DNA Damage and Somatic Mutations in Mammalian Cells After Irradiation With a Nail Polish Dryer Nature Communications

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• In this study, mammalian cell lines with acute or chronic exposure to ultraviolet (UV) nail polish dryers were found to have mutagenic and cytotoxic changes on in vitro clonal expansion models. Specifically, genomic profiling revealed higher levels of mutations in cells exposed to UV nail polish dryer, with C > A mutations being highly elevated compared with controls. These mutagenic changes were previously attributed to reactive oxygen species.
• UV nail polish dryers induce cytotoxic and mutagenic changes on in vitro cell line models and may cause cancers of the hand.

–  Kelly B. Scarberry, MD

Abstract

Ultraviolet A light is commonly emitted by UV-nail polish dryers with recent reports suggesting that long-term use may increase the risk for developing skin cancer. However, no experimental evaluation has been conducted to reveal the effect of radiation emitted by UV-nail polish dryers on mammalian cells. Here, we show that irradiation by a UV-nail polish dryer causes high levels of reactive oxygen species, consistent with 8-oxo-7,8-dihydroguanine damage and mitochondrial dysfunction. Analysis of somatic mutations reveals a dose-dependent increase of C:G>A:T substitutions in irradiated samples with mutagenic patterns similar to mutational signatures previously attributed to reactive oxygen species. In summary, this study demonstrates that radiation emitted by UV-nail polish dryers can both damage DNA and permanently engrave mutations on the genomes of primary mouse embryonic fibroblasts, human foreskin fibroblasts, and human epidermal keratinocytes.

Nature Communications

DNA damage and somatic mutations in mammalian cells after irradiation with a nail polish dryer

Nat Commun 2023 Jan 17;14(1)276, M Zhivagui, A Hoda, N Valenzuela, YY Yeh, J Dai, Y He, SP Nandi, B Otlu, B Van Houten, LB Alexandrov 

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Efficacy of Secukinumab in Patients With Moderate to Severe Hidradenitis Suppurativa

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• This study reporting the results from two randomised, placebo-controlled, phase III trials showed that patients with moderate to severe hidradenitis suppurativa receiving secukinumab 300 mg every 2 weeks had a greater hidradenitis suppurativa clinical response compared with those receiving placebo. Secukinumab 300 mg every 4 weeks met the clinical endpoint for hidradenitis suppurativa clinical response in only one of the trials. The improvement was sustained at 52 weeks. There were no new safety concerns for secukinumab identified during the trials.
• Secukinumab 300 mg every 2 weeks is more effective than placebo for the treatment of patients with moderate to severe hidradenitis suppurativa.

–  Kelly B. Scarberry, MD

Abstract

BACKGROUND

Few therapeutic options are available for patients with moderate-to-severe hidradenitis suppurativa. We aimed to assess the efficacy of secukinumab in patients with moderate-to-severe hidradenitis suppurativa in two randomised trials.

METHODS

SUNSHINE and SUNRISE were identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials done in 219 primary sites in 40 countries. Patients aged 18 years old or older with the capacity to provide written informed consent and with moderate-to-severe hidradenitis suppurativa (defined as a total of ≥5 inflammatory lesions affecting ≥2 distinct anatomical areas) for at least 1 year were eligible for inclusion. Included patients also agreed to daily use of topical over-the-counter antiseptics on the areas affected by hidradenitis suppurativa lesions while on study treatment. Patients were excluded if they had 20 or more fistulae at baseline, had ongoing active conditions requiring treatment with prohibited medication (eg, systemic biological immunomodulating treatment, live vaccines, or other investigational treatments), or met other exclusion criteria. In both trials, patients were randomly assigned (1:1:1) by means of interactive response technology to receive subcutaneous secukinumab 300 mg every 2 weeks, subcutaneous secukinumab 300 mg every 4 weeks, or subcutaneous placebo all via a 2 mL prefilled syringe in a double-dummy method as per treatment assignment. The primary endpoint was the proportion of patients with a hidradenitis suppurativa clinical response, defined as a decrease in abscess and inflammatory nodule count by 50% or more with no increase in the number of abscesses or in the number of draining fistulae compared with baseline, at week 16, assessed in the overall population. Hidradenitis suppurativa clinical response was calculated based on the number of abscesses, inflammatory nodules, draining fistulae, total fistulae, and other lesions in the hidradenitis suppurativa affected areas. Safety was assessed by evaluating the presence of adverse events and serious adverse events according to common terminology criteria for adverse events, which were coded using Medical Dictionary for Regulatory Activities terminology. Both the SUNSHINE, NCT03713619, and SUNRISE, NCT03713632, trials are registered with ClinicalTrials.gov.

FINDINGS

Between Jan 31, 2019, and June 7, 2021, 676 patients were screened for inclusion in the SUNSHINE trial, of whom 541 (80%; 304 [56%] women and 237 [44%] men; mean age 36·1 years [SD 11·7]) were included in the analysis (181 [33%] in the secukinumab every 2 weeks group, 180 [33%] in the secukinumab every 4 weeks group, and 180 [33%] in the placebo group). Between the same recruitment dates, 687 patients were screened for inclusion in the SUNRISE trial, of whom 543 (79%; 306 [56%] women and 237 [44%] men; mean age 36·3 [11·4] years) were included in the analysis (180 [33%] in the secukinumab every 2 weeks group, 180 [33%] in the secukinumab every 4 weeks group, and 183 [34%] in the placebo group). In the SUNSHINE trial, significantly more patients in the secukinumab every 2 weeks group had a hidradenitis suppurativa clinical response (rounded average number of patients with response in 100 imputations, 81·5 [45%] of 181 patients) compared with the placebo group (60·7 [34%] of 180 patients; odds ratio 1·8 [95% CI 1·1-2·7]; p=0·0070). However, there was no significant difference between the number of patients in the secukinumab every 4 weeks group (75·2 [42%] of 180 patients) and the placebo group (1·5 [1·0-2·3]; p=0·042). Compared with the placebo group (57·1 [31%] of 183 patients), significantly more patients in the secukinumab every 2 weeks group (76·2 [42%] of 180 patients; 1·6 [1·1-2·6]; p=0·015) and the secukinumab every 4 weeks group (83·1 [46%] of 180 patients; 1·9 [1·2-3·0]; p=0·0022) had a hidradenitis suppurativa clinical response in the SUNRISE trial. Patient responses were sustained up to the end of the trials at week 52. The most common adverse event by preferred term up to week 16 was headache in both the SUNSHINE (17 [9%] patients in the secukinumab every 2 weeks group, 20 [11%] in the secukinumab every 4 weeks group, and 14 [8%] in the placebo group) and SUNRISE (21 [12%] patients in the secukinumab every 2 weeks group, 17 [9%] in the secukinumab every 4 weeks group, and 15 [8%] in the placebo group) trials. No study-related deaths were reported up to week 16. The safety profile of secukinumab in both trials was consistent with that previously reported, with no new or unexpected safety findings detected.

INTERPRETATION

When given every 2 weeks, secukinumab was clinically effective at rapidly improving signs and symptoms of hidradenitis suppurativa with a favourable safety profile and with sustained response up to 52 weeks of treatment.

The Lancet

Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials

Lancet 2023 Feb 03;[EPub Ahead of Print], AB Kimball, GBE Jemec, A Alavi, Z Reguiai, AB Gottlieb, FG Bechara, C Paul, EJ Giamarellos Bourboulis, AP Villani, A Schwinn, F Ruëff, L Pillay Ramaya, A Reich, I Lobo, R Sinclair, T Passeron, A Martorell, P Mendes-Bastos, G Kokolakis, PA Becherel, MB Wozniak, AL Martinez, X Wei, L Uhlmann, A Passera, D Keefe, R Martin, C Field, L Chen, M Vandemeulebroecke, S Ravichandran, E Muscianisi 

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Long-Term Efficacy and Safety of 1% Glycopyrronium Bromide Cream in Patients With Severe Primary Axillary Hyperhidrosis

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• In this long-term, open-label, phase IIIb study, 518 patients with primary axillary hyperhidrosis (PAHH) were treated with topical 1% glycopyrronium bromide (GPB) cream once daily for 4 weeks and then a minimum of twice weekly for the remaining 72 weeks. A significant reduction in sweat production was noted at week 12 compared with the baseline measures. The quality-of-life measures were significantly improved throughout the study compared with the baseline measures. Overall, GPB cream was well-tolerated, with dry mouth being the most commonly reported adverse event.
• Topical 1% GPB cream has the potential to be a more cost-effective alternative to glycopyrronium tosylate wipes in the US for the treatment of patients with PAHH.

–  Ruth McTighe, MD

Abstract

BACKGROUND

Primary axillary hyperhidrosis (PAHH) strongly affects the patient's quality of life. To date, topical treatment options are limited. One percent glycopyrronium bromide (GPB) showed promising efficacy and safety in a pivotal 4-week Phase 3a study.

OBJECTIVES

To assess efficacy and safety of topical 1% GPB cream in patients with severe PAHH in a long-term study of 72 weeks versus baseline.

METHODS

This was a long-term, open-label, Phase 3b trial for 72 weeks including 518 patients with severe PAHH. Patients were treated with 1% GPB cream once daily for 4 weeks, followed by a flexible dosing scheme (min. twice per week, max. once daily). Primary endpoint was the absolute change in sweat production from baseline to week 12. Further study endpoints included assessment of the severity of PAHH and the impact on quality of life.

RESULTS

Total median sweat production decreased by 119.30 mg (-65.6%, both median) until week 12. Absolute change in sweat production from baseline to week 12 in logarithmic values was statistically significant (p < 0.0001). Patients' quality of life was improved at all study time points compared to baseline, as assessed by Hyperhidrosis Quality of Life Index and Dermatology Life Quality Index (p < 0.0001). Treatment was safe and locally well-tolerated with only few mild to moderate adverse drug reactions (ADRs). Dry mouth and application site erythema were the most common reported ADRs.

CONCLUSIONS

Treatment with 1% GPB cream over 72 weeks significantly reduces sweat production and improves quality of life in patients with severe PAHH. One percent GPB cream is well-tolerated and provides an effective treatment option for long-term use in patients with severe PAHH.

Journal of the European Academy of Dermatology and Venereology: JEADV

Long-term efficacy and safety of 1% glycopyrronium bromide cream in patients with severe primary axillary hyperhidrosis: Results from a Phase 3b trial

J Eur Acad Dermatol Venereol 2023 Jan 06;[EPub Ahead of Print], RM Szeimies, C Abels, A Kilic, H Reich, B Berger, E Schulze Zur Wiesche, K Schramm, L Litzka, S Heimstaedt-Muskett, C Masur 

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DPP4 Inhibitors Confer Increased Odds of Bullous Pemphigoid Even Years After Drug Initiation in Patients With Diabetes

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• The authors of this population-based nested case–control study found that patients with diabetes exposed to DPP4 inhibitors had an 80% increased odds of developing bullous pemphigoid (BP) compared with those not exposed. BP was most likely to develop 1 to 2 years after drug initiation, but DPP4 inhibitor use was associated with BP development even after 6 or more years following drug initiation. Patients with diabetes exposed to DPP4 inhibitors who developed BP were more likely to be hospitalized and had more outpatient dermatologist visits than those with BP who were not exposed.
• These findings indicate that patients with diabetes exposed to DPP4 inhibitors are at an increased risk of developing BP and that BP commonly occurs years after drug initiation.

–  Kelly B. Scarberry, MD

Abstract

The timing pattern in which dipeptidyl-peptidase IV inhibitors (DPP4i) confer the risk of bullous pemphigoid (BP) is unknown. To investigate the odds of BP following exposure to DPP4i and to perform a duration-response analysis evaluating the risk of BP in relation to the duration of exposure to the culprit drug. A population-based nested case-control study was performed comparing diabetic patients with BP (n = 1458) with age-, sex- and ethnicity-matched diabetic control subjects (n = 6051) with respect to the prevalence of exposure to DPP4i. Adjusted odds ratios (ORs) were estimated by logistic regression. Overall exposure to DPP4i was associated with an 80% increase in the odds of subsequent BP (OR, 1.81; 95% CI, 1.46-2.08; P < 0.001). In an intraclass analysis, the odds of BP were increased in association with vildagliptin (OR, 3.40; 95% CI, 2.69-4.29; P < 0.001) and sitagliptin (OR, 1.56; 95% CI, 1.33-1.84; P < 0.001). In a duration-response analysis, the highest likelihood of BP was found 1-2 years after commencing the drug (OR, 2.66; 95% CI, 1.97-3.59; P < 0.001). The odds of BP were increased across all time periods and retained its statistical significance even ≥ 6 years after the drug initiation (OR, 1.44; 95% CI, 1.09-1.91; P = 0.011). Relative to other diabetic patients with BP, patients with DPP4i-associated BP were more likely to be admitted to inpatient dermatologic wards (OR, 1.66; 95% CI, 1.30-2.13; P < 0.001) and had higher mean(SD) numbers of outpatient dermatologist visits (14.7[14.8] vs. 12.3[13.2], respectively; P = 0.006). DPP4i should be suspected as a predisposing factor for BP even numerous years after the drug initiation.

Archives of Dermatological Research

Dipeptidyl-peptidase IV inhibitor (DPP4i) confers increased odds of bullous pemphigoid even years after drug initiation

Arch Dermatol Res 2023 Jan 01;315(1)33-39, K Kridin, O Avni, G Damiani, D Tzur Bitan, E Onn, O Weinstein, AD Cohen 

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Characteristics, Detection, and Prevalence of Lanolin-Induced Contact Dermatitis

TAKE-HOME MESSAGE

• Lanolin, a complex mixture used frequently for its emollient properties, is a weak sensitizer, with an estimated 0.4% of the European population demonstrating contact allergy to it. Despite this low prevalence, certain patients are susceptible to lanolin contact allergy, including the young and elderly and those with stasis dermatitis, leg ulcers, perianal/genital dermatitis, or atopic dermatitis. Lanolin may produce a false-negative patch test in these patients when it is tested on normal skin.
• Lanolin is the contact allergen of the year, and special considerations need to be taken when patch testing for lanolin contact allergy.

Abstract

Lanolin is a complex mixture of high molecular weight esters, aliphatic alcohols, sterols, fatty acids, and hydrocarbons that has been widely used for centuries for its emollient properties. The purification of crude lanolin into lanolin wax and the processing of this wax into various derivatives began in 1882 and continue to this day with newer highly purified anhydrous lanolins. Controversy as to lanolin's allergenicity began in the 1920s and remains an issue. The most appropriate patch test preparation(s) for detecting allergy remain disputed. Detection of lanolin-induced contact dermatitis in diseased skin by patch testing on normal skin may lead to false negative results. Patients with a positive patch test to lanolin may tolerate use of lanolin on normal skin. Although lanolin is a weak sensitizer and the frequency of contact allergy to it in the European population reportedly is 0.4%, there are high-risk concomitant conditions: stasis dermatitis, leg ulcers, perianal/genital dermatitis, and atopic dermatitis (AD). Children and the elderly are also at greater risk of developing contact allergy to lanolin, partly because of comorbidities (AD and stasis dermatitis/leg ulcers, respectively). Finally, in the United States, non-Hispanic white patients are more likely than their non-Hispanic black counterparts to be lanolin allergic.

Dermatitis

Lanolin

Dermatitis 2023 Jan 11;34(1)4-12, BA Jenkins, DV Belsito 

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Skin Care Physicians of Costa Rica

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Surgical Techniques and Presurgical Mapping of Lentigo Maligna and Lentigo Maligna Melanoma by Reflectance Confocal Microscopy

Abstract

Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non-Randomized Studies instrument. Meta-analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline-recommended margin was insufficient in 21.6%-44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%-1.9%), and highest for WLE (13%; 95% CI, 7.2%-21.6%). The mean follow-up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld-RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma-associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH-RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.

Journal of the European Academy of Dermatology and Venereology: JEADV

Lentigo maligna (melanoma): A systematic review and meta-analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy

J Eur Acad Dermatol Venereol 2023 Jan 18;[EPub Ahead of Print], YS Elshot, DCKS Tio, ASE van Haersma-de With, W Ouwerkerk, B Zupan-Kajcovski, MB Crijns, CEJM Limpens, WMC Klop, MW Bekkenk, AJM Balm, MA de Rie 

Written by

 

 

Jane Grant-Kels MD

A group from predominantly the University of Amsterdam undertook a MEDLINE, Embase, and PubMed database search through May 2022 of the different surgical techniques used in the treatment of lentigo maligna (melanoma; LM/LMM). Additionally, they investigated clinicians who employed handheld reflectance confocal microscopy (RCM) pre-op to determine LM/LMM margination. The outcomes they evaluated were local recurrences and survival. A total of 41 studies were included involving 5059 LM and 1271 LMM; surgical techniques included wide local excision (WLE) and staged excision and Mohs' micrographic surgery (MSS). Only 6 studies included pre-op RCM to determine lateral margins of the LM/LMM.

They found the following:

• The guideline-recommended margin was insufficient in 21.6%–44.6% of LM/LMM cases.
• The local recurrence rate was the lowest for patients treated by MMS combined with immunohistochemistry.
• The local recurrence rate was the highest for WLE.
• Handheld RCM decreased the rate of positive histological margins with MMS or WLE and decreased the number of surgical stages required for MMS.
• Most regional and distant recurrences developed in patients treated by WLE.

The authors concluded that there was a clear reduction in local recurrences using MMS over WLE and that the pre-op use of handheld RCM showed a trend in the reduction of incomplete resections and local recurrences even when used with WLE.

MMS, especially with the use of immunohistochemistry, is now considered the best practice for LM/LMM when available as it has been demonstrated to reduce recurrences. Better presurgical planning with the pre-op use of handheld RCM to evaluate the lateral extension of the neoplasm has also been documented to reduce the number of stages needed during the Mohs procedure, time to closure, and recurrences. The authors of this study, however, did not discuss what protocol or how the handheld RCM was employed to determine the melanoma lateral margins. Unfortunately, the authors did not make note of the fact that many institutions did not have RCM available, the use of RCM for lateral margin determination could be very time-consuming, and the interpretation of the images required significant training. As an admitted confocal enthusiast, I am hopeful that the availability of the technology and training needed for interpretation will be addressed and corrected in the next few years as science continues to demonstrate how helpful RCM can be in the care of our patients.

I am optimistic that articles like this one will stimulate more Mohs surgeons to obtain a confocal and learn how to read RCM stacks and mosaics. In my opinion, the use of RCM will replace many biopsies, avoiding unnecessary biopsies of benign lesions and allowing patients to go directly to definitive surgery and only undergo one procedure when appropriate. In addition, RCM will help our surgeons better establish the lateral margins of tumors prior to surgery, which will enhance the likelihood of one excision and/or avoid the need for more than one or two Mohs stages. This prediction would result in less surgery for patients (with reduced morbidity) and significant savings to the healthcare system.

TAKE-HOME MESSAGE

• The authors of this systematic review and meta-analysis of 41 studies, including 5059 cases of lentigo maligna (LM) and 1271 cases of LM melanoma (LMM), found that Mohs micrographic surgery (MMS) with immunohistochemistry (IHC) had the lowest recurrence rate (<1%) out of all the examined surgical techniques. Five of the included studies examined hand-held reflectance confocal microscopy (HH-RCM) and showed that its use decreased the positive margin and local recurrence rates, even when used with wide local excision.
• MMS with IHC and HH-RCM for presurgical mapping, when feasible, allow for a lower risk of local recurrence when excising LM/LMM.

–  Ruth McTighe, MD

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Safety and Efficacy of Dupilumab in Adults With Atopic Dermatitis

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• This study involving 347 patients with moderate to severe atopic dermatitis (AD) treated with dupilumab found that the median Eczema Area and Severity Index (EASI) score decreased from 18 at baseline (week 4) to 2 at week 52. This improvement continued through 104 weeks (median EASI, 1.7). However, two-thirds of the patients had persistence of head-and-neck lesions at week 104. Unsurprisingly, conjunctivitis was the most common adverse event, affecting 25% of the study participants.
• Dermatologists should be aware that dupilumab might not prove as effective at treating head-and-neck dermatitis as AD in other locations.

–  Ruth McTighe, MD

Written by

 

 

Robert Sidbury MD, MPH

Phase III trials demonstrate safety and efficacy of new therapies over a circumscribed study period, often 12–16 weeks for dermatologic medications. We must, however, rely on post-marketing investigation to paint a more realistic portrait of real-life risks and benefits. Vittrup and colleagues assessed a Danish cohort of 347 adults with atopic dermatitis followed for up to 104 weeks to address some of these issues relating to dupilumab.

First, Eczema Area and Severity Index (EASI) scores continued to improve throughout the study period, with a mean baseline EASI of 18 (10.6–25.12), 3.7 (1.2–6.2) at 1 year, and 2.0 (0.8–3.6) at 2 years. Patients should know that improvement is most dramatic during the first 4 to 16 weeks, but gains may yet occur and effects are durable. Second, dupilumab is not a good medication for everyone with atopic dermatitis. Nearly 5% dropped out due to adverse effects (25% developed conjunctivitis first presenting at a mean of 201 days) and 2% due to lack of efficacy. Third, there were no new safety signals. Finally, and perhaps most intriguingly, a striking percentage of patients with head and neck dermatitis reported refractoriness to dupilumab (76% reported head and neck dermatitis at baseline vs 68% at 2 years). New-onset facial erythema, a vexing adverse effect reported in some dupilumab-treated patients, was rarely seen in this cohort.

As new medications for atopic dermatitis come online — three have been approved in the past year alone — providers will have an abundance of choices, previously unheard of in AD therapy.  Shared decision–making must take into consideration individual patient characteristics to optimally match patient and therapy. Granular analysis of this sort will lead the way

Abstract

BACKGROUND

Evaluation of effectiveness and safety of new systemic treatments for atopic dermatitis (AD) after approval is important. There are few published data exceeding 52-week therapy with dupilumab.

OBJECTIVES

To examine the safety, effectiveness and drug survival of dupilumab in a Danish nationwide cohort with moderate-to-severe AD up to 104 weeks exposure.

METHODS

We included 347 adult patients with AD who were treated with dupilumab and registered in the SCRATCH registry during 2017-2022.

RESULTS

At all visits, we observed improvement in AD severity measured by Eczema Area and Severity Index (EASI) [median (IQR)]. EASI score at baseline was 18.0 (10.6-25.2), at week 4: 6.5 (3.5-11.6), at week 16: 3.7 (1.2-6.2), at week 52: 2.0 (0.8-3.6), at week 104: 1.7 (0.8-3.8). While drug survival was high (week 52: 90%; week 104: 86%), AD in the head-and-neck area remained present in most patients at high levels; proportion with head-and-neck AD at baseline was 76% and 68% at week 104. 35% of patients reported any AE. Conjunctivitis was the most frequent (25% of all patients) and median time to first registration of conjunctivitis was 201 days.

CONCLUSIONS

While 2-year drug survival was 86%, dupilumab was unable to effectively treat AD in the head-and-neck area, and conjunctivitis was found in 25% of patients.

Journal of the European Academy of Dermatology and Venereology: JEADV

A nationwide 104 weeks real-world study of dupilumab in adults with atopic dermatitis: Ineffectiveness in head-and-neck dermatitis

J Eur Acad Dermatol Venereol 2023 Jan 06;[EPub Ahead of Print], I Vittrup, NS Krogh, HHP Larsen, J Elberling, L Skov, KS Ibler, GBE Jemec, CG Mortz, RO Bach, C Bindslev-Jensen, MG Dalager, A Egeberg, T Agner, M Deleuran, C Vestergaard, JP Thyssen 

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Prenatal Maternal Risk Factors Contributing to Atopic Dermatitis: A Systematic Review and Meta-Analysis of Cohort Studies

The researchers found that gestational diabetes, maternal history of allergy, and prenatal history of eczema (odds ratios, 7.2, 2.14, and 2.46, respectively) were major determining nonmodifiable risk factors in early manifestation of AD in children. Leading causes of early AD manifestation also included maternal exposure to industrial products, exposure to antibiotics during pregnancy, and passive smoking during pregnancy (odds ratios, 1.89, 3.59, and 2.60, respectively).

"Both genetic and environmental factors play a pivotal role in early manifestation of AD," the authors write. "Further studies are required [to] clarify the mechanisms and ways to manage the modifiable factors to the least."

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Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis

TAKE-HOME MESSAGE

• This systematic review investigated the parameters of treatment that are important to caregivers and patients with atopic dermatitis. The key themes identified included concerns about adverse effects, relief from itching, a preference for nonprescription therapy, and a preference for a strong doctor–patient relationship.
• This study identifies six key themes that patients and their caregivers value regarding the treatment of atopic dermatitis.

–  Joshua R. Ortego, MD

Written by

 

 

Sarah L. Chamlin MD

Patient and caregiver preferences guide our daily practice but are rarely incorporated into clinical practice guidelines.  This systematic review evaluated patient and caregiver preferences for atopic dermatitis (AD) treatment and identified 62 eligible studies for inclusion.  Six themes were identified and include preference for treatments that have minimal effect on quality of life, preference for relief of itching and burning, fear and concern about adverse events, improved adherence with a strong patient-clinician relationship, preference for minimal topical corticosteroids and preference to start with nonprescription, natural treatments.  The authors suggest that these themes can inform future guidelines and studies. 

Sadly, patient and caregiver preferences for AD therapy are poorly matched with the reality of effectively AD therapy.  Corticosteroid phobia remains rampant, and the ongoing search for a natural remedy has persisted for decades.  Thankfully, a strong patient-clinician relationship emerged as an important theme.  Shared decision that includes education and empathetic counseling about risks and benefits of treatments likely improves outcomes for our suffering AD patients and may even increase our own job satisfaction. 

Abstract 

IMPORTANCE

Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available.

OBJECTIVE

To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized.

EVIDENCE REVIEW

Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence.

FINDINGS

A total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias.

CONCLUSIONS AND RELEVANCE

In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.

JAMA Dermatology

Values and Preferences of Patients and Caregivers Regarding Treatment of Atopic Dermatitis (Eczema): A Systematic Review

JAMA Dermatol 2023 Jan 25;[EPub Ahead of Print], KA Maleki-Yazdi, AF Heen, IX Zhao, GH Guyatt, EA Suzumura, N Makhdami, L Chen, T Winders, KE Wheeler, J Wang, J Spergel, JI Silverberg, PY Ong, M O'Brien, SA Martin, PA Lio, ML Lind, J LeBovidge, E Kim, J Huynh, M Greenhawt, WT Frazier, K Ellison, K Capozza, A De Benedetto, M Boguniewicz, WS Begolka, RN Asiniwasis, LC Schneider, DK Chu 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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a mobile device.

Clinicophotobiological Characterization of Photoaggravated Atopic Dermatitis

Abstract

IMPORTANCE

Photoaggravated atopic dermatitis (PAD) is estimated to affect 1.4% to 16% of patients with AD but remains poorly characterized with limited published data.

OBJECTIVE

To provide detailed clinical and photobiological characterization of PAD.

DESIGN, SETTING, AND PARTICIPANTS

This case series study used cross-sectional data collected from 120 consecutive patients diagnosed with PAD from January 2015 to October 2019 at a tertiary center referral unit for photobiology.

MAIN OUTCOMES AND MEASURES

Routinely collected standardized clinical and photobiological data were analyzed using descriptive statistics, and regression analysis explored associations between demographic and clinical data.

RESULTS

Of 869 patients who underwent photoinvestigation, 120 (14%) were diagnosed with PAD (69 female [58%]; median age, 45 [IQR, 31-61] years; range, 5-83 years; skin phototypes [SPTs] I-VI). Of these patients, 104 (87%) were adults. All patients had a history of AD, and most (62 of 104 [60%]) presented with sunlight-provoked or photodistributed eczema; median age at photosensitivity onset was 37 years (range, 1-72 years). Past-year Dermatology Life Quality Index score was greater than 10 for 80 of 103 adults (78%), and 82 of 119 (69%) had vitamin D (25-hydroxyvitamin D) level insufficiency or deficiency (<20 ng/mL; to convert ng/mL to nmol/L, multiply by 2.496). Broadband UV radiation provocation test results were positive for 112 patients (93%). In 28 patients (23%) with abnormal monochromator phototest findings, sensitivity occurred to UV-A, UV-B, and/or visible light, and UV-A of 350 ± 10 nm was the most prevalent wavelength. Photopatch test reactions were positive for 18 patients (15%). Patients with SPTs V to VI (31 [26%]) vs SPTs I to IV (89 [74%]) were younger at photosensitivity onset (median age, 24 years [IQR, 15-37 years] vs 40 years [IQR, 25-55 years]; P = .003), were more likely to be female (23 [74%] vs 46 [52%]; P = .03), and had a lower vitamin D status and a higher frequency of abnormal monochromator phototest findings.

CONCLUSIONS AND RELEVANCE

In this case series study, PAD affected patients with different ages and SPTs and was associated with substantially impaired quality of life. The findings suggest that confirming PAD through phototesting may provide better personalized care for patients through identification of provoking wavelengths, relevant photocontact allergies, and appropriate photoprotection advice.

TAKE-HOME MESSAGE

• This case series characterizes the clinical traits of patients with photoaggravated atopic dermatitis (PAD). A total of 869 patients underwent photoinvestigation, with 120 patients (14%) ultimately being diagnosed with PAD. The patients tended to report seasonal worsening of eczema, photodistributed exacerbations, or sunlight-provoked rash.

• Understanding the signs and symptoms of PAD can help clinicians diagnose and treat patients with this rare subtype of atopic dermatitis.

–  Joshua R. Ortego, MD

JAMA Dermatology

Clinicophotobiological Characterization of Photoaggravated Atopic Dermatitis

JAMA Dermatol 2022 Jul 27;[EPub Ahead of Print], KJ Rutter, MD Farrar, EJ Marjanovic, LE Rhodes 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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a mobile device.

What role does diet play in rosacea?

With conflicting information regarding whether certain foods or supplements may alleviate or trigger rosacea symptoms, authors of a review published in the Journal of Clinical and Aesthetic Dermatology sought to provide an up-to-date review of the evidence on the relationship between diet and rosacea. 

The review found that omega-3 fatty acids, probiotics and prebiotics, and dairy were shown to have potential benefits for patients. Spicy foods, alcohol, fatty foods, histamine (dried fruits, shellfish, aged cheese, avocados, processed meats) and cinnamaldehyde (chocolate, citrus fruits, tomatoes) may potentially trigger rosacea symptoms. While several types of foods appear to be associated with exacerbation of rosacea, there are no recommendations that can be applied to all patients, the authors conclude. 

Researchers describe various treatments currently available to manage rosacea. Read more.

Related content:

• Can proteasome inhibitors effectively treat rosacea? – DermWorld (October 2021)

• Refocusing on rosacea – DermWorld (December 2018)

• For your patients: How to prevent rosacea flare-ups

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.