaneous adverse reactions occurred in 50 subjects. Patients were asked to complete a questionnaire on the type of COVID-19 vaccine received, the time of onset of cutaneous reactions, and the dates of administration. Out of 2740 individuals who received the COVID-19 vaccination, 50 were diagnosed with cutaneous adverse reactions to vaccine, after the first dose in 28 patients, after the second in 20, and after both in two. We reported localized injection site erythema in 12 patients and generalized cutaneous reactions in 38 patients. Our study shows that cutaneous adverse reactions to COVID-19 vaccination are not common and most often occur after the first dose, recurring infrequently after the second dose. These reactions are usually easily manageable and, even in severe generalized cases, oral antihistamines and corticosteroids were sufficient for resolution. Therefore, except for immediate hypersensitivity reactions, cutaneous adverse reactions do not represent a contraindication to the completion of the vaccination cycle.
Successful follicular unit extraction in a case of inactive, recalcitrant alopecia barbae
Amit Kerure,Nitika Deshmukh,Shashank Bansod,Aseem Sharma
doi : 10.1111/dth.15156
Volume 34, Issue 6 e15156
Alopecia areata (AA) is a non-scarring autoimmune type of alopecia. Hair transplantation in AA is not practiced as the implanted follicular grafts might be destroyed due to underlying autoimmune pathology. A biopsy proven 28?year old male patient of AA presented to us with an 8-year history of a hairless patch over the beard area. He underwent many treatments by other dermatologist with oral, topical, and intralesional immunosuppressants, which curtailed his disease progression but failed to re-grow hair. Biopsy during his visit revealed absence of inflammatory infiltrates and empty hair tracts replaced by fibrotic tracts. Follicular unit extraction (FUE) was done successfully after counseling the patient about the controversial role of hair transplant surgery in AA. Hair growth was achieved within 6?months with no recurrence during 1-year follow up. FUE can be opted for long-standing and clinically stable cases of AA; histopathology and dermoscopy being the guiding lights in determining the disease inactivity.
Distal nail embedding treatment using autogenous nails
Kazuya Kashiyama,Motoi Nakano,Akihito Higashi,Shoko Ashizuka,Yuki Moriuchi,Atsuhiko Iwao,Katsumi Tanaka
doi : 10.1111/dth.15163
Volume 34, Issue 6 e15163
A regrowing nail tip after nail avulsion may excessively curve and invaginate into the nail bed. This is treated as a type of ingrown toenail, and is known as distal nail embedding. In most cases, further growth restores the original shape evenly over the nail bed. However, it is often painful and such cases may require treatment. We report a surgical approach that we applied to six cases of distal nail embedding involving pain or deformity of nails caused by a nail tip invaginating into the nail bed and/or cessation of forward nail growth. As our method involves removing a portion of the embedded tip edge nail and inserting the removed nail into the remaining depressed portion, the nail can grow over the bulge. In all six patients in whom we applied this method, the pain and nail deformity resolved and there was no recurrence. We used autogenous nails, which can reduce the pressure imbalance on a nail bed, and this contributed to improving the morphology of nails and nail beds. In addition, the risk of a hypertrophied nail is reduced because half of the nail adheres to the nail bed. Special materials are unnecessary and this method can be conducted with simple outpatient department procedures. There were no cases of a fixed nail section detaching due to a bulge at the nail tip. The inserted nail was maintained in all cases for several months until the nail grew over the bulge.
Efficacy and safety of botulinum toxin injection in reducing deltoid muscle hypertrophy
Sun Hye Shin,Su Jung Park,Seung Hoon Yeoum,Choon Shik Youn,Kui Young Park
doi : 10.1111/dth.15168
Volume 34, Issue 6 e15168
With the increasing demand for body contouring, botulinum toxin (BTX) injection is being widely used off-label for muscular hypertrophy. However, to the best of our knowledge, no study has investigated the clinical efficacy of BTX type A (BTX-A) in deltoid muscle hypertrophy. This study was conducted to evaluate the efficacy and safety of intramuscular injection of BTX in reducing deltoid muscle hypertrophy. Overall, 10 patients with bilateral deltoid muscle hypertrophy were treated with an intramuscular injection of prabotulinum toxin A, with a total of 50?units [U] administered per patient. As measured by ultrasonography, the thickness of the deltoid muscles was significantly decreased at weeks 2 and 12. In addition, the clinical assessment score by blinded investigators was improved after the treatment; however, patients' satisfaction scores were relatively low. No major complications were reported. Therefore, intramuscular injection of BTX-A seems to be a candidate for novel treatment option for deltoid muscle hypertrophy. Further larger clinical studies are warranted to confirm the efficacy of BTX-A.
