Search Results for "Autoimmune Disorders"
J Drugs Dermatol. 2011;10(11):1328-1330.
Stephanie A. Steinweg BSa and Anthony A. Gaspari MDb| |
Severe Autoimmune Adverse Events Post Herpes Zoster Vaccine: A Case-Control Study of Adverse Events in a National Database
Yi Chun Lai BSa and Yik Weng Yew MBBS MPHa,b| |
J Drugs Dermatol. 2015;14(7):681-684.
Joseph Lillis BA, Roger I. Ceilley MD, Paula Nelson RN| |
Autoimmune Progesterone Dermatitis: A Diagnosis to Consider in a Patient With Cyclical Cutaneous Eruptions
Alexa B. Steuer MPH,a,b Sharon Scherl MD,c and Robin Ashinoff MDb,d| |
J Drugs Dermatol. 2017;16(10):1040-1042.
Grace Sun MD, Carina A. Wasko MD, Sylvia Hsu MD| |
Michael Lundin BS,a Simran Chawa BS,a Amit Sachdev MD,b Dhaval Bhanusali MD,c Kristina Seiffert-Sinha MD,d Animesh A. Sinha MD PhDd| |
J Drugs Dermatol. 2014;13(4):409-413.
Asra Ali MD and John M. Martin IV MD| |
Scoping Scalp Disorders: Practical Use of a Novel Dermatoscope to Diagnose Hair and Scalp Conditions
Nicole E. Rogers MD| |
OBJECTIVE: This paper will show how the Canfield DermScope can quickly and easily identify various nonscarring and scarring scalp disorders. Its open design does not change the direction of affected hairs or blanch certain features such as erythema. Features like perifollicular hyperkeratosis and loss of follicular orifices are still easily visible.
METHODS and MATERIALS: The author prospectively photographed patients with hair and scalp disorders in private practice between 2011 to 2012 using the handheld Canfield DermScope device.
RESULTS: The presence of scale, erythema, tufting, miniaturized or broken hairs, and loss of follicular orifices were quickly identified to make a diagnosis.
CONCLUSION: The diagnosis of hair and scalp disorders can be greatly facilitated by the use of the DermScope device.
J Drugs Dermatol. 2013;12(3):283-290.
Sahar Y. Naseer MS,a Liza Gill BS,b Jay Shah MD,b and Animesh A. Sinha MD PhDa| |
J Drugs Dermatol. 2014;13(10):1225-1230.
Increased Prevalence of Psychiatric Disorders and Health Care-Associated Costs Among Patients With Moderate-to-Severe Psoriasis
Methods: In a retrospective, matched case-control study, data for services from nearly 75 health care plans in the United States (U.S.) were collected from PharMetrics Patient Centric Database using International Classification of Diseases, Ninth Revision Clinical Modification codes, identifying a total of 39,855 adults with moderate-to-severe psoriasis (n=7,971) and without (controls; n=31,884). Patients with psoriasis had at least one psoriasis health care claim and received at least one medical/prescription treatment claim within two consecutive years. Psychiatric comorbidities and treatments among patients and controls were determined by claims. Annual inpatient, outpatient, emergency room, and prescription costs for those with and without psoriasis and those with and without psychiatric disorders were compared.
Results: Patients had significantly higher prevalence of anxiety (6.9% versus 4.4%), depression (9.2% versus 5.3%), bipolar disorder (1.1% versus 0.5%), or delirium (0.3% versus 0.1%; P<0.05) than controls (others P<0.0001). Significantly higher proportions of patients with psoriasis received antidepressants (6.1% versus 0.9%), anxiolytics (5.0% versus 0.8%), or antipsychotics (5.9% versus 0.9%) compared with controls (each P<0.0001). Total health care costs for patients with psoriasis (US $11, 369.47) were significantly higher than for controls ($3,427.60; P<0.001). Psoriasis patients with psychiatric disorders had significantly higher health care costs ($17,637.66) than those without psychiatric disorders ($10,362.80; P<0.001).
Conclusion: The prevalence of psychiatric disorders is higher in patients with moderate-to-severe psoriasis than in controls. Annual health care costs are higher in psoriasis patients with psychiatric disorders than in those without psychiatric disorders.
J Drugs Dermatol. 2011;10(8):843-850.
Frank Martiniuk PhD, David S. Lee MD, Anthony Gaspari MD, Herman Yee MD PhD, Luis Chiriboga PhD, Maryann Huie PhD, Kam-Meng Tchou-Wong PhD, and William R. Levis MD| |
Monica B. Schadlow, MD; Grant J. Anhalt, MD and Animesh A. Sinha, Md, PhD| |
Faris Azzouni MD,a Nathalie Zeitouni MD PhD,b and James Mohler MDa| |
J Drugs Dermatol. 2013;12(2):e30-e35.
J Drugs Dermatol. 2012;11(10):1166-1173.
Ashley Walker DO, Rupa Reddy DO,a Stanley Skopit DO MSEa| |
Kelley Pagliai Redbord MD, C. William Hanke MD| |
Development of Subacute Cutaneous Lupus Erythematosus Associated With the Use of Imiquimod to Treat Actinic Keratoses
Thomas J. Burnett MD, Joseph C. English III MD, Laura Korb Ferris MD PhD| |
Jashin J. Wu MDa and Young M. Choi BS| |
Jonathan R. Van Meter MD, Tami B. Cassis MD, Jeffrey P. Callen MD, Soon Bahrami MD| |
David A. Sanchez BS,a,e Joshua D. Nosanchuk MD,b,c and Adam J. Friedman MDa,d,| |
J Drugs Dermatol. 2015;14(2):127-130.
