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Reply to: Topical cyclosporine 5% cream in Zoon's balanitis resistant to other therapies: A case report
Richard Edward Watchorn,Ashley Helen Spencer,George Kravvas,Christopher Barry Bunker
doi : 10.1111/dth.15215
Volume 35, Issue 1 e15215
Letter in response to “Reply to: Topical cyclosporine 5% cream in Zoon's balanitis resistant to other therapies: A case report”
Giuseppe Argenziano,Giulia Briatico,Gaetano Licata
doi : 10.1111/dth.15220
Volume 35, Issue 1 e15220
Retrospective analysis of ocular adverse events with topical hydrocortisone when used for dermatologic indications
Yu Wang,Joseph Jorizzo
doi : 10.1111/dth.15178
Volume 35, Issue 1 e15178
Repurposing super saturated potassium iodide as an adjunctive treatment in mucormycosis: An exposition in a diabetic patient with rhino-orbital disease with cutaneous extension
Kabir Sardana,Pooja Arora,Sachin Goel,Ankur Gupta,Aastha Agarwal,Purnima Malhotra,Ankur Majumder
doi : 10.1111/dth.15181
Volume 35, Issue 1 e15181
Addisonian pigmentation responding to vitamin B12: The nails tell the story!
Ananya Sharma,Saurabh Bhatia,Rhea Ahuja,Kanika Sahni
doi : 10.1111/dth.15187
Volume 35, Issue 1 e15187
The clinical impact of hedgehog pathway inhibitors and statin therapy in the treatment of locally advanced basal cell carcinoma: A case report
Luciana Trane,Flavia Silvestri,Federico Venturi,Biancamaria Zuccaro,Federica Scarfì,Vincenzo De Giorgi
doi : 10.1111/dth.15191
Volume 35, Issue 1 e15191
Case report: Pyogenic granuloma—just salt, a simple and pain-free treatment
Andrea Bernales Salinas,Angel Toro Sepúlveda,Heidi Meier Pincheira,Ricardo Sánchez Castillo
doi : 10.1111/dth.15194
Volume 35, Issue 1 e15194
Vismodegib treatment in advanced basal cell carcinomas: Real-life experience
Alessia Villani,Gabriella Fabbrocini,Claudia Costa,Massimiliano Scalvenzi
doi : 10.1111/dth.15195
Volume 35, Issue 1 e15195
Sudden onset of vitiligo after COVID-19 vaccine
Giulia Ciccarese,Francesco Drago,Samuele Boldrin,Matilde Pattaro,Aurora Parodi
doi : 10.1111/dth.15196
Volume 35, Issue 1 e15196
“Covid arm”: Abnormal side effect after Moderna COVID-19 vaccine
Vincenzo Picone,Fabrizio Martora,Gabriella Fabbrocini,Laura Marano
doi : 10.1111/dth.15197
Volume 35, Issue 1 e15197
An uncommon phenomenon with common medications in a case of bi-segmental vitiligo
Rohit Kothari,Durga Madhab Tripathy,Sunmeet Sandhu,Deepak Vashisht,Siddharth Bhatt,Amol Gopal Rathod
doi : 10.1111/dth.15199
Volume 35, Issue 1 e15199
Neoadjuvant intralesional methotrexate for juvenile xanthogranuloma in an adult
Alejandra Tomás-Velázquez,Miguel Reyes-Múgica,Alberto González-Menchen,Ángela Estenaga,Javier Antoñanzas,Ana Morelló-Vicente,Rafael Salido-Vallejo
doi : 10.1111/dth.15200
Volume 35, Issue 1 e15200
New repair strategy: Treatment of V-shaped divided nevus on eyelids with fish-mouth flap
Hanjiang Gu,Yumin Xia,Xuanfeng Tan
doi : 10.1111/dth.15201
Volume 35, Issue 1 e15201
A case of erythrodermic psoriasis successfully treated with apremilast
Matteo Megna,Sonia Sofìa Ocampo-Garza,Gabriella Fabbrocini,Eleonora Cinelli,Angelo Ruggiero,Elisa Camela
doi : 10.1111/dth.15204
Volume 35, Issue 1 e15204
Frontal fibrosing alopecia following beta blocker injectable mesotherapy: Is it more than a simple coincidence?
Refka Frioui,Sana Mokni,Mariam Tabka,Colandane Belajouza,Mohamed Denguezli
doi : 10.1111/dth.15206
Volume 35, Issue 1 e15206
Bullous pemphigoid triggered by COVID-19 vaccine: Rapid resolution with corticosteroid therapy
Massimo Dell'Antonia,Speranza Anedda,Federica Usai,Laura Atzori,Caterina Ferreli
doi : 10.1111/dth.15208
Volume 35, Issue 1 e15208
Successful therapy of disseminated patch-type granuloma annulare with upadacitinib in a patient with rheumatoid arthritis
Wiebke Sondermann,Eva Hadaschik,Christof Specker
doi : 10.1111/dth.15211
Volume 35, Issue 1 e15211
Real-world evidence of biologic treatments in moderate–severe psoriasis in Italy: Results of the CANOVA (EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: An obserVAtional longitudinal study of real-life clinical practice) study
Delia Colombo,Luca Bianchi,Gabriella Fabbrocini,Salvatore Corrao,Annamaria Offidani,Luca Stingeni,Antonio Costanzo,Giovanni Pellacani,Ketty Peris,Federico Bardazzi,Giuseppe Argenziano,Silvana Ruffolo,Paolo Dapavo,Carlo Carrera,Maria Concetta Fargnoli,Aurora Parodi,Marco Romanelli,Piergiorgio Malagoli,Marina Talamonti,Matteo Megna,Massimo Raspanti,Matteo Paolinelli,Katharina Hansel,Alessandra Narcisi,Andrea Conti,Clara De Simone,Marco Adriano Chessa,Alina De Rosa,Eugenio Provenzano,Michela Ortoncelli,Chiara Moltrasio,Rosaria Fidanza,Martina Burlando,Annalisa Tonini,Francesca Maria Gaiani,Lucia Simoni,Alessandra Ori,Martina Fiocchi,Emanuela Zagni
doi : 10.1111/dth.15166
Volume 35, Issue 1 e15166
EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: An obserVAtional (CANOVA) study was aimed at providing real-world evidence of the effectiveness of biologics in Italian patients with moderate–severe psoriasis. It was an observational, retro-prospective cohort study conducted in 17 Italian dermatology clinics. Adult patients with moderate–severe plaque psoriasis, who started a biologic treatment between 24?weeks and 24?months before enrolment, were included. With a follow-up visit at 6 months after enrolment, each patient had at least 12?months of observation. The primary objective was to describe the clinical response rates (PASI 75) after 16/24/52?weeks from biologic treatment start. Secondary outcomes were sustained response, quality of life, and treatment satisfaction. Of the 669 eligible patients (64% males), 52% were naïve to biologics, though a mean duration of psoriasis since first diagnosis of 18.6?years (SD 13.2). The most frequently prescribed biologics were secukinumab (41%), ustekinumab (25%), TNF-inhibitors (22%) and ixekizumab (12%). PASI 75 was achieved by 86% of patients (95% CI: 82%–89%) at 16?weeks, 90% (87%–93%) at 24?weeks, and 91% (89%–94%) at 52?weeks. Patients achieving PASI 90 and PASI 100 at 52?weeks were 75% (71%–79%) and 53% (49%–57%), respectively. Sustained PASI 75 response after 1 year from treatment start was achieved by 78% (74%–82%) of patients. Mean DLQI total score was 2.3 (SD 3.9) at enrollment and decreased at the final visit to 1.8 (3.6). A high level of treatment satisfaction was expressed by patients over the study period. This large real-world study confirms in the clinical practice the good effectiveness and acceptability of biologics in psoriasis patients.
Long-term inflammatory rosacea management with subantibiotic dose oral doxycycline 40?mg modified-release capsules once daily
James Q. Del Rosso,Sam Brantman,Hilary Baldwin
doi : 10.1111/dth.15180
Volume 35, Issue 1 e15180
An important goal of effective rosacea treatment is to maximize the duration of remission. This was a two-part study. Part 1 was a multicenter, open-label, 12-week study in which adults with moderate or severe inflammatory lesions (papules and pustules) of rosacea received subantibiotic dose oral doxycycline 40?mg modified release (SDD40) and topical metronidazole gel 1%. Part 2 was a multicenter, randomized, double-blind, placebo-controlled, 40-week study in which successfully treated subjects received once-daily SDD40 or placebo capsules. The primary objective was to assess relapse and efficacy during long-term use of SDD40 versus placebo. Relapse was defined as a return to baseline investigator global assessment (IGA) or lesion count, or any other necessary change in treatment. Part 1 enrolled 235 subjects. Sixty-five subjects in the SDD40 treatment group and 65 subjects in the placebo group met the definition of treatment success at week 12, and were included in the Part 2 analysis. At the end of Part 2, half as many subjects in the SDD40 group had relapsed compared to the placebo group (13.8% [n = 9] vs. 27.7% [n = 18], p?<?0.05). Significant differences in the median change in inflammatory lesion counts were also observed (p?<?0.05). Adverse events (AEs) were generally mild–moderate in severity, and most were not treatment-related. Stinging/burning responded with more improvement in subjects treated with SDD40. After 52?weeks of once-daily treatment, subantibiotic dose doxycycline significantly reduced the relapse rate and inflammatory lesion counts in subjects with moderate-to-severe inflammatory rosacea.
