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Cover Image, Volume 35, Issue 2
Liang Joo Leow,Natalie Teh
doi : 10.1111/dth.15336
Volume 35, Issue 2 e15336
Intralesional biologics for inflammatory dermatoses: A systematic review
Justine R. Seivright,Natalie M. Villa,Devea R. De,Jennifer L. Hsiao,Vivian Y. Shi
doi : 10.1111/dth.15234
Volume 35, Issue 2 e15234
Biologic medications are systemic therapeutic options for inflammatory dermatoses. Local forms of administration are less well-studied. To provide a summary of intralesional (IL) administration of biologics for various non-malignant inflammatory dermatologic conditions reported in the literature. A systematic review was performed in the PubMed and Embase databases from 2000 to 2020. Inclusion criteria included the local use of biologic medications for non-malignant cutaneous conditions. Quality was assessed with the modified Oxford Centre for Evidence-Based Medicine ratings. A total of 19 articles describing the use of 5 biologic medications in 9 dermatologic conditions were identified, comprising 172 patients. Conditions successfully treated with intralesional biologics included pemphigus vulgaris (rituximab), granuloma faciale (rituximab), perianal Crohn's disease (infliximab), lichen sclerosus (adalimumab), and necrobiosis lipoidica (etanercept and infliximab). Intralesional etanercept reduced pruritus associated with keloids. A case report of the use of infliximab for pyoderma gangrenosum did not demonstrate any efficacy. There was no consistent effect noted with treatments for sarcoidosis (infliximab) or cutaneous lymphoid hyperplasia (rituximab). Local administration of biologic medications may offer an additional method of treating refractory inflammatory dermatoses, but further study is needed to develop standardized dosing protocols, clarify efficacy rates, and identify optimal treatment candidates.
Treatment of chronic venous disorder: A comprehensive review
Nikolaos Chaitidis,Damianos G. Kokkinidis,Zoi Papadopoulou,Maria Kyriazopoulou,Dimitrios Schizas,Christos Bakoyiannis
doi : 10.1111/dth.15238
Volume 35, Issue 2 e15238
Chronic venous disorder (CVD) is highly prevalent vascular disorder affecting up to 45% of the general population, with clinical manifestations ranging from teleangiectasias to venous leg ulcers (VLUs). We examined the currently available data in order to provide an updated, comprehensive review on treatment options of CVD. We searched MEDLINE, Cochrane, Scopus, EMBASE, ClinicalTrials, and OpenGrey databases for relevant articles in English published until November 2020. Compression treatment is the mainstay of conservative treatment. Pharmacological treatment can provide significant symptomatic relief and hence it should be considered as part of conservative treatment. Transcutaneous Lacer treatment (TCL) is a safe and effective alternative option to sclerotherapy for treatment of C1 stage. High ligation and stripping (HL/S), ultrasound-guided foam sclerotherapy (UGFS), endovenous thermal ablation (EVTA) systems and non thermal non tumescent ablation (NTNT) systems are safe and efficacious first-line options for treatment of saphenous insufficiency. Interventional treatment of co-existing incompetent perforator veins (IPVs) is not supported by contemporary evidence. Regarding deep venous insufficiency (DVI), treatment of symptomatic femoroiliocaval occlusive venous disease refractory to conservative treatment with percutaneous transluminal venoplasty stenting has produced encouraging results.
Treatment of retronychia: A systematic review and suggested treatment algorithm
Andrea Sechi,Corrado Zengarini,Bianca Maria Piraccini,Aurora Alessandrini,Francesca Bruni,Annalisa Patrizi,Luigi Naldi,Michela Starace
doi : 10.1111/dth.15251
Volume 35, Issue 2 e15251
Retronychia is an inflammatory disorder typical of the great toes characterized by arrested nail growth, ingrowth of the nail plate into the proximal nail fold and paronychia. There is no standardized treatment for retronychia, and its management should be weighed based on the severity stage, treatment modality, and clinical outcome. In this paper, a systematic review of the literature was performed to assess all published data regarding the treatment of retronychia. A total of 231 patients from 24 studies were included in the analysis. Conservative management was adopted in mild-intermediate forms, consisting of medical (topical or intralesional high-potency corticosteroids) and podiatric treatment (taping, clipping back the onycholytic plate, orthosis), leading to a global cure rate of 41.2%, with no reported side effects. Non-conservative management, that is, chemical or surgical avulsion of the nail plate, proved resolutive in 71.2% of cases. Surgical avulsion of the nail plate produced the highest cure rate (78.2%), but was burdened by 9.6% of long-term sequelae, mainly nail dystrophies. A decision-making algorithm was designed to give clinicians treatment indications based on the severity stage of retronychia, treatment invasiveness, and possible clinical outcomes.