Rachel Seidel,b.c Nicolette Lavi,c and Lisa Chipps MD MSa,c| |
CASE: A woman in her second trimester presented with an intensely pruritic vesiculobullous rash diagnosed as PG. She was started on prednisone and gradually tapered to an appropriate maintenance dose until her uncomplicated delivery of a full-term healthy newborn.
CONCLUSION: Proper management of PG requires a suitable pharmacotherapy regimen, close observation, and collaboration with a multi-disciplinary treatment team. These steps are crucial to reduce maternal morbidity, lessen fetal risk, and adequately prepare for the possibility of unfavorable obstetric outcomes.
J Drugs Dermatol. 2015;14(8):904-907.
John B. Stephens MDand Michael G. Wilkerson MD| |
J Drugs Dermatol. 2011;10(2):202-205.
Lawrence Transfer Factor: Transference of Specifc Immune Memory by Dialyzable Leukocyte Extract from a CD8+ T Cell Line
Jason F. Wang BA,a Andrew J. Park BA,b Tina Rendini RN,c William R. Levis MD| |
Lawrence transfer factor (TF) is defned as dialyzable leukocyte extract (DLE) that can transfer antigen-specifc cell-mediated immunity from a person testing positive for the antigen in a delayed type hypersensitivity skin test manner to a person negative for the same antigen.
A recent article by Myles et al1 has identifed a DLE isolated from an established CD8+ T cell line capable of transferring antigen-specifc immunity. The DLE contains a portion of the beta chain of the T cell receptor and additional nucleotide and protein factors that are being subjected to further modern biochemical analysis.
After months of study that included interviews of TF physician-scientists, we conclude that an antigen-specifc TF exists for most, if not all, antigens. By working from a CD8+ T cell line with modern biochemical technology, it should be possible to identify and patent products capable of treating infectious diseases, antigen-responsive cancers, and autoimmune disorders.
J Drugs Dermatol. 2017;16(12):1198-1206.
Thalidomide and Analogues: Potential for Immunomodulation of Inflammatory and Neoplastic Dermatologic Disorders
Barry Ladizinski BS, Edward J. Shannon PhD, Miguel R. Sanchez MD, William R. Levis MD| |
Ife J. Rodney MD, Oge C. Onwudiwe MD, Valerie D. Callender MD, and Rebat M. Halder MD| |
J Drugs Dermatol. 2013;12(4):420-427.
David S. Lee MD,a* Nicholas Gulati BA,b* Frank Martiniuk PhD,c William R. Levis MDd| |
J Drugs Dermatol. 2011;10(10):1192-1194.
Lauren C. Strazzulla BA, Lorena Avila MD, Kristen Lo Sicco MD, Jerry Shapiro MD| |
Lichen planopilaris (LPP) is a variant of lichen planus that affects the scalp causing scarring hair loss. Patients also frequently experience symptoms of scalp itch, pain, and burning. To date, there are no long-term remittive nor curative therapies available. Low-dose naltrexone has anti-inflammatory properties and has recently been described in the context of treating autoimmune conditions. This retrospective medical record review describes four LPP patients treated with low-dose (3 milligrams per day) naltrexone. This medication provided benefit in these four patients including reduction in symptoms of pruritus, clinical evidence of inflammation of the scalp, and disease progression. All patients tolerated naltrexone without adverse effects. This is the first case series demonstrating the beneficial effects of low-dose naltrexone for patients with LPP. This medication was well-tolerated by the patients and is cost-effective.
J Drugs Dermatol. 2017;16(11):1140-1142.
Sandeep S. Saluja MD and Matthew Q. Hand MD| |
Pimecrolimus 1% Cream in the Treatment of Cutaneous Lesions of Pemphigus Vulgaris: A Double-blind, Placebo-controlled Clinical Trial
Fariba Iraji MD, Ali Asilian MD, Amir Hossein Siadat MD| |
Yasuhiro Horiuchi MD, SangJae Bae MD, Ichiro Katayama MD| |
Andrew F. Alexis MD MPH| |
Exacerbation of Paranoid Schizophrenia in a Psoriatic Patient after Treatment with Cyclosporine A, but not with Etanercept
Sergio Di Nuzzo MD, Martina Zanni MD, Giuseppe De Panfilis MD| |
Brooke Bair DO and David Fivenson MD| |
Objective and Methods: Sodium thiosulfate has been used to systemically treat calciphylaxis with little to no adverse effects. We report two cases of ulcerative calcinosis cutis which were refractory to multiple topical treatments and did not improve with correction of underlying electrolyte abnormalities.
Results: Both cases showed an excellent response to topical 25% sodium thiosulfate compounded in zinc oxide.
Limitations: We are limited by a small sample size (n=2) in this case series.
Conclusions:We recommend topical sodium thiosulfate 25% as an alternative treatment for dystrophic calcinosis cutis.
J Drugs Dermatol. 2011;10(9):1042-1044.
Habibollah Alamdari MD, Lauren Snitzer MD, and Nora K. Shumway MD| |
Resident Rounds. Part II: Distinguishing Porphyria Disorders: Biochemical Markers and Associated Findings
James L. Griffith Jr. MS and Robert Bacigalupi MD| |
Jennifer Hayes BAa and John Koo MDb| |
The potential relationship between systemic retinoids used in dermatology and affective disorders is controversial. Acitretin, which is widely used in the treatment of psoriasis is part of this controversy secondary to its chemical relation to isotretinoin, a drug which has been associated with a large number of anecdotal case reports of depression and suicidal ideation. Moreover, an FDA package insert precaution regarding acitretin's association with depression and suicide has elevated the level of concern for patient safety. The objective of this article is to review the evidence in the literature regarding acitretin's association with affective disorders. After 12 years of worldwide use only two cases involving acitretin have been reported in the literature. In addition, despite many anecdotal cases involving isotretinoin, there have been no clinical studies that have proven a causal relationship between isotretinoin and depression or suicidal ideation. For acitretin there have been no systematic clinical studies that examine such a relationship. Moreover, it is notable that the FDA precaution regarding depression and suicide on the package insert of acitretin predates the publication of the aforementioned two cases. This suggests that a relationship between acitretin and affective disorders is a class labeling rather than a scientifically proven association.