Platelet rich plasma application by dermapen microneedling and intradermal point-by-point injection methods, and their comparison with clinical findings and trichoscan in patients with androgenetic alopecia
Kubra Nur Ozcan,Serpil Sener,Nihal Altunisik,Dursun Turkmen
doi : 10.1111/dth.15182
Volume 35, Issue 1 e15182
Androgenetic alopecia (AGA) is a progressive hair loss disease that occurs with the effect of androgens and genetic predisposition. Hair thinning and hair loss affect people's self-confidence and self-image more than is thought. In these patients, platelet rich plasma (PRP) treatment is used in addition to the limited medical treatments available. However, there is a lack of standardization for the application method of PRP treatment in the literature. The number of studies in which objective data and hair analysis parameters were revealed to demonstrate the effectiveness of PRP treatment is also very limited. In this study, it was aimed to show the efficacy of PRP treatment with trichoscan data in AGA patients and to compare dermapen-mediated microneedling and point-by-point technique injection application methods. The study was conducted with 62 male AGA patients, aged between 18 and 55?years, who applied to the University Faculty of Medicine, Department of Dermatology, and ranged from Norwood-Hamilton Stage II–V. The patients were randomly divided into two groups and one group was given microneedling with a dermapen, an electrical device that makes automatic needling, and the other group was given manual injection with point-by-point technique with a 30-gauge needle. Before the first treatment, each patient underwent a trichoscan hair analysis evaluation. A total of four sessions of PRP treatment were performed, as three sessions at 2-week intervals and the fourth session 1?month after the last session. The mean age of the cases was 33.13?±?6.36. According to Norwood-Hamilton staging, stage III was detected with the highest rate of 46% (29). Hair pulling test became significantly negative after treatment (p?<?0.05). Statistically significant differences were found in trichoscan analysis parameters for hair count, hair density, terminal hair count, and terminal hair density in both groups compared to pretreatment (p?<?0.05). Between the groups, a statistically significant difference was found between the averages of anagen hair, telogen hair, and hair length in the dermapen treated group compared to the group treated with the point-by-point technique. In our study, the efficacy of PRP treatment for AGA patients was demonstrated by trichoscan parameters. Among the PRP application methods, dermapen-mediated application was found to be superior to the point-by-point technique in terms of anagen, telogen, and average hair length parameters.
Long-term effect of azelaic acid peel on sebum production in acne
Anna Szyma?ska,Elzbieta Budzisz,Anna Erkiert-Polguj
doi : 10.1111/dth.15186
Volume 35, Issue 1 e15186
Seborrhea and the associated oily skin are undoubtedly the problem of women and men around the world. The pathogenesis of acne vulgaris involves excessive activity of sebaceous glands, as well as disturbances in the composition of sebum. The aim of the study was to assess the severity of seborrhea in a group of acne vulgaris patients and to determine the effect of a 20% azelaic acid solution on the activity of sebaceous glands. Twenty seven women, aged 19–25?years, underwent a series of six treatments with the application of a 20% solution of azelaic acid to the face. The mean values of sebum level showed a decreasing tendency. On the forehead, the results were as follows—195.5 before the treatment and 162.7 2?weeks after the last treatment. Measurements of the right cheek decreased from 175.3 to 141.3 The measurements taken 3?months after the study were 151.3 on the forehead and 138.9 on the cheek. Similarly, the values determining the total number of acne lesions and the severity of the disease according to the IGA scale also changed significantly. Chemical peel with 20% azelaic acid shows long-term sebostatic action, which inhibits the formation of new acne lesions.
Triple combination therapy of narrowband ultraviolet B, fractional carbon dioxide laser and topical bimatoprost 0.01% for non-segmental vitiligo on non-facial areas: A randomized half-body, double-blind, placebo-controlled, comparative study
Silada Kanokrungsee,Saranya Khunkhet,Salinee Rojhirunsakool,Kamonwan Thadvibun,Thanyapat Sahaspot
doi : 10.1111/dth.15198
Volume 35, Issue 1 e15198
Combination therapy shows superior outcomes over monotherapy in treating vitiligo. Topical bimatoprost is a melanogenic agent effectively used to induce repigmentation. However, topical bimatoprost 0.01% has never been explored in non-facial vitiligo, and triple therapy of phototherapy, fractional laser and topical bimatoprost has never been examined. This study aims to investigate the efficacy and safety of triple-modality treatment, combining narrowband ultraviolet B (NB-UVB), fractional carbon dioxide (CO2) laser and topical bimatoprost 0.01% for stable non-segmental vitiligo on non-facial areas. Fifteen vitiligo patients with at least two symmetrical, comparable-sized lesions on non-facial regions were included. The paired lesions were randomized to receive a treatment regimen of twice-daily application of either bimatoprost 0.01% solution or placebo in combination with once-monthly fractional CO2 laser and twice-weekly NB-UVB therapy for 12?weeks. There were no statistically significant differences in the vitiligo surface area (VSA) and melanin concentration (MC) at baseline between treatment sides. After 12?weeks of treatment, the percentage change from baseline of MC on the triple-therapy side was significantly higher than that on the dual-therapy side, 27.17?±?13.62% versus 22.82?±?10.10% (p =?0.028). The change from baseline of VSA was also greater on the triple-therapy side; however, a statistically significant difference was not reached. Improvement grades of repigmentation and adverse events were similar on both sides. Triple therapy with NB-UVB, fractional CO2 laser and topical bimatoprost 0.01% tends to be safe and more effective as compared to dual therapy of NB-UVB and fractional CO2 laser in non-facial vitiligo.
Comparison of noninvasive screening tools for hepatic fibrosis, association with methotrexate cumulative dose, and risk factors in psoriasis patients
Janet H. M. Lee,Chai Har Loo,Wooi Chiang Tan,Choon Kin Lee,Adawiyah Jamil,Yek Huan Khor
doi : 10.1111/dth.15203
Volume 35, Issue 1 e15203
Methotrexate (MTX) is a first-line systemic psoriasis therapy with risk of liver fibrosis. Noninvasive tools for liver fibrosis screening are Fibroscan®, Fibrosis-4 (FIB-4) index, and aspartate aminotransferase-to-platelet ratio (APRI) index. To compare Fibroscan®, FIB-4, and APRI in detecting fibrosis, determine association of fibrosis with MTX cumulative dose, and explore risk factors for fibrosis. A case–control study involving psoriasis patients aged ?18?years with MTX cumulative dose ?1?g, with age and sex-matched MTX naïve psoriasis patients was performed. Noninvasive tools were used to assess liver fibrosis. Sixty-one patients on MTX and 54 controls participated. Fibroscan® detected fibrosis in 22 (36.1%) patients on MTX compared to 11 (19.6%) controls (p = 0.05). FIB-4 predicted fibrosis in 13 (21.3%) patients on MTX and in 10 (17.9%) controls (p = 0.64) while APRI diagnosed 7 (11.5%) versus 7 (12.5%), p = 0.65. No significant correlation between Fibroscan® assessed liver stiffness and MTX cumulative dose (p = 0.47). Independent risk factors for liver fibrosis were MTX use with raised alanine aminotransferase (OR = 68.56, 95% CI 8.26; 568.86, p?<?0.001), diabetes mellitus (OR = 30.35, 95% CI 7.52; 122.42, p?<?0.001), and raised BMI (obese patients OR = 8.26, 95% CI 1.73–39.43, p = 0.02; overweight patients OR = 6.29, 95% CI 1.28–30.99, p = 0.01). Liver fibrosis occurred in both MTX naïve and MTX-treated psoriasis patients. Fibroscan® detected higher prevalence of liver fibrosis compared to FIB-4 and APRI. Cumulative MTX does not correlate with fibrosis severity. Fibroscan® is recommended prior to MTX therapy and at regular intervals especially among patients with diabetes and increased BMI.
Comparison of the efficacy of microneedling versus CO2 fractional laser to treat striae alba: A randomized clinical trial
Nasrin Saki,Farzaneh Rahimi,Fatemeh Sadat Pezeshkian,Seyedeh Yasamin Parvar
doi : 10.1111/dth.15212
Volume 35, Issue 1 e15212
Striae distensae (SD) are common skin conditions that have posed a significant challenge regarding their assessment and treatment. The present study aimed to evaluate the efficacy of microneedling in comparison to fractional CO2 laser therapy. Similar striae were selected and photographed. Each side was randomly assigned to be treated with CO2 fractional laser or microneedling four times at monthly intervals and followed up for 10 months. Outcome measures including the length and width of the largest striae, dermatologist assessed improvement, patients' satisfaction, and visual analog scale (VAS) were assessed. Wilcoxon signed-rank test and Mann-Whitney U test were used to assess the efficacy of treatments. Forty patients with a mean age of 28.1?years were included. The median cross-section of the largest striae decreased significantly in both groups (P-value <0.001), without statistically significant differences between the two groups before and 6 months after treatment. VAS also improved significantly in both groups, and there were no statistically significant differences between the two treatments in all visits. No clinically significant adverse effects were observed. Fractional CO2 laser and microneedling are both efficient treatments to resolve SD. A new light should be shed on the microneedling modality as it is more economical than the other treatment options.
Comparison of the efficacy and safety of intralesional injection of tranexamic acid and the topical application of Kligman combination drug in the treatment of macular amyloidosis
Mohammadreza Ghassemi,Masoumeh Roohaninasab,Seyed Abolfazl Kamani,Afsaneh Sadeghzadeh-Bazargan,Azadeh Goodarzi
doi : 10.1111/dth.15213
Volume 35, Issue 1 e15213
Macular amyloidosis (MA) is a common form of cutaneous amyloidosis that manifests as dark spots consisting of brown pigments with a rippled pattern on the skin, and the treatment of this condition is highly challenging. The aim of this study was to compare the efficacy and safety of intralesional injection of tranexamic acid (TXA) and topical application of Kligman combination drug in the treatment of macular amyloidosis. In this double-blind clinical trial, a total of 43 patients, who were diagnosed with MA, were treated with two different methods of intralesional injection of tranexamic acid and topical application of Kligman combination drug. Both therapeutic methods were effective in improving MA and significantly reduced hyperpigmentation of the treated areas, but tranexamic acid was significantly more effective than the Kligman combination drug. Significantly, greater improvements were observed in the group of patients treated with tranexamic acid. In the tranexamic acid treatment group, ?E was reduced from 11.39 in the first session to 8.53 in the third session, and in the Kligman treatment group, it was reduced from 8.79 in the first session to 6.32 in the third session (p <?0.05). In addition, the pruritus score in patients treated with topical tranexamic acid injection was lower compared to the patients treated with the topical application of the Kligman combination drug. The results of this study demonstrated the significant positive effects of both treatment methods, but in terms of reducing melanin content, intralesional injection of tranexamic acid was a more effective method. Both treatments considered safe for MA. In tranexamic acid group, patients logically experienced a tolerable pain during injection but they significantly had significantly lower local pruritic discomfort during study. So, based on the positive findings of this study we suggest to use tranexamic acid in combination with other effective therapeutic methods for treatment of MA especially use of its topically applied form in combination with non-aggressive needling that results in better drug delivery without the experience of injection pain. Selection of the best administration route of tranexamic acid for hyperpigmented lesions depends on the each patient characteristic and their previous theraputic results that may vary case by case.
Real world practice indirect comparison between guselkumab and risankizumab: Results from an Italian retrospective study
Angelo Ruggiero,Gabriella Fabbrocini,Eleonora Cinelli,Matteo Megna
doi : 10.1111/dth.15214
Volume 35, Issue 1 e15214
IL-23-inhibitors, such as guselkumab and risankizumab, represent the newest class of biologics approved for psoriasis. Phase III trials have shown their efficacy and safety. However, real life data are still scant. to indirectly compare the effectiveness, safety and tolerability of guselkumab and risankizumab in real world practice. An Italian single-center retrospective cohort study enrolling moderate-to-severe psoriasis patients from September 1, 2018 and December 31, 2020 was performed to indirectly compare guselkumab and risankizumab efficacy and safety. Sixty eight patients were included (36 received guselkumab and 32 risankizumab). The groups were comparable for all analyzed characteristics, except for mean psoriasis duration (p?<?0.01) which was higher for guselkumab. In guselkumab group, mean PASI reduced from 16.1?±?6.4 (baseline) 2.1?±?0.9 (week-28) (p?<?0.001) up to 0.9?±?0.8 (week-44) (p?<?0.001). In risankizumab group mean PASI decreased from 13.5?±?4.9 (baseline) 1.9?±?0.8 (p?<?0.001), (week-28) (p?<?0.001) up to 0.9?±?0.4 (week-40) (p?<?0.001). No significant difference in mean PASI and BSA were observed between the treatments. No cases of serious AEs, injection site reaction, candida, malignancy, cardiovascular events were reported in both groups. Guselkumab and risankizumab showed favorable efficacy and safety profile, being comparable in terms of PASI90 and PASI100 responses as well as in AEs frequency and discontinuation rates.
Is biologic therapy the future of granuloma annulare treatment?
Klaudia Dopytalska,Natalia Gabzdyl,Micha? Szczerba,El?bieta Szyma?ska,Irena Walecka
doi : 10.1111/dth.15188
Volume 35, Issue 1 e15188
Granuloma annulare (GA) is a benign inflammatory skin disease that presents with erythematous papules and annular plaques. The pathogenesis of GA remains unknown and may potentially involve type 1?T helper cell (Th1)-mediated delayed-type hypersensitivity reaction. GA is associated with many conditions such as malignancy, trauma, thyroid disease, diabetes mellitus, and viral infection. The role of biological treatment is under investigation. In this article, we present a case of GA development following systemic treatment of psoriatic arthritis in a 59-year-old patient; golimumab therapy resulted in the successful treatment of both psoriatic arthritis and GA. This is the first case report describing GA therapy using golimumab.
Emerging off-label esthetic uses of botulinum toxin in dermatology
Kevin Phan,Shannon Younessi,Danielle Dubin,Matthew J. Lin,Hooman Khorasani
doi : 10.1111/dth.15205
Volume 35, Issue 1 e15205
Botulinum toxin is a neurotoxic protein produced by Clostridium botulinum, the bacterium responsible for botulism. Botulinum toxin was first used for therapeutic indications in the 1970s for the treatment of strabismus. With greater understanding of its underlying physiology and safety profile, the use of botulinum toxin has now expanded to a range of cosmetic and medical indications. We performed a systematic review of current literature on the applications of botulinum toxin on off-label esthetic uses. Electronic databases were searched for original published studies including randomized trials, observational or cohort studies, as well as relevant case reports. To add to the body of evidence, our review summarizes and synthesizes key study characteristics, results, and level of evidence for each use case. Although the body of evidence remains weak, there is increasing support for the use of botulinum toxin in emerging off-label esthetic uses of botulinum toxin in dermatology.
Hyperhidrosis treatments in hidradenitis suppurativa: A systematic review
Terri Shih,Katrina Lee,Justine R. Seivright,Devea R. De,Vivian Y. Shi,Jennifer L. Hsiao
doi : 10.1111/dth.15210
Volume 35, Issue 1 e15210
Hyperhidrosis impairs quality of life (QOL) in hidradenitis suppurativa (HS) patients and may exacerbate HS. However, there is limited literature on whether hyperhidrosis treatments improve HS disease. To systematically review literature on efficacy and tolerability of hyperhidrosis treatments in HS patients. In May 2021, MEDLINE and EMBASE databases were systematically searched by two reviewers per PRISMA guidelines for articles on hyperhidrosis and HS. Sixteen articles met inclusion criteria (2 randomized controlled trials [RCTs], one case–control study, three cross-sectional studies, 10 case-studies/series), encompassing 252 HS patients across studies. They examined botulinum toxin A (BTX-A) (n = 6) and B (BTX-B) (n = 1), suction-curettage (n = 1), diode laser (n = 1), and microwave-based energy device (MED) (n = 3). Overall, BTX treatments improve HS severity, QOL, hyperhidrosis, and were well-tolerated. Suction-curettage did not improve disease. One HS patient tolerated diode laser well, with improvement in sweating and HS. One RCT studying MED was discontinued due to adverse events. Two studies reported MED-induced HS. BTX was overall helpful in HS patients, including in patients without concomitant hyperhidrosis. However, more prospective studies are needed to examine its utility in HS. There is potential harm of MEDs in HS. Most studies examining hyperhidrosis treatments in HS patients are low level of evidence. Larger RCTs should examine the efficacy and tolerability of hyperhidrosis treatments in HS.
COVID vaccination in patients under treatment with rituximab: A presentation of two cases from Iran and a review of the current knowledge with a specific focus on pemphigus
Parvaneh Hatami,Kamran Balighi,Hamed Nicknam Asl,Zeinab Aryanian
doi : 10.1111/dth.15216
Volume 35, Issue 1 e15216
SARS-COV2 vaccines were approved without long-term monitoring due to emergent situations. This has raised some issues about the timing and protocol of receiving vaccines in specific situations such as patients receiving immunomodulatory agents including rituximab, which is widely used for various disorders such as multiple sclerosis, pemphigus, and many rheumatologic disorders. We described two cases of pemphigus vulgaris (a new case and one with flare-up) following vaccination with Astrazeneca in Iran and reviewed the existing data in this regard through searching on PubMed, Google Scholar, and Scopus. All of the relevant papers published until June 28, 2021, which we could access their full-texts were included. We found some recommendations made by rheumatologists, neurologists, and dermatologists in regard to vaccination timing in this group of patients and tried to summarize them to provide a practical guide for clinicians. Clinicians should perform a careful, individualized risk–benefit assessment for their patients and consider a delay in rituximab administration after completion of COVID vaccination if there is not any considerable risk of disease relapse or organ failure. Moreover, choosing vaccines with potential of providing protection after single dose, especially in countries with limited access to vaccines may be a reasonable approach.
Pediatric discoid lupus erythematosus: Short report
Tatiana Hawat,Salwa Ballouz,Hala Megarbane,Roger Haber
doi : 10.1111/dth.15170
Volume 35, Issue 1 e15170
Pediatric discoid lupus erythematosus (DLE) is a rare inflammatory skin disorder. This article aims to review all the available clinical and therapeutic data on reported cases of pediatric DLE. A systematic review of the literature was conducted using Pubmed and Embase with no limitation on publication date, sex, or nationality. Thirty-two articles were included with 201 cases, a mean age of 8.9?years (2?months–16?years) and an F:M ratio of 1.8. Lesions were located on the head and neck in 58.5% and were disseminated in 36.5% of the cases. Associated symptoms were pruritus (10.1%) and alopecia (8.7%). 12% progressed to systemic lupus erythematosus (SLE) and 14.5% had concurrent SLE. The only statistically significant predictor for progression to SLE was the onset of symptoms before or at the age of 10?years (p =?0.004). Treatments consisted mainly of sunscreens (26.3%), topical corticosteroids (24.3%), and oral antimalarials (25.3%). Retrospective nature of the included studies, small sample size, short duration of follow-up and limited data on the patients' demographics. Pediatric DLE affects mostly the head and neck, with a female predominance, a possible association with inflammatory and autoimmune diseases, and overall good treatment response and prognosis.
Safety of SARS-CoV-2 vaccines in psoriatic patients treated with biologics: A real life experience
Maria Letizia Musumeci,Giuliana Caruso,Andrea Calogero Trecarichi,Giuseppe Micali
doi : 10.1111/dth.15177
Volume 35, Issue 1 e15177
Vaccination is the most effective method to prevent and control the SARS-CoV-2 infection and biologics are not considered a contraindication for vaccination. The burning question is that safety data are lacking since patients taking drugs affecting the immune system were excluded from clinical trials leading to vaccine approbation. Moreover, it seems that vaccination could worsen psoriasis. We conducted a survey to investigate the safety of SARS-CoV-2 vaccines in psoriatic patients treated with biologics. A total of 150 patients with stable plaque psoriasis treated with biologics for at least 2 months were evaluated in a 3?months period. Fifty patients (22 F/28 M; age: 33–83?years) only underwent the first and second doses of SARS-CoV-2 vaccines. All patients discontinued their biological agents 10?days before and 10?days after each dose of vaccine. Of these, 24 patients were treated with anti-TNF, 14 with anti-IL17, 7 with anti-IL12-23, and 5 with anti-IL23. After the vaccines, all patients were evaluated at day 2, 7, and 14 for local and/or systemic side effects and/or adverse drug reactions to SARS-CoV-2 vaccines. None of the patients experienced any side effects or a psoriatic flare. Only one patient treated with infliximab biosimilar referred an exacerbation of psoriasis after vaccine. The remaining 100 patients reported that they did not get the vaccine yet. Our preliminary data confirm that SARS-CoV-2 mRNA vaccines are safe for patients with chronic plaque psoriasis treated with biologics and did not trigger psoriasis, although these data should be validated in a larger population. We encourage an early SARS-CoV-2 vaccines administration in all psoriatic patients on immunosuppressant drugs.
Treating pediatric cutaneous Leishmania tropica with systemic liposomal amphotericin B: A retrospective, single-center study
Yehonatan Noyman,Assi Levi,Dan Ben Amitai,Shiran Reiss-Huss,Fareed Sabbah,Emmilia Hodak,Tomer Mimouni,Rivka Friedland
doi : 10.1111/dth.15185
Volume 35, Issue 1 e15185
Leishmania tropica (L. tropica) cutaneous leishmaniasis (CL) is associated with high morbidity and low response rate to therapy, especially in pediatric patients. Intravenous (IV) liposomal amphotericin B (LAmB) has been used off-label as a treatment for L. tropica CL for many years. However, data regarding its efficacy and safety in children is lacking. In order to evaluate the efficacy and safety of IV LAmB for treating pediatric patients with L. tropica, we retrospectively reviewed electronic medical records of 24 children who were diagnosed with L. tropica CL and treated with IV LAmB during 2014–2020, at a tertiary medical center in Israel. Fourteen (58%) completed the treatment protocol and 10 (42%) experienced an infusion-related adverse event (IRAE) leading to treatment termination. Complete response was noted in 6/14 (43%) patients, while 8/14 (57%) failed to respond. Lower response rate was noted in lesions involving the mid-facial area. The relatively low response rate is speculated to result from a low dose of LAmB, short follow-up period, and difficult to treat anatomic locations. The observation of a lower response rate for mid-facial lesions should be validated in larger cohorts. The highrisk of IRAE should be considered in physician decisions regarding this treatment.
A rare case of self-healing giant condyloma acuminatum
Shuang Jin,Linxi Liu,Rong Li,Xuyue Zhou,Ziwei Wang,Chao Luan,Kun Chen,Dan Huang
doi : 10.1111/dth.15189
Volume 35, Issue 1 e15189
Giant condyloma acuminatum (GCA) which is also called Buschke-Lowenstein tumor. It is a rare tumor of the anorectal area and external genitalia associated with low-risk HPV types 6 or 11. GCA has a high-rate of recurrence (66%) and malignant transformation (56%). The clinical features of GCA are progression of exophytic, ulcerative, and cauliflower-shaped tumors, it has significant dimensions and may undergo malignant transformation such as squamous cell carcinoma or cervical cancer. It is difficult to treat GCA, and it may be impossible for GCA to self-healing, but we herein report a rare case of a 19-year-old female with self-healing GCA.
Cost minimization analysis of mainstay treatments in cutaneous lupus erythematous
Syed Kazim Rizvi,Benjamin F. Chong
doi : 10.1111/dth.15190
Volume 35, Issue 1 e15190
Cutaneous lupus erythematosus (CLE) can be treated with multiple oral immunosuppressants but cost analyses of these treatments are lacking. We aimed to assess the relative cost difference between various oral medications for CLE using a cost-minimization analysis. Annual direct costs for 10 oral medications used in CLE were calculated including cost of medications and patient monitoring, which include office visits, laboratory and radiological studies, and procedures. Medication costs were taken from the National Average Drug Acquisition Cost calculated by the Centers of Medicare and Medicaid Services or the Average Wholesale Price. Monitoring guidelines were obtained from expert consensus and FDA-approved recommendations. Methotrexate had the lowest total direct cost ($899.31), followed by hydroxychloroquine ($1007.38), mycophenolate mofetil ($1162.12), azathioprine ($1193.71), chloroquine ($2525.01), dapsone ($2750.68), cyclosporine ($2976.32), thalidomide ($75,831.44), and lenalidomide ($316,104.03). For medications used for CLE patients, the medication cost contributes the most to differences between direct costs. Limitations include insufficient patient outcome data to ascertain medication efficacy, exclusion of cost of medication-related adverse events and hospitalizations, and medication cost data not reflecting all payers. Clinicians can use this data to help discern which medication to prescribe CLE patients with financial constraints and reduce healthcare spending.
Real-life effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis
Andac Salman,Özlem Apti Sengun,Meryem Aktas,Oktay Ta?kapan
doi : 10.1111/dth.15192
Volume 35, Issue 1 e15192
Atopic dermatitis (AD) is a common, chronic inflammatory condition with a substantial negative impact on the quality of life. Dupilumab, the first biologic approved for the treatment of moderate-to-severe AD, binds IL-4R? and inhibits signaling of both IL-4 and IL-13. This study aimed to determine the real-life effectiveness and safety of dupilumab treatment in patients with moderate-to-severe AD. The results of the study indicates high effectiveness and safety of dupilumab in real-life conditions. The treatment was continued during the COVID-19 pandemic in most of the patients without any adverse outcome. The rate of conjunctivitis was higher compared to clinical trials, nevertheless treatment was not discontinued in any patients due to adverse effects.
Absolute Psoriasis Area and Severity Index as a valuable marker to determine initial treatment response in psoriasis patients treated with guselkumab in routine clinical care
Ulrich Seidl,Andreas Pinter,Dagmar Wilsmann-Theis,Sietske Poortinga,Kirsten Morrison,Ulrich Mrowietz,Sascha Gerdes
doi : 10.1111/dth.15193
Volume 35, Issue 1 e15193
Guselkumab is an anti-interleukin-23p19 monoclonal antibody approved as a first-line medication in patients with moderate-to-severe plaque-type psoriasis and second-line in active psoriatic arthritis. In the clinic, patients who have shown a lack of previous treatment efficacy and/or tolerability are often prescribed guselkumab. These patients generally have less severe psoriasis compared to clinical trial cohorts, reflected in lower Psoriasis Area and Severity Index (PASI). To evaluate treatment response in a real-world setting, we conducted a multicenter-retrospective chart review in three specialized dermatological centers. Seventy-four patients who received guselkumab treatment were included in the study and baseline characteristics were described. The mean PASI at baseline was 13.0 (±?6.7). After 12?weeks of treatment 40 patients could be followed up at the participating centers and efficacy was assessed: 72.5% of these patients achieved an absolute PASI ?5 (55.0% ?3; 42.5% ?2) whereas only 57.5% of patients were able to gain a delta PASI reduction of at least 75%. Using the absolute PASI as a treatment goal rather than response rate revealed that guselkumab was highly effective in this real-world setting. In conclusion, the absolute PASI proved to be a more valuable tool to measure treatment outcome.
Biological therapy in patients with psoriasis: What we know about the effects on renal function
Giulia Veronesi,Alba Guglielmo,Aldo Gardini,Lidia Sacchelli,Camilla Loi,Annalisa Patrizi,Federico Bardazzi
doi : 10.1111/dth.15202
Volume 35, Issue 1 e15202
Psoriasis is a chronic inflammatory dermatosis affecting 2%–3% of the general population. The link between psoriasis and renal dysfunction has been investigated, demonstrating a common pro-inflammatory pathogenesis. This study is aimed at evaluating renal function in patients with moderate-to-severe chronic plaque psoriasis treated with biological therapy. We analyzed 92 patients, correlating PASI and serum creatinine levels at baseline, after 6?months and after 1?year of continuous treatment with biological therapy. Data were analyzed using paired t-test and the linear mixed model for PASI and serum creatinine levels correlation, whereas the analysis of variances (ANOVA) was used for creatinine levels assessment between the baseline, the 6-months and, 1-year later evaluation. We observed a significant mean decrease in comparing serum creatinine levels after 1?year of biological therapy (p?<?0.001). Interestingly, PASI reduction is correlated with creatinine decrease, and the renal function improvement is greater when complete psoriasis remission is attained. Our data suggest that a drop in systemic inflammation, secondary to biological therapy administration, might improve renal function. Future research is needed to confirm and expand our findings.
Guselkumab-associated bullous pemphigoid in a psoriasis patient: A case report and review of the literature
Martina Burlando,Niccolò Capurro,Astrid Herzum,Emanuele Cozzani,Aurora Parodi
doi : 10.1111/dth.15207
Volume 35, Issue 1 e15207
Drug-induced bullous pemphigoid (DBP) associated to biologics administered for psoriasis is rare. DBP has been described especially in association with anti-TNF-? drugs and anti-IL12 and 23, but never in relation to guselkumab (anti-IL23). We report the case of a 76-year-old male patient with severe psoriasis (PASI 20), presenting with generalized tense bullae and erosions after being recently switched to guselkumab therapy. Histology and direct immunofluorescence confirmed the suspect of bullous pemphigoid (BP). Guselkumab administration was interrupted, low-dose oral corticosteroid therapy was introduced and after only 1-month remission was obtained with no new lesions appearing. As outlined in the presented case, DBP's onset typically follows the introduction of a new drug in patients taking polypharmacy. In addition, DBP may spontaneously regress after discontinuation of the triggering drug and it responds very rapidly to steroid therapy. Up to date, DBP has been described after biological therapy for psoriasis in 11 patients, following administration of ustekinumab, efalizumab, etanercept, secukinumab, and adalimumab. Conversely, DBP after guselkumab therapy for psoriasis has never been reported in published studies. We highlight the need to face and document increasing, though rare, side effects of biologic therapies, as new biologic molecules are being constantly developed and administered to psoriatic patients, to promptly interrupt treatment when needed.