Early localized vitiligo, a medical emergency: Long-term follow-up study
Samia M. Esmat,Dalia Bassiouny,Rehab Hegazy,Suzan Shalaby,Nanis Ragab,Sarah Ibrahim,Rania M. Mogawer
doi : 10.1111/dth.15219
Volume 35, Issue 2 e15219
In spite of multiple therapeutic regimens for vitiligo, disease relapse remains a challenge. Most guidelines consider systemic treatments only in rapidly progressive disease with wider surface areas. This delay in halting the immune attack, may give the chance for further disease progression as well as establishment of resident memory T-cell population predisposing to future relapses. To assess the ability of early systemic therapy of localized (<2% BSA), recent onset (<6?months) vitiligo to control disease activity and minimize the possibility of recurrence. Twenty-five patients with recent onset (<6?months), localized (<2% BSA) vitiligo were included. Patients received pulse dexamethasone therapy for 6?months plus topical treatments and NB-UVB sessions. Patients were followed monthly as regards percent of repigmentation and VIDA score. To detect recurrence, biannual assessment was done for 4?years. Eighty-four percent of patients had acrofacial lesions and 44% had facial lesions. Arrest of activity was achieved after 3.65?±?2.19?months. Complete repigmentation was achieved in a mean duration of 6.88?±?0.2?months. At the end of the 4-year follow up, recurrence occurred in 32% of patients. In spite of recurrence, localized disease (<2% BSA) was secured. A significantly higher incidence of recurrence was associated with cases with bilateral distribution of lesions. Early systemic immunomodulation for recent localized vitiligo is a successful approach to achieve early control of disease activity and minimize the incidence of recurrence. Such cases should not be overlooked but managed as early as possible; it is a race against time.
Antibacterial and anticandidal effects of atmospheric-pressure, non-thermal, nitrogen- and argon-plasma pulses
Chang Ki Kim,Heesu Kim,Hyun-Jo Kim,Sung Bin Cho
doi : 10.1111/dth.15222
Volume 35, Issue 2 e15222
Atmospheric-pressure, non-thermal plasma destroys microorganisms by directly reacting with hydrocarbon molecules in the cell wall and/or by damaging the cytoplasmic membrane, proteins, and DNA with charged particles and reactive species. The aim of our study was to evaluate the antibacterial and anticandidal effects of atmospheric-pressure, non-thermal, nitrogen- and argon-plasma pulses on various pathogen preparations. The resultant antibacterial and anticandidal effects were assessed by evaluating percent and log reduction values for pathogen colonies. Nitrogen-plasma pulses emitted at an energy of 1.5 J and argon-plasma pulses generated at 0.5 J elicited remarkable antibacterial effects on Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus (MRSA) and anticandidal effects on Candida albicans. Nitrogen-plasma pulses at a pulse count of five elicited remarkable antibacterial effects on Cutibacterium acnes at the energy settings of 1.75, 2.5, and 3 J, but not at 1 J. Meanwhile, argon-plasma pulses showed antibacterial effects on C. acnes at an energy of 0.5 and 0.65?J. Nitrogen- or argon-plasma pulses exert antibacterial and anticandidal effects on bacterial and fungal pathogens.
Juvenile xanthogranulomas in Asian children
Lynette Wei Yi Wee,Hua Yen Ling,Valerie Pui Yoong Ho,Alice Yee Wah Foong,Mark Jean Aan Koh
doi : 10.1111/dth.15224
Volume 35, Issue 2 e15224
Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytic disorder. It can rarely be associated with systemic involvement. There is a paucity of literature on JXG in Asian children. We aim to describe the epidemiology, clinical features, systemic associations, histological features and outcome of a cohort of Asian children with JXG, and review the literature on the condition. We retrospectively reviewed the demographic, clinical and histological data of patients less than 16?years of age, diagnosed with JXG at our tertiary pediatric hospital between January 2002 and April 2019. A total of 147 children with JXG were identified, with a slight male preponderance of 53.1%. The median age of the onset was 15.5 months, with 69.4% presenting before 2?years of age. There was no racial predilection. The most frequently involved site was the head and neck region (44.2%). The majority of patients (76.2%) presented with a solitary lesion. Spontaneous resolution was documented in 57.7% of our patients with mean duration to resolution of 18.8 months. The proportion and speed of resolution did not differ in children with single or multiple lesions. No ophthalmologic complications were detected in our study cohort. JXG in children is generally limited to the skin and is rarely associated with systemic involvement, including the eye. Unless clinically indicated, the results from our study does not support routine screening for juvenile myelomonocytic leukemia, eye or systemic complications, even in the setting of multiple cutaneous JXGs.
Combination of carboxytherapy with narrowband-ultraviolet B in the treatment of recalcitrant areas of vitiligo: A randomized clinical trial
Saeedeh Farajzadeh,Fateme Yazdanpanah,Maryam Khalili,Saman Mohammadi,Behzad Iranmanesh,Mahin Aflatoonian
doi : 10.1111/dth.15229
Volume 35, Issue 2 e15229
Carboxytherapy has been used in the treatment of autoimmune skin diseases such as psoriasis and morphea. Carboxytherapy has antioxidant effects, and leads to better tissue oxygenation, and release of growth factors. In this article, we decided to evaluate efficacy of combined carboxytherapy and narrowband-ultraviolet B (NB-UVB) compared to NB-UVB alone in the treatment of vitiligo. This is a prospective, split-body double-blind comparative study performed in patients with generalized stable vitiligo in acral areas and extremities referred to dermatology clinic of Afzalipour hospital in Kerman University of Medical Sciences. NB-UVB was performed three times a week in non-consecutive days for 4?months. In each patient, one lesion was randomly treated with carboxytherapy (weekly sessions for total of 16 sessions). Efficacy of treatment was evaluated by percentage of repigmentation of the lesions. Chi-square test and analysis of variance test (ANOVA) were used to compare efficacy of treatment based on demographic features of the patients and clinical features of the lesions, respectively. Twenty-eight patients with mean age of 32.35?±?7.37?years old completed the study. At the end of the treatment, 37% of the patients in combination therapy group demonstrated more than 75% improvement compared to 0% in the monotherapy group (p = 0.001). There was no significant difference between either demographic features of the patients (age, sex, and skin phototypes) or duration of disease with efficacy of the treatment in both groups. Combination of carboxytherapy with NB-UVB leads to higher percentage of repigmentation and patients' satisfaction compared to monotherapy with NB-UVB.
Effectiveness and safety of guselkumab for the treatment of psoriasis in real-world settings at 24?weeks: A retrospective, observational, multicentre study by the Spanish Psoriasis Group
Elena del Alcázar,Anna López-Ferrer,Álvaro Martínez-Doménech,Ricardo Ruiz-Villaverde,Mª. del Mar Llamas-Velasco,Vicenç Rocamora,Marc Julià,Jaime Notario,Lourdes Rodríguez Fernández-Freire,Antonio Sahuquillo-Torralba,David Vidal,Raquel Rivera,Gregorio Carretero,Almudena Mateu,Pablo de la Cueva,José Manuel Carrascosa
doi : 10.1111/dth.15231
Volume 35, Issue 2 e15231
Data on the effectiveness and safety of a drug in real-world clinical practice complement the evidence from clinical trials, which are carried out in a different setting. Little has been published on the effectiveness and safety of guselkumab in the treatment of psoriasis in clinical practice. The ojective of this study was to assess the effectiveness and safety of guselkumab at 24?weeks in patients with moderate to severe plaque psoriasis in routine clinical practice. A retrospective, multicentre study of adult patients with moderate to severe plaque psoriasis treated with guselkumab for at least 24 weeks was carried out in Spain. We studied 343 patients, 249 of whom were followed for 24?weeks. By week 24, the mean (SD) psoriasis area severity index (PASI) had decreased from 11.1 (7.3) to 1.7 (2.8) (?9.3; [?10.2;-8.4]), 85.9% of the patients had achieved PASI score of 4 or less and 77.9% a PASI score of 2 or less. In terms of relative PASI response, 59.4% of the patients achieved a PASI-90 response and 49.0% a PASI-100 response. On multivariate analysis, two factors reduced the probability of a PASI of 2 or less at 24?weeks: a BMI ?30 (OR, 0.44; 95% CI, 0.22–0.88) and a greater previous exposure to biologic therapy (OR, 0.69; 95% CI, [0.56–0.84]). Adverse events were rare (9.9%) and led to withdrawal from treatment in only nine patients (2.6%) by the end of the follow-up period. The results of this study confirm the high efficacy and safety of guselkumab indicated by the clinical trial data. In clinical practice, the absolute PASI score appears to be a better marker of response to treatment than the relative value.
Effectiveness of neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: A prospective cohorts study
Marta Bergón-Sendín,Ana Pulido-Pérez,Lula María Nieto-Benito,Lucía Barchino-Ortiz,Jesús Díez-Sebastián,Ricardo Suárez-Fernández
doi : 10.1111/dth.15233
Volume 35, Issue 2 e15233
Intralesional methotrexate (il-MTX) has been used in cutaneous squamous cell carcinoma (cSCC) achieving important reductions in tumor size. However, there is a lack of controlled studies on this regard. The primary objective was to analyze the effect of il-MTX on tumor size in cSCC. As a secondary objective, we evaluated its impact on the surgical approach. We conducted a prospective cohorts study that included 200 patients with histologically confirmed cSCC. Patients in Group 1 (Cases) received neoadjuvant treatment with il-MTX prior to surgery. Patients in Group 2 (Controls) underwent scheduled surgery without prior neoadjuvant therapy. Clinical measurements of lesions were made at the time of inclusion in the study and before surgery. No intergroup statistical differences were found between the assessed variables. In Group 1, tumor size reduction occurred in 93% of the patients after il-MTX therapy. Tumor surface was reduced by 54%. Complex reconstructions were needed in 15% of these patients. In Group 2, tumor surface increased by 33.1% and complex reconstructions were needed in 40% of patients. Intergroup differences were statistically significant (p <?0.001). Neoadjuvant Il-MTX therapy achieves very important tumor size reduction and significantly simplifies surgical treatment.