J Drugs Dermatol. 2011;10(4):409-412.
Evidence-Based Skincare: The Importance of Offering Moisturization, Relief, and Protection in Common Skin Disorders
Leon H. Kircik MD| |
Simon Nigen, MD, FRCPC; Sandra R. Knowles, BScPhm; and Neil H. Shear, MD, FRCPC| |
Christopher M. Wolfe PA-C, Nicole Tafuri BS, Keith Hatfield PA-C| |
Bexarotene and Its Potential Role in the Treatment of Neurological Disorders: Beyond Its Role as an Anti-Cancer Agent
Shailendra Kapoor MD| |
Ronald B. Vender MD FRCPC, Orli Goldberg MD| |
Hanna Kim, MD| |
Lindsey A. Brodell MD and Milan Anadkat MD| |
M.E. Balañá; C. Alvarez Roger; A. V. Dugour and N. A. Kerner| |
Asli Aksu Çerman MD, Sezgi Sarıkaya Solak MD, İlknur Altunay MD, and Nihal Asli Küçükünal MD| |
OBJECTIVE : The aim of the study was to evaluate the efficacy and safety of topical calcipotriol for the treatment of mild-to-moderate patchy AA.
METHOD: Forty-eight patients with mild-to-moderate AA were enrolled in the retrospective, 12-week trial. Calcipotriol cream was applied to the affected areas twice a day. Severity of Alopecia Tool (SALT) score and hair regrowth rate were calculated at baseline and at 3, 6, 9, and 12 weeks.
RESULTS: At week 12, the total response was achieved in 69.2% of patients. When the mean SALT score of patients at week 12 was compared to that of patients at baseline, the value at week 12 was significantly lower (P= 0.001). A regrowth score (RGS) ≥ 3 (hair regrowth of ≥ 50%) was observed in 75% of patients, whereas a RGS ≥ 4 (hair regrowth of ≥ 75%) was observed in 62.5% of patients and the complete regrowth rate (hair regrowth= 100%) was 27.1%.
CONCLUSION: Calcipotriol may serve as a safe and effective treatment option in mild-to-moderate patchy AA, and calls for more extensive controlled studies with this treatment.
J Drugs Dermatol. 2015;14(6):616-620.
Robert A. Swerlick MD aand Caren F. Campbell MD b| |
J Drugs Dermatol. 2013;12(1):99-102.
Pollution as a Risk Factor for the Development of Melasma and Other Skin Disorders of Facial Hyperpigmentation ‑ Is There a Case to Be Made?
Wendy E. Roberts MD FAAD| |
J Drugs Dermatol. 2015;14(4):337-341.
Inflammatory Mediators are Inhibited by a Taurine Metabolite in CpG Oligodeoxynucleotide and IFN-r Activated Macrophage Cell Line
Bo Sook Kim DVM PhD,a Daryl S. Spinner PhD,b Richard J. Kascsak PhD,b Seung Yong Park DVM PhD,c In Soo Cho DVM PhD,d Georgia Schuller-Levis PhD,e and Eunkyue Park PhDe| |
J Drugs Dermatol. 2013;12(5):551-557.
Jennifer J. Lee MD, Thomas F. Downham II MD| |
Concurrent Antiphospholipid Syndrome and Sutaneous Sarcoidosis Due toInterferon Alfa and Ribavirin Treatment for Hepatitis C
Michi M. Shinohara MD, Claudia Davis ARNP, John Olerud MD| |
Evidence-Based Skincare: The Importance of Offering Moisturization, Relief, and Protection in Common Skin Disorders
Joy Makdisi BS and Adam Friedman MD FAAD| |
Development of Systemic Lupus Erythematosus in aPatient With Rheumatoid Arthritis Following TreatmentConversion of Infl iximab to Adalimumab
Jamaiya Havel BA, Sina Aboutalebi MD, Lauren Doughty MD, Marla Wirges MD| |
Tuyet A. Nguyen BA BS and Adam J. Friedman MD| |
J Drugs Dermatol. 2013;12(10):1131-1137.
Kendra Gail Bergstrom MD FAAD| |
J Drugs Dermatol. 2013;12(6):715-716.
J Drugs Dermatol. 2012;11(8):907-910.
Introduction: Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis. It has also been used for a spectrum of
other difficult-to-treat dermatoses, including hyperkeratotic and inflammatory dermatoses and non-melanoma skin cancers. Here we
review the available data regarding both FDA-approved and off-label uses of acitretin, clinically relevant adverse events, precautions
Methods: A PubMed literature search was conducted utilizing the search term "acitretin," which yielded 714 hits. Results were further limited to English language clinical trials in human subjects. Of 78 articles evaluated for relevance, 60 were included for review.
Results: Acitretin is effective as monotherapy and in multidrug therapeutic regimens for the treatment of psoriasis and other hyperkeratotic and inflammatory disorders, as well as for malignancy chemoprevention. Its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity. Potential adverse effects may be reduced or avoided by using lower doses of acitretin or in combination with other therapies.
Limitations: The reviewed studies include many small trials and case reports of the use of acitretin for psoriasis. Studies of acitretin therapy for the treatment of other cutaneous disorders are limited.
Conclusion: Acitretin is a beneficial treatment for psoriasis, and should be considered when not contraindicated. Particularly when used in combination with ultraviolet (UV) phototherapy, is a safe and cost effective therapeutic strategy.
J Drugs Dermatol.2011;10(7):772-782.
Background: Some dermatologic disorders are known to be much more common in patients of color, but the leading dermatologic
disorders in patients of color have not yet been described on the basis of nationally representative data.
Purpose: To determine the leading dermatologic disorders for each major racial and ethnic group in the United States.
Methods: We queried the National Ambulatory Medical Care Survey (NAMCS) for the leading diagnoses in patient visits to U.S. dermatologists from 1993 to 2009. The leading diagnoses were tabulated for each racial and ethnic group, and the top conditions were compared between groups. In a separate analysis, visits for skin conditions regardless of physician specialty were analyzed for leading diagnoses in each racial and ethnic group.
Results: The top five diagnoses for African-American patients in dermatology clinics were acne, unspecified dermatitis or eczema, seborrheic dermatitis, atopic dermatitis, and dyschromia. For Asian or Pacific Islander patients, the top five were acne, unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis, and seborrheic keratosis. By contrast, in Caucasian patients, the top five were actinic keratosis, acne, benign neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma skin cancer. In Hispanic patients of any race, the leading diagnoses were acne, unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin, and viral warts. When the leading dermatologic diagnoses across all physician specialties were assessed, the top diagnoses for African-Americans were unspecified dermatitis or eczema, acne, dermatophytosis of scalp and beard, sebaceous cyst, and cellulitis or abscess; for Asians or Pacific Islanders were unspecified dermatitis or eczema, acne, atopic dermatitis, urticaria, and psoriasis; and for Caucasians were acne, unspecified dermatitis or eczema, actinic keratosis, viral warts, and sebaceous cyst. For Hispanics of any race, they were unspecified dermatitis or eczema, acne, sebaceous cyst, viral warts, and cellulitis or abscess. For a sole diagnosis of a dermatologic condition, only 28.5% of African-Americans' visits and 23.9% of Hispanics' visits were to dermatologists, as compared to 36.7% for Asians and Pacific Islanders and 43.2% for Caucasians.
Limitations: The data are based on numbers of ambulatory care visits rather than numbers of patients. Data on race or ethnicity were not collected for some patients.
Conclusions: Several dermatologic disorders are much more commonly seen in patients of color. Acne and unspecified dermatitis or eczema are in the top five for all major U.S. racial and ethnic groups. There may be an opportunity to improve the care of patients of color by ensuring they have equal access to dermatologists.
J Drugs Dermatol. 2012;11(4):466-473.
Heat-Shock Proteins as Drugs: Potential Applications in Cancer, Infections, and Autoimmune and Atopic Diseases
Aton M. Holzer MD, Frank Martiniuk PhD, William R. Levis MD| |
Aditya K Gupta MD PhD FRCP(C), Karyn Nicol HBMSc| |
Hendrik Uyttendaele, Md, PhD; Joseph Obadiah, MD and Marc Grossman, MD| |
Anjali Shetty BS, Catherine B. Marcum MD, L. Frank Glass MD, John D. Carter MD| |
Douglas N. Robins MD| |
Catherine Buell MD, John Koo MD| |
Pemphigus Foliaceus Presenting As Eruptive Seborrheic Keratosis and Responding to Oral Gold Treatment
Mohammed M. Bagheri, MD; Mehran Alagheband, MD; Omeed M. Memar, MD PhD and David B. Eiler, MD| |
Stephen F. D'Addario, MD; Matthew E. Bryan, MD; Warren A. Stringer, MD and Sandra Marchese Johnson, MD| |
Adolfo C. Fernandez-Obregon MD| |
Anna Cristina Garza-Mayers BA PhDa,b and Daniela Kroshinsky MD MPHa,b| |
BACKGROUND: Treatment of vitiligo is aimed at repigmentation and often consists of multiple modalities, none of which are universally or rapidly successful. Extensive cases are most often treated with ultraviolet light therapy, which can be both costly and time-consuming. Though vitiligo is an autoimmune disease, there is no current data to support systemic immunosuppressive monotherapy.
CASE SUMMARY: Here we present a case series of 3 patients with vitiligo treated for 11-16 months with low-dose methotrexate (12.5-25 mg per week) with folic acid supplementation with clinically significant skin repigmentation, with response within 6 months in one case. There were no severe adverse effects reported.
CONCLUSION: These cases demonstrate an unexplored effective and steroid-sparing therapeutic alternative in patients with vitiligo for whom topical therapy has failed and phototherapy is cost-prohibitive or ineffective.
J Drugs Dermatol. 2017;16(7):705-706.
Aimee Leonard MD, Miriam Keltz Pomeranz MD, Andrew G Franks Jr MD| |
J Drugs Dermatol. 2013;12(10):1177-1179.
Jyoti Pathria Mundi MD, Lauren Cerullo MD, Jonathan Cotliar MD| |
Evan Jones MD, Adam Korzenko BS, David Kriegel MD| |
Joanna L. Chan, AB; Linda Davis-Reed, MD and Alexa Boer Kimball, MD, MPH| |
F. Emily Bell, MD and Melissa P. Daniles, MCS| |
Melissa B. Hoffman MD,a Rachna A. Bhandari MD,b and Animesh A. Sinha MD PhDc| |
J Drugs Dermatol. 2016;15(7):821-829.
Nikki Vyas BS,a Nishit S. Patel MD, band George F. Cohen MDb| |
J Drugs Dermatol. 2013;12(2):210-216.
Brian C. Schulte BSE, Wesley Wu MD, and Ted Rosen MD| |
J Drugs Dermatol. 2015;14(9):964-968.