Clinical, dermoscopic, and histopathologic evaluation of vitamin C versus PRP, with microneedling in the treatment of mixed melasma: A split-face, comparative study
Amal T. Abdel-Rahman,Fatma G. Abdel-Hakeem,Maha H. Ragaie
doi : 10.1111/dth.15239
Volume 35, Issue 2 e15239
Melasma is a common esthetic problem affecting the face with a lot of risk factors being incriminated. Although several treatment options are available, none of them is satisfactory. This split face prospective study aimed to compare the efficacy of microneedling with vitamin C versus with platelet-rich plasma (PRP) in the management of mixed melasma. Ten females with bilateral mixed facial melasma were treated with six sessions of microneedling. After the needling vitamin C was applied on the right side of the face and PRP was applied on the left side. Clinical, dermoscopic, and histological assessment of the used treatments was done 1?month after the last session. The clinical and dermoscopic clearance of melasma was proved significantly on both sides of the face but was more significant with vitamin C (P =?0.005). Reduction of epidermal melanin and dermal melanophages was more observed with vitamin C. Moreover, MART-1 stain revealed a more significant reduction in the epidermal, dermal, and the total MART-1 positive cells with vitamin C (P =?0.044, 0.039, and 0.035, respectively). Microneedling with vitamin C was more efficient in treating mixed melasma than with PRP.
Subcision, chemical peels, and platelet-rich plasma: Combination approaches for the treatment of striae distensae
Howyda M. Ebrahim,Amira Salem,Tagreed Salah,Fatma Eldesoky,Hala Mohamed Morsi
doi : 10.1111/dth.15245
Volume 35, Issue 2 e15245
Striae distensae (SD) are disfiguring skin condition causing cosmetic troubles and psychological distress. The aim was to compare the efficacy and safety of platelet-rich plasma (PRP) versus its combination with subcision or medium-depth peeling (glycolic acid 70% followed by trichloroacetic acid [TCA] 35%) for SD treatment. Seventy-five female patients with SD were divided into three equal groups with the contralateral side in each patients represented the control group. Group A treated with PRP, group B received PRP?+?subcision while group C received PRP?+?combined peeling (GA 70%?+?TCA 35%). Primary outcome included clinical improvement, patients' satisfaction, and Dermatology Life Quality Index (DLQI). Striae measurement, skin biopsies were also assessed. Very much improvement was achieved in 28%, 44%, and 36% in groups A, B, and C respectively. The combined groups (B and C) showed significantly higher patients' satisfaction and DLQI than group A (p =?0.03), (p?<?0.0001). A significant decrease in all striae measurements was achieved with all groups (p < 0.001); however, groups B and C showed more decrease (p = 0.2 and 0.4). A highly significant decrease in the mean number of sessions was found in group B (p?<?0.0001). All groups demonstrated improvement in dermal collagen deposition, which was higher in the combined groups. Side effects were mild and well tolerated. The combination of PRP with subcision or peeling was more effective and offered a higher therapeutic response than PRP alone. Moreover, the subcision has superior efficacy in striae albae and safer in darker skin types.
Analysis of clinical factors as possible predictors of response to omalizumab and relapse after treatment discontinuation in chronic spontaneous urticaria
Caterina Foti,Paolo Romita,Francesca Ambrogio,Margherita Fanelli,Rosanna Panebianco,Gino Antonio Vena,Nicoletta Cassano,Mariagrazia Ragusa,Roberta Giuffrida,Valeria Papaianni,Francesco Borgia,Serafinella Patrizia Cannavò,Fabrizio Guarneri
doi : 10.1111/dth.15248
Volume 35, Issue 2 e15248
Omalizumab is a monoclonal anti-IgE antibody which is effective in chronic spontaneous urticaria (CSU), although clinical response appears to be variable in the real-life setting. The aim of this study was to evaluate whether the response of CSU to omalizumab and disease relapse are associated with individual and/or clinical characteristics of patients. We retrospectively evaluated the clinical records of 124 patients treated with omalizumab for moderate to severe CSU refractory to antihistamines. Disease activity was assessed using the urticaria activity score over the last 7?days (UAS7). After 24?weeks of treatment, 91% of patients showed complete remission (UAS7 = 0) or good control (UAS7?<?7) of CSU. Omalizumab was re-administered in 45 patients because of recurrence of moderate to severe symptoms at week 8 after treatment discontinuation or later, and clinical results achieved with retreatment were similar to those observed in the first course. Among the parameters included in our analysis (age and sex of patients, documented history of atopy or autoimmune thyroid disease, CSU duration and baseline severity, concurrent angioedema, and association with chronic inducible urticaria), none was associated with response to omalizumab in our study population. Similarly, these parameters did not significantly differ between patients who experienced CSU relapse and those without relapse. Predictors of response to omalizumab treatment in CSU patients are still unclear, and further studies are needed to evaluate the presence of baseline factors that can influence treatment outcome.
Two superior antioxidants: Ferulic acid and ascorbic acid in reducing signs of photoaging—A split-face comparative study
Kamila Zdu?ska-P?ciak,Anna Ko?odziejczak,Helena Rotsztejn
doi : 10.1111/dth.15254
Volume 35, Issue 2 e15254
The assessment of the signs of photoaging in mexametric (melanin and erythema index), corneometric (hydration level), and cutometric (elasticity) examination after the treatment with ascorbic acid and ferulic acid. This study was conducted in a group of 20 women aged 39–61 (mean age 54), with Fitzpatrick skin types II and III. The study included a series of eight treatments performed once a week. Two layers of peeling, based on 14% ferulic acid (left half of the face) and 12% l-ascorbic acid serum (right half of the face) were applied. To determine skin parameters: moisture, elasticity, melanin level, and erythema intensity, the Multi Probe Adapter Systems (Courage + Khazaka electronic GmbH, Köln, Germany) were used. Additionally, before and after the series of treatments, photographs were taken with the standardized photographic system Fotomedicus (Elfo®). The results of mexametric measurement for melanin level and erythema intensity were statistically significant (p?<?0.0001) for both acids. Slightly greater lightening of the skin was demonstrated for ascorbic acid. The results of corneometric measurement of hydration level for ferulic acid and ascorbic acid were both statistically significant (p?<?0.0001). First beneficial changes in improved elasticity could be observed as early as after 8?weeks but the increase in flexibility grew with time (after 12?weeks). These changes affected both acids and all measurement points. The changes in parameters were highly statistically significant (p?<?0.0001). Based on the conducted research, it is not possible to state which of the tested acids is more effective in reducing the symptoms of photoaging. Both acids (ascorbic and ferulic), which have a high antioxidant potential, affect the measurable parameters of the skin: pigmentation (melanin index), erythema (erythema index), skin hydration, and elasticity.
Evaluating the risk-to-benefit ratio of using cotrimoxazole as a pneumocystis pneumonia preventative intervention among pemphigus patients treated with rituximab: A retrospective study with 494 patients
Hannaneh Faraji,Maryam Daneshpazhooh,Amir Hooshang Ehsani,Hamidreza Mahmoudi,Soheil Tavakolpour,Zeinab Aryanian,Saeed Aslani,Hamidreza Khodaveisi,Kamran Balighi
doi : 10.1111/dth.15257
Volume 35, Issue 2 e15257
Rituximab is widely used as the first-line treatment for pemphigus patients. Since it depletes the B cells, it increases the risk of infections. Here, we evaluated the prophylactic efficacy of cotrimoxazole in decreasing the risk of pneumocystis pneumonia (PCP) infection in the pemphigus patients treated with rituximab. The medical records of confirmed pemphigus patients receiving rituximab were evaluated in two groups; those who received cotrimoxazole as a prophylactic after rituximab and patients who only received rituximab without any prophylaxis. The occurrence of PCP infection was determined in each group and compared. Medical records of 494 patients, including 301 women and 193 men, with the mean age of 46.74?years were analyzed. The phenotypes of the disease were mucocutaneous (n =?364), mucosal (n =?88), and cutaneous (n =?42). Among them, 235 cases had received cotrimoxazole as a prophylaxis and 259 patients did not. The incidence of PCP in total patients was 2 (0.4%), one in each group. Accordingly, no significant difference was observed in the incidence of PCP between two groups (p =?0.84). Also, no cotrimoxazole-related side effect was observed in the treated group. It seems that due to the low incidence of PCP in pemphigus patients treated with rituximab, prophylactic cotrimoxazole therapy is not necessary and it only increases the overall therapy cost and might cause cotrimoxazole-related adverse effects in some patients. However, regarding its probable beneficial effect in patients with long-term history of immunosuppressive therapy, more studies are required.
Clinical clearance of complex basal cell carcinoma in patients receiving sonidegib: A case series
Liang Joo Leow,Natalie Teh
doi : 10.1111/dth.15217
Volume 35, Issue 2 e15217
Basal cell carcinoma (BCC) is the most common cancer worldwide. While most BCC cases respond to surgical management, complex BCC often presents treatment challenges for patients unsuitable for, or refractory to, surgery and radiotherapy—limiting treatment options. Hedgehog pathway inhibitors (HHI) have emerged as an important treatment option for patients with complex BCC—providing a durable treatment modality and improved clinical outcomes. We present a case series of 10 patients with complex BCC treated with sonidegib, an oral HHI, at a dose of 200?mg once daily for a mean duration of 6 months and a mean follow-up of 7 months. Of these patients, sonidegib monotherapy was curative in eight cases. Of the remaining two patients, treatment with sonidegib arrested tumor progression and decreased tumor size to a point where surgical removal was straightforward. The positive treatment response we observed supports use of sonidegib as an effective treatment option for patients with complex BCC.
Cutaneous adverse events related to COVID-19 vaccines: A cross-sectional questionnaire-based study of 867 patients
Mohammad Reza Pourani,Mohammad Shahidi Dadras,Mehri Salari,Reem Diab,Nastaran Namazi,Fahimeh Abdollahimajd
doi : 10.1111/dth.15223
Volume 35, Issue 2 e15223
Considering the emergency approval of the Food and Drug Administration for widespread use of coronavirus disease 2019 (COVID-19) vaccines, evaluating potential vaccine-related adverse effects is critical as it will allow physicians to diagnose and manage these complications properly. In this descriptive cross-sectional questionnaire-based study, we evaluated the possible side effects of the COVID-19 vaccine from June 1, 2021 to June 21, 2021. The Iranian population is generally vaccinated with AstraZeneca, Sputnik V, Sinopharm, and Bharat vaccines. The continuous and categorical variables were described and data analyzed by the SPSS software version 25. Cutaneous reactions occurred in 30% of individuals vaccinated against COVID-19. The most common cutaneous complications were focal injection site reaction, exanthematous rash, and urticaria. There were infrequent cutaneous adverse events that included vesicular eruption, pernio-like lesions, angioedema, erythema multiforme-like eruption, and zoster. Acquainting physicians with COVID-19 vaccine-related cutaneous complications will assist them in detection and management. In addition, introducing these complications to individuals might improve acceptance of vaccine-related adverse effects in the general population.
Sleep loss and the skin: Possible effects of this stressful state on cutaneous regeneration during nocturnal dermatological treatment and related pathways
Ellen M. S. Xerfan,Monica L. Andersen,Anamaria S. Facina,Sergio Tufik,Jane Tomimori
doi : 10.1111/dth.15226
Volume 35, Issue 2 e15226
Cutaneous homeostasis can be modulated by sleep. Although there is little evidence about the efficacy of medications topically applied in the morning compared to those administered in the evening, they are commonly prescribed to be used overnight. Poor sleep may affect the tegument, but its repercussion on dermatological therapy is not clear. This communication aims to carry out an overview on the relationship between sleep and the skin, particularly in respect of the effectiveness of topical substances during the night versus the day; and the possible impact of sleep dysregulation on these treatments. Features related to this external organ, involving hydration, blood flow, and the permeability of the superficial barrier have physiological variations in sleep period. Our hypothesis is that sleep loss could alter drug absorption in the dermis and impair the success of the treatment. This can depend on the integrity of the mechanical skin barrier, and the enzymatic process after drug penetration, which may be influenced by the circadian rhythm. We raise the role of sleep disturbance in relation to skin aging and the cutaneous microbiota. The organ integrity and local immunology can be guided by sleep distress, which can modify the control of dermatological diseases. Future comparative analyses are warranted to explore the possible changes of the integumentary system influenced by circadian rhythm, and interference in response to topical dermal treatments. We emphasize the importance of sufficient sleep to improve the clinical management of several dermatosis and cosmetic complaints that need percutaneous therapeutics.
Anti-IL17 and anti-IL23 biologic drugs for scalp psoriasis: A single-center retrospective comparative study
Alessandra Narcisi,Mario Valenti,Andrea Cortese,Francesco Toso,Giulia Pavia,Luigi Gargiulo,Riccardo Borroni,Antonio Costanzo
doi : 10.1111/dth.15228
Volume 35, Issue 2 e15228
Scalp is a frequent localization of psoriasis that has a massive impact on patient's quality of life. Managing this psoriasis' manifestation is often challenging, thus biologic drugs are widely used as a treatment option in refractory scalp psoriasis. The aim of our study is to retrospectively compare the efficacy of anti-interleukin (IL) 23 drugs (guselkumab, tildrakizumab, risankizumab) and anti-IL17 or anti-IL17RA biologics (secukinumab, ixekizumab, and brodalumab) in real-life patients affected by scalp psoriasis. One hundred twenty-seven patients with a clinical diagnosis of scalp psoriasis and a baseline scalp Physician Global Assessment ?3 were enrolled; 65 patients were treated with anti-IL23 and anti-IL62 with anti-IL17 or anti-IL17RA. Statistical analysis trough ?2 test was performed in order to evaluate the percentage of response among the two groups of patients. Responders' percentage of patients under anti-IL23 was 41.5%, 75.4%, 88.1%, 87.5%, 93.7%, and 100% at Week 4, 16, 48, 96, and 144, respectively. In the group on anti-IL17 was 62.9%, 90.3%, 91.2%, 97.3%, 96.9%, and 95.2% at Week 4, 16, 48, 96, and 144, respectively. Both anti-IL17 and anti-IL23 appeared to be effective on scalp psoriasis; in particular patients treated with anti-IL17 drugs reached a faster significant reduction of the lesions; on the other hand, anti-IL23 monoclonal antibodies were slightly superior in maintaining the clinical improvement through the follow-up.
Effect of topical application of platelet-rich plasma on chronic venous leg ulcerations
Simon Bossart,S. Morteza Seyed Jafari,Mathias Lehmann,Andreas Jossi-Will,Esther Sane,Kristine Heidemeyer,Petra Schorno,Lorenzo Pelloni,Anna Rammlmair,Christoph Schlapbach
doi : 10.1111/dth.15236
Volume 35, Issue 2 e15236
Wound products that reliably support healing of chronic leg ulcers remain a huge unmet need in clinical practice. Due to the lack of standardized comparable protocols and different systems for platelet-rich plasma (PRP) preparation, there is limited data on healing rates in chronic venous ulcers. In our case series with a total of seven chronic leg ulcers in four patients, we investigated the healing rates based on standardized digital photographs of chronic venous ulcers after application of topical PRP using a digital imaging software. In 5 out of 7 ulcers, the PRP-treated wound half showed faster healing as compared the control half of the wound. In this case series, PRP-treated sides of chronic venous leg ulcers showed a tendency for accelerated healing as compared to nontreated collateral wound side. Our data support the evaluation of topical PRP treatment in the management of chronic venous leg ulcers.
Split-face comparative trial of 785-nm picosecond neodymium:yttrium-aluminum-garnet laser and precision cryotherapy combination treatment for facial benign pigmented lesions
Jae Wan Park,Hye Sung Han,Young Gue Koh,Suk Bae Seo,Gun-Ho Kim,Kui Young Park
doi : 10.1111/dth.15240
Volume 35, Issue 2 e15240
Cryotherapy (or cryosurgery) has been performed to treat various skin lesions in the field of dermatology; however, to the best of our knowledge, no study has investigated its efficacy and safety for benign pigmented lesions. Therefore, we conducted a split-face study to evaluate the efficacy and safety of cryotherapy in the treatment of benign pigmented lesions. A total of five subjects were included. Picosecond laser therapy was performed to treat the whole face and cryotherapy for half the face. Four weeks after completing the treatment sessions, patients showed more clinical improvement on the laser and cryotherapy combination treatment side than on the laser-only side, with no adverse events. Our study demonstrated that cryotherapy is a potential adjuvant therapeutic modality for benign pigmented lesions.
Frontal edema due to mesotherapy for androgenetic alopecia: A case series
Daniel Fernandes Melo,David Saceda-Corralo,Antonella Tosti,Flavia Weffort,Machado Carla Jorge,Claudia Carreira de Barros,Raquel de Melo Carvalho,Michela Starace
doi : 10.1111/dth.15247
Volume 35, Issue 2 e15247
Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy—or intradermotherapy—is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4?days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.
Multiple cycles of rituximab therapy for pemphigus: A group of patients with difficult- to-treat disease or a consequence of late rituximab initiation?
Kamran Balighi,Parvaneh Hatami,Mohammad Javad Sheikh Aboli,Maryam Daneshpazhooh,Maryam Ghiasi,Hamid Reza Mahmoudi,Zeinab Aryanian
doi : 10.1111/dth.15249
Volume 35, Issue 2 e15249
Pemphigus is a serious autoimmune disease with few appropriate therapeutic options. Although rituximab (RTX) has recently shown great promise in this regard, the best protocol of its administration is remains to be elucidated. This study aimed to evaluate the patients who need at least 3?cycles of treatment with RTX to identify hard-to-treat patients' characteristics, which might lead to consider more prompt protocols for treatment of them. A retrospective cross-sectional study was conducted on 45 patients with pemphigus vulgaris who received at least 3?cycles of RTX. Their demographic, clinical, and laboratory data as well as details of treatment protocol and final clinical situation of patients were evaluated. Totally, 45 patients (21 men and 24 women) with mean age of 44.33?years were included in this paper. Women were about 8?years older than men (mean age: 48.1?years versus 40.1?years, p: 0.011) and needed RTX approximately 2?years later in their course of disease (gap: 41.04 months vs. 14.85?months, p: 0.003). Buccal, truncal, and scalp regions were the most frequent sites of involvement respectively. A significant decrease in both anti-Dsg1, 3 was seen at last visit compared to baseline. However, the amount of this decrement was not significantly different between them (p: 0.083). Partial remission in 31.11%, complete remission in 24.44%, relapse in 15.56%, partial remission on treatment in 15.56% and complete remission on treatment in 13.33% were seen at the last follow-up session. RTX is an effective medication for PV even in patients with refractory disease and its therapeutic effect is increased with each subsequent cycle. Male gender, severe oral mucosal involvement on disease onset and extensive scalp and truncal lesions as first cutaneous manifestation of disease are more likely to be signs of refractory PV. Hence, it is reasonable to consider more prompt protocols for treatment of these cases. Moreover, late prescription of RTX during the course of disease might play a role in presence of more resistant form of disease.
Apremilast for the treatment of palmo-plantar non-pustular psoriasis: A real-life single-center retrospective study
Giulia Pavia,Luigi Gargiulo,Andrea Cortese,Mario Valenti,Federica Sanna,Riccardo G. Borroni,Antonio Costanzo,Alessandra Narcisi
doi : 10.1111/dth.15253
Volume 35, Issue 2 e15253
Palmoplantar psoriasis (PP) is a type of psoriasis that involves the skin of the palms and soles and can present as hyperkeratotic, similar to the vulgaris psoriasis of the body. Apremilast, as an oral inhibitor of phosphodiesterase 4 (PDE4), is currently approved for the treatment of psoriatic arthritis and for moderate-to-severe psoriasis in adult patients who have not responded or have contraindications or do not tolerate other systemic treatments. We evaluated the efficacy and safety of apremilast in the treatment of non-pustular palmo-plantar psoriasis in a cohort of 12 patients. We found a clinical response of clear/almost clear palmoplantar psoriasis (PPPGA score 0/1) in 83.33% of our patients, at week 16. No significant safety issues were reported and none of our patients had to discontinue the drug.
Psychodynamic approach in the treatment of trichotillomania
Erica L. Aukerman,Stacy Nakell,Mohammad Jafferany
doi : 10.1111/dth.15218
Volume 35, Issue 2 e15218
A toe ulcer in a patient with essential thrombocythemia successfully treated with a combination of anagrelide and prednisolone
Tatsuro Sugai,Yasuyuki Yamaguchi,Atsushi Narahira,Takuma Nohara,Hiroyuki Nakamura,Ko Ebata,Hideyuki Ujiie
doi : 10.1111/dth.15221
Volume 35, Issue 2 e15221
Pityriasis rosea after Moderna mRNA-1273 vaccine: A case series
Fabrizio Martora,Gabriella Fabbrocini,Claudio Marasca
doi : 10.1111/dth.15225
Volume 35, Issue 2 e15225
Patients' perception, and adherence to treatment with biosimilar adalimumab in psoriasis
Sahar Dadkhahfar,Laya Ohadi,Yasaman Rahimi,Reza M. Robati,Marjan Shekarabi,Omid Zargari,Mohammad Shahidi-Dadras
doi : 10.1111/dth.15227
Volume 35, Issue 2 e15227
From step flap to hatchet flap: How to change an ongoing reconstructive procedure
Imma Savarese,Diletta Bonciani,Laura Vanzi,Roberto Cecchi
doi : 10.1111/dth.15230
Volume 35, Issue 2 e15230
Linear IgA bullous dermatosis secondary to piperacillin-tazobactam
Emilio Garcia-Mouronte,Miguel Dominguez-Santas,Diego Bueno-Sacristan,Carlos Azcarraga-Llobet,Emilio de Dios Berna-Rico,Maria Belen de Nicolas-Ruanes,Carmen Moreno Garcia-del Real
doi : 10.1111/dth.15232
Volume 35, Issue 2 e15232
Long-standing recalcitrant subcorneal pustular dermatosis responding to topical mometasone furoate cream
Shyam B. Verma,Uwe Wollina
doi : 10.1111/dth.15235
Volume 35, Issue 2 e15235
Patient with atopic dermatitis, hyper IgE syndrome and ulcerative colitis, treated successfully with dupilumab during pregnancy
Inés Gracia-Darder,Jaime Pons De Ves,Miguel Reyero Cortina,Ana Martín-Santiago
doi : 10.1111/dth.15237
Volume 35, Issue 2 e15237
New-onset bullous pemphigoid after inactivated Covid-19 vaccine: Synergistic effect of the Covid-19 vaccine and vildagliptin
Ecem Bostan,Beril Yel,Neslihan Akdogan,Ozay Gokoz
doi : 10.1111/dth.15241
Volume 35, Issue 2 e15241
Anal and rectal locally advanced basal cell carcinoma treated with sonidegib
Claudio Conforti,Ludovica Toffoli,Ferruccio Degrassi,Nicola di Meo,Iris Zalaudek
doi : 10.1111/dth.15242
Volume 35, Issue 2 e15242
The treatment of refractory atypical bullous pemphigoid with generalized eczema and intense pruritus with dupilumab
Wei Li,Suiqing Cai,Xiaoyong Man
doi : 10.1111/dth.15243
Volume 35, Issue 2 e15243
The impact of COVID-19 pandemic on psoriasis patients in northern Greece
Zoe Apalla,Christina Fotiadou,Anastasia Emvalomati,Aikaterini Patsatsi,Myrto Trakatelli,Anastasia Trigoni,Athanassios Kyrgidis,Christina Trakatelli,Georgios Papazisis,Aimilios Lallas,Ourania Droggoula,Melpomeni-Maria Giannakaki,Valentina Oflidou,Styliani Siskou,Maria Boziou,Kalliopi Karydi,Athena Daponte,Christina Kemanetzi,Fragkiski Tsatsou,Eirini Kyrmanidou,Elizabeth Lazaridou
doi : 10.1111/dth.15244
Volume 35, Issue 2 e15244
Guselkumab does not appear to influence the IgG antibody response to SARS-CoV-2
Dillon Mintoff,Farida Benhadou
doi : 10.1111/dth.15246
Volume 35, Issue 2 e15246
Generalized granuloma annulare: Narrow-band UVB phototherapy combined with tacrolimus ointment
Edoardo Cammarata,Astrid Lappi,Stefania Nicola,Paolo Borrelli
doi : 10.1111/dth.15250
Volume 35, Issue 2 e15250
Papular acrodermatitis of childhood-like eruption triggered by SARS-CoV-2 vaccination: Report of two cases
Pablo Villagrasa-Boli,Juan Monte-Serrano,Sara Martínez-Cisneros,Miguel Fernando García-Gil,Alejandro Lapeña-Casado,Joana Cruañes-Monferrer,Andrea Montes-Torres,Mariano Ara-Martín
doi : 10.1111/dth.15252
Volume 35, Issue 2 e15252
Dupilumab-induced psoriasis in a patient with atopic dermatitis and alopecia totalis: A case report and literature review
Kelly E. Flanagan,Isabel M. Pupo Wiss,James T. Pathoulas,Chloe J. Walker,Maryanne M. Senna
doi : 10.1111/dth.15255
Volume 35, Issue 2 e15255
Pityriasis rosea like eruption: A dermatological manifestation of Coronavac-COVID-19 vaccine
Gözde Emel Gökçek,Eda Öksüm Solak,Emine Çölgeçen
doi : 10.1111/dth.15256
Volume 35, Issue 2 e15256