Treatment Patterns and Perceptions of Treatment Attributes, Satisfaction and Effectiveness Among Patients With Psoriasis
Marco daCosta DiBonaventura PhD, Samuel Wagner PhD RP, Heidi C. Waters MS, MBA, Chureen Carter PharmD, MS| |
Jennifer C. Sri BS, Charlotte L. Tsai MD, April Deng MD, Anthony A. Gaspari MD| |
To Treat or Not to Treat? Management of Guttate Psoriasis and Pityriasis Rosea inPatients With Evidence of Group A Streptococcal Infection
Karthik Krishnamurthy DO, Ashley Walker DO, Charles A. Gropper MD, Cindy Hoffman DO| |
Andrew F. Alexis MD MPH| |
Kelly K. Park MD, Rebecca C. Tung MD, Arlene Ruiz de Luzuriaga MD MPH| |
Fortunately, Promius Pharma, one of the leaders in this field, has now brought to market a generic formulation of clocortolone pivalate 0.1% that is exactly the same as their original branded product. This has been shown to be effective and well tolerated in the management of several corticosteroid-responsive dermatoses, and is a welcome addition to the treatment armamentarium.
Zülal Erbagci MD, A. Almıla Tuncel MD, Ibrahim Erbagci MD| |
Anne Lynn S. Chang MD, Joanna Badger MD,Wingfield Rehmus MD MPH, Alexa Boer Kimball MD MPH| |
Introduction: Erosive mucosal lichen planus is thought to be an autoimmune disease mediated by increased T-cell activation and proliferation. Alefacept is a biologic agent that selectively targets memory T cells.
Objective: To evaluate the preliminary efficacy and safety of alefacept in the treatment of moderate to severe mucosal LP.
Methods: Seven subjects were randomly selected to receive either alefacept 15 mg or placebo every week for 12 weeks. Endpoints of the case series were the Physician Global Assessment (PGA) of disease severity, mucosal pain (MP) severity, and itch severity (IS). Both subjects and investigators were blinded.
Results: Two of the subjects receiving alefacept achieved significant improvement during the study. There were no serious adverse events during the course of the study period.
Conclusions: In this small case series, alefacept may have conferred a modest therapeutic response in erosive lichen planus (LP). Larger multicenter prospective studies will be needed to determine whether alefacept can improve erosive LP in a statistically significant way.
Lucia Seminario-Vidal MD PhD, Wendy Cantrell DNP, and Boni E. Elewski MD| |
J Drugs Dermatol. 2015;14(8):901-902.
Fiona P. Blanco MD, Richard K. Scher MD FACP| |
CTLA 4-induced Splenomegaly and A Review of the Literature Pertaining to Autoimmune Complications of Therapy
Navid Ezra BS, Natalie B. Goltche BS, Shahrad Hakimian BS, Arash Afari MD| |
John L. Meisenheimer MD| |
Vesna Petronic-Rosic MD MSc, Elizabeth Myers, Christopher R. Shea MD, Thomas Krausz MD| |
Salman Bin Dayel MDa and Khalid AlGhamdi MDb| |
Objective: To evaluate the safety and efficacy of alefacept in the treatment of vitiligo.
Methods: After providing informed written consent, 4 adult patients with widespread vitiligo (covering a body surface area ≥5%) were treated with weekly intramuscular injections of 15 mg alefacept for 12 weeks. All patients were monitored clinically, by laboratory investigation, and by digital image analysis. All patients were followed up with for 24 weeks.
Results: All patients tolerated alefacept well, without any adverse events. None of the patients showed any repigmentation. However, 1 patient developed new depigmented patches during treatment with alefacept.
Limitations: A pilot study with a small number of patients.
Conclusion: Alefacept as a monotherapy for vitiligo treatment did not result in any patient improvement, and further evaluation in larger studies may be required.
J Drugs Dermatol. 2013;12(2):159-161.
Mark Abdelmalek MD, Shruti Mahindrakar BS, Elizabeth Wiser MD| |
Ifedayo O. Kuye BAa and Gideon P. Smith MD PhDb| |
J Drugs Dermatol. 2017;16(2):162-166.
Iqbal Bukhari MD| |
Samreen Z. Choudhry MD,a Neal Bhatia MD,b Roger Ceilley MD,c Firas Hougeir MD,d
Robert Lieberman MD,e Iltefat Hamzavi MD,a and Henry W. Lim MDa
J Drugs Dermatol. 2014;13(2):148-153.
Erling Thom PhD| |
Amongst various treatment methods and substances, oral supplementation with a specific bioavailable proteoglycan stands out as a promising new therapeutic treatment method.
J Drugs Dermatol. 2016;15(8):1001-1004.
Adam R. Mattox DO MS, Jeaneen A. Chappell MD, and M. Yadira Hurley MD| |
J Drugs Dermatol. 2013;12(2):217-219.
Hannah Liu BS, Rachel Schleichert MD, and Anthony A. Gaspari MD| |
J Drugs Dermatol. 2013;12(3):360-361.
J Drugs Dermatol. 2012;11(8):979-987.
Navjeet K. Sidhu-Malik, MD and Andrew L. Kaplan, MD| |
Levamisole Induced Necrosis of the Skin and Neutropenia Following Intranasal Cocaine Use: A Newly Recognized Syndrome
John Mouzakis MD,a Charurut Somboonwit MD,b Seetha Lakshmi MBBS,c Mark Rumbak MDd John Sinnott MD,e Basil Cherpelis MD,f Jonathan Keshishian MDg| |
Levamisole is a veterinary anti-helminthic used to treat several autoimmune conditions but also commonly utilized as an additive in cocaine distribution. Toxicity resulting in agranulocytosis and cutaneous necrosis in association with cocaine use is an infrequently described phenomenon of an emerging problem. Although levamisole is found extensively in the cocaine supply of the United States, relatively few cases of necrotic skin lesions associated with intranasal use have been reported. The skin necrosis secondary to levamisole toxicity is characterized by variable findings on biopsy, ranging from leukocytoclastic vasculitis to occlusive vasculopathy. The following case describes a 54-year-old male who developed fever, agranulocytosis, p-ANCA autoantibodies and extensive skin necrosis following heavy intranasal cocaine use. Necrosis of greater than 50% of the patient's total body surface area resulted and was followed by thorough wound debridement.
J Drugs Dermatol. 2011;10(10:1204-1207.
J Drugs Dermatol. 2012;11(10):1200-1206.
J Drugs Dermatol. 2012;11(5):622-625.
Bone Mineral Density in Patients With Alopecia Areata Treated With Long-Term Intralesional Corticosteroids
Aman Samrao MD,a Jennifer M. Fu MD,a,b Steven T. Harris MD,b and Vera H. Price MDa| |
Methods: In this retrospective, cross-sectional case series, 18 patients with patchy alopecia areata treated at 4- to 8-week intervals with intralesional triamcinolone acetonide for at least 20 months were evaluated for BMD using dual-energy x-ray absorptiometry (DXA). Follow-up DXA measurements were obtained in those with abnormal findings.
Results: Nine out of 18 patients (50%) had abnormal DXA results. Patients with the following risk factors were more likely to have abnormal BMD: age older than 50 years, body mass index less than 18.5 kg/m2, lack of weight-bearing exercise, smoking history, postmenopausal status, past stress fracture, family history of osteopenia or osteoporosis, and a cumulative intralesional triamcinolone acetonide dose of greater than 500 mg.
Conclusion: Patients with patchy alopecia areata who receive chronic intralesional triamcinolone acetonide therapy should be counseled on preventive measures for osteoporosis and monitored for effects on BMD.
J Drugs Dermatol. 2013;12(2):e36-e40.
Andrew F. Alexis MD MPHa and Paul Blackcloud BA| |
J Drugs Dermatol. 2013;12(suppl 9):s123-s127.
Tiffani K. Hamilton MD| |
New Insight Into the Pathophysiology of Hair Loss Trigger a Paradigm Shift in the Treatment Approach
Neil S. Sadick MD,a Valerie D. Callender MD,b Leon H. Kircik MD,c,d,e,f,g Sophia Kogan MDh| |
Hair loss affects millions of men and women of all ages and ethnicities, impacting appearance, social interactions, and psycho-emotional well-being. Although a number of options are available, they are limited, carry a potential risk of side effects, and none have proven to be comprehensive for treatment of hair loss. Across the spectrum of hair loss disorders, there has long been a segmentation into distinct mechanisms, driving the main trend in current therapeutics to focus on targeting single molecules or pathways. However, research points to similar dysregulation of intrinsic signaling pathways within follicle physiology that span the hair loss disorder spectrum – with a common inflammatory component identified in most hair loss pathogenesis, including that of androgenetic alopecia (AGA).
J Drugs Dermatol. 2017;16(11 Suppl):s135-140.
Rapid Improvement in Digital Ischemia and AcralContracture in a Collodion Baby Treated With Topical Tazarotene
Rosemarie H. Liu MD, Beth Becker MD, Juliet Gunkel MD, Joyce Teng, MD, PhD| |
Lichenoid Dermatitis From Interferon alpha-2a in a Patient With Metastatic Renal Cell Carcinoma and Seronegative HCV
Amelia E. Bush MD,a Sharon R. Hymes MD,b and Sirunya Silapunt MDc| |
Cutaneous reactions to interferon, including a lichenoid drug reaction, are most commonly reported in patients undergoing treatment for hepatitis C virus (HCV) infection. There have been case reports of interferon-induced lichen planus in seronegative HCV patients with lymphoproliferative disorders and melanoma. We report the case of a 71-year-old man undergoing treatment with interferon for metastatic renal cell carcinoma (RCC) who developed an eruption 2 months after starting interferon. Clinical and histological findings from biopsies supported a diagnosis of interferon-induced lichen planus. To our knowledge, this is the first known case of a lichenoid drug eruption from interferon in a seronegative HCV patient with metastatic RCC.
J Drugs Dermatol. 2017;16(7):714-716.
Multivesicular Emulsion: A Novel, Controlled-Release Delivery System for Topical Dermatological Agents
Joseph Bikowski MD, Radhakrishnan Pillai PhD, Braham Shroot PhD| |
Ritu Saini MD, Stephanie Lehrhoff MD, Deborah S. Sarnoff MD| |
James Q. del Rosso, Do, FAOCD| |
Clinical Relevance of Skin Barrier Changes Associated With the Use of Oral Isotretinoin: The Importance of Barrier Repair Therapy in Patient Management
James Q. Del Rosso DO FAOCD| |
J Drugs Dermatol. 2013;12(6):626-631.
Observation: We report a case of a 71-year-old male with invasive squamous cell carcinoma of the left heel and renal cell carcinoma who presented with urticarial bullous pemphigoid.
Conclusions: There are few case reports in the literature associating bullous pemphigoid and renal cell carcinoma or squamous cell carcinoma. To our knowledge, this is the first reported case of coincident renal cell carcinoma, squamous cell carcinoma and urticarial BP. This case further supports investigation for underlying malignancy in patients with BP, particularly in the elderly.
J Drugs Dermatol. 2012;11(2):234-238.
Efficacy and Safety of the Topical Sensitizer Squaric Acid Dibutyl Ester in Alopecia Areata and Factors Influencing the Outcome
Ajith C. MD, Somesh Gupta MD DNB, Amrinder Jit Kanwar MD MNAMS| |
Objective: To study efficacy, safety, and factors influencing the outcome in the treatment of alopecia areata.
Method: During a 4-year period, 70 patients of alopecia areata, unresponsive to conventional therapies, were treated with SADBE for a period of 4 months and thereafter depending on the response with initial therapy. The percent scalp hair loss was calculated using “Severity of Alopecia Tool” (SALT) score before and after the therapy.
Results: Out of 70 patients, 6 were lost to follow-up and 4 could not develop sensitization; therefore, data of 60 patients was available for analysis. The overall success rate was 43%. In patients with <50% scalp involvement; the success rate was better (68%) than in those with >50% involvement (29%). The response was better in patients with late onset and shorter duration of disease. Family history of alopecia areata or other autoimmune diseases, personal or family history of atopy, presence of auto antibodies in serum, and presence of nail changes were associated with poorer prognosis. Out of 26 patients who responded, relapse occurred in 21 (81%) patients.
Conclusion: In conclusion, SADBE is an effective and well-tolerated mode of therapy in Indian patients of AA, although the long-term results of SADBE were not encouraging.
Gina R. Chacon MD, David J. Wolfson MD, Carlos Palacio MD, Animesh A. Sinha MD PhD| |
Longitudinal Tracking of Autoantibody Levels in a Pemphigus Vulgaris Patient: Support for a Role of Anti-Desmoglein 1 Autoantibodies as Predictors of Disease Progression
Nadia Y. Abidi MD, Irene Lainiotis BS, Gretchen Malikowski MD, Kristina Seiffert-Sinha MD, and Animesh A. Sinha MD PhD| |
Evaluation of a Newly Available ELISA for Envoplakin Autoantibodies for the Diagnosis of Paraneoplastic Pemphigus
Jennifer Gall Powell MD,a,c Raminder K. Grover MD,a,b Richard W. Plunkett PhD,a,b
Kristina Seiffert-Sinha MD,a and Animesh A. Sinha MDa
OBSERVATIONS: We measured the specificity of IIF on RBE to be 86% which is on the lower end of the previously reported specificity of 83% to 98.9%. The ELISA for envoplakin autoantibodies has a technical sensitivity of 100%, diagnostic sensitivity of 83%, and specificity of 91%.
CONCLUSIONS AND RELEVANCE: This ELISA for envoplakin autoantibodies is now commercially available and technically easier to perform then the immunoblot. We recommend that this new ELISA serves as a confirmatory test in cases of a positive IIF on RBE given its higher specificity.
J Drugs Dermatol. 2015;14(10):1103-1106.
The Role of a Midpotency Topical Corticosteroid and the Clinical Relevance of Formulation Characteristics in the Management of Commonly Encountered Eczematous and Inflammatory Dermatoses in Adults and Children:Focus on the Pharmacologic Properties of Clocortolone Pivalate 0.1% Cream
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2013;12(2)(suppl):s5-s10.
Joseph Alcalay MD, Dani Ben-Amitai, Ronen Alkalay MD MBA| |
Multifocal Scalp Abscesses with Subcutaneous Fat Necrosis and Scarring Alopecia as a Complication of Scalp Mesotherapy
Razan Kadry MD, Issam Hamadah MD, Abdullah Al-issa MD, Lawrence Field MD| |
Adam J. Mamelak MD, Adrianna Jackson MD, Rabia Nizamani BS, Ofer Arnon MD,Nanette J. Liegeois MD PhD, Richard J. Redett MD, Patrick J. Byrne MD| |
Objective: The authors describe the current role of leech therapy in cutaneous surgery and medicine.
Methods: Case series and review of the literature.
Results: Leech saliva contains anticoagulative, anti-aggregative and vasodilatory components. Combined with the annelid’s mechanical ability to extract blood, leeches can contribute to patients’ health with minimal risks.
Conclusion: Leeches should be considered as novel therapies for disorders of coagulation and venous congestion. Implementation of leech treatment should be tempered with the potential adverse effects, including Aeromonas infection and a drop in hematocrit that might require a blood transfusion.
Multiple Nonmelanoma Skin Cancers in a Patient With Epidermolytic Hyperkeratosis on Long-standingRetinoid Therapy
Deborah S. Sarnoff MD FAAD FACP, Ritu Saini MD FAAD| |
Leon H. Kircik MDa and Panagiotis Zografos MScb| |
J Drugs Dermatol. 2015;14(10):1113-1116.
Andreas J. Bircher, MD and Christian Surber, MD| |
Adrenergic Urticaria and Rheumatoid Arthritis in a Patient With Melanoma: An Intricate Medical Management
Adrenergic urticaria is an uncommon yet probably under-diagnosed form of urticaria,¹ which is considered a form of neurogenic acute reaction mainly triggered by acute stress.²,³ The author presents a case of AU, however, that is only partially explained by a stress setting, though it is strongly associated with the course of an autoimmune disease.
J Drugs Dermatol. 2012;11(3):409-412.
Maj. Jeremy Scott Kennedy DO, Col. (Ret) Richard L. Devillez MD, Maj. Jeffrey Scott Henning DO| |
Plasmapheresis for Refractory Urticarial Vasculitis in a Patient with B-Cell Chronic Lymphocytic Leukemia
Jessica L. Alexander MD, Amer N. Kalaaji MD, James M. Shehan MD, Benjamin K. Yokel MD, Mark R. Pittelkow MD| |
Mehods: We report a case of refractory urticarial vasulitis developing in association with B-cell chronic lymphocytic lukemia in a 46- year-old man. We also reviewed the literature to identify other cases of urticarial vasculitis managed with this therapeutic modality.
Results: The diesease progressively improved during 6 treatments with palsmapheresis (plasma exchange). In additional cases indentified in the literatrue, plasmaphersis was generally effective and well tolerated.
Conclusion: On the basis of these findings, we propose that plasmapheresis be considered a treatment option for refractory urticarial vasculitis.
Joseph F. Fowler Jr. MD, Heather Woolery-Lloyd MD, Heidi Waldorf MD, Ritu Saini MD| |
Claudia Hossain BS,a Dennis A. Porto MD,b Iltefat Hamzavi MD,b and Henry W. Lim MDb| |
J Drugs Dermatol. 2016;15(4):384-387.
J Drugs Dermatol. 2012;11(6):708-713.
Leon H. Kircik MD, Neh Onumah MD, Joshua A. Zeichner MD, Elena Sotiriou MD PhD, Christina Goussi MD, Aimilios Lallas MD, Eleni Chovarda MD, Zoe Apalla MD, Elisabeth Lazaridou MD PhD, Demetris Ioannides MD PhD| |
Amrollah Ahmadi MD, Babak Barikbin MD, Mohsen Naseri MD PhD, Mohammadali Mohagheghi MD| |
Methods: In a randomized, double-blind clinical trial, 28 patients (11 male, 17 female) with chronic plaque-type psoriasis were randomly assigned to treatment and placebo groups. Patients in treatment group received HESA-A tablet 25 mg/kg twice a day orally and control group received placebo with the same method for 6 months and were followed clinically during the study.
Results: At the end of study, in the treatment group psoriatic plaques were absent (no evidence of psoriasis or complete remission) in 9 cases (64.2%) and was very mild (controlled, but not entirely cleared) in 5 cases (35.8%). Disease relief was observed in 10 (71.4%) patients after 4 months, in 2 cases (14.3%) after 5 months and in 2 (14.3%) other patients after 6 months while none of the controls showed disease improvement.
Conclusion: This study showed rapid and good efficacy and safety of HESA-A in the treatment of plaque-type psoriasis.
Magdalene Dohil MD, Leslie Baumann MD, Hema Sundaram MD, Jason Emer MD| |
Providing optimal patient outcomes continues to be a challenge in the treatment and management of dermatologic conditions. Most physicians and patients are interested in doing everything possible to optimize the treatment of their skin disease. This is especially important in treating patients with chronic disorders such as eczema, acne, psoriasis, rosacea, photodamage and the negative effects of aging. Physicians and patients often explore the therapeutic benefits of natural ingredients as alternative or complementary treatments to conventional methods. It is important that dermatologists remain up-to-date on the research and new advances in skin care products with natural ingredients.
This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 1 category 1 CME Credit.
E. Eugene Bain III MD,a Shane A. Meehan MD,a Elizabeth K. Hale MDa,b| |
J Drugs Dermatol. 2014;13(5):598-600.
Joseph Bikowski MD FAAD| |
Alan B. Fleischer Jr MD| |
Rosacea and acne are chronic inflammatory skin conditions that share an inflammatory pathogenesis, but clinically remain quite distinct. Although many have long assumed that these conditions are primarily infectious, emerging evidence suggests that inflammation plays a critical role in the pathogenesis of these disorders. Part of the innate immune system, the antimicrobial and proinflammatory cathelicidins, may be downregulated by both azelaic acid and subantimicrobial doxycycline. In acne, the creation of papules, pustules and nodules is clearly mediated through immune mechanisms, and the antiinflammatory effects of retinoids play a key role in management. Recent observations help us understand in greater detail the role that inflammation plays in these two diseases, and the mechanisms by which commonly used medications exert their effect by modulating inflammatory processes. This review will present and synthesize recently acquired information as it relates to inflammatory acne and rosacea pathogenesis and clinical management.
J Drugs Dermatol. 2011;10(6):614-620.
Cutaneous Lupus Erythematosus in a Patient Undergoing Intravitreal Bevacizumab Injections: Case Report and Review of the Literature
Nathan Cleaver DO,a James Ramirez MD,b and Stuart Gildenberg MDa| |
CASE PRESENTATION: We report a case of a 63 year-old Caucasian female who presented with subacute cutaneous lupus erythematosus six weeks after initiating two intravitreal injections of bevacizumab for central serous choroidopathy.
CONCLUSION: We report the first documented case of a cutaneous lupus erythematosus eruption following bevacizumab administration as a monotherapy.
J Drugs Dermatol. 2013;12(9):1052-1055.
Eric Lee MD, Mina Zarei MD, Charlotte LaSenna BS, Gabriel Villada MD, and Paolo Romanelli MD| |
METHODS AND MATERIALS: A search of the University of Miami Dermatopathology database was performed to identify all available patient specimens within the various subtypes of psoriasis. IL-17A IHC staining was performed using 4 μm paraffin skin sections. 1:25 dilution of IL-17A antibody was used. Stained slides were analyzed using a semi-quantitative scoring method ranging from negative to three plus.
RESULTS: Palmoplantar and pustular psoriasis cases showed consistently strong IL-17A staining. Plaque psoriasis cases showed intermittent to strong IL-17A staining. The results in the scalp and guttate psoriasis cases showed variable results.
CONCLUSION: The results of our study suggests the significant role of the cytokine IL-17A in the development of palmoplantar and pustular psoriasis. However, scalp and guttate subtypes showed variable expression from negative to strongly positive, which demonstrates a case by case basis expression of IL-17A. Therefore, exploring the IHC characterization of subtypes of psoriasis will help dermatologists better understand the pathogenesis of each subtype and help clinicians optimize treatments.
J Drugs Dermatol. 2015;14(10):1133-1136.
Heather K. Hamilton MD,a Evelyn Lilly MD,a,b Kenneth A. Arndt MD,a and Jeffrey S. Dover MD FRCPCa| |
OBJECTIVE: To determine the prevalence of psychotropic medication use in cosmetic dermatology patients compared to the prevalence of such medication use in general dermatology patients.
METHODS & MATERIALS: The study was a retrospective chart review of female patients, 18 or older, new to a private practice. Exclusion criteria included dermatologic disorders with known psychosocial comorbidity. Psychotropic medication use was recorded.
RESULTS: The percentage of subjects in the medical group (n=156) who reported using psychotropic medications was 22.2% compared to 26.8% in the cosmetic group (n=154; P=0.09).
CONCLUSION: The prevalence of psychotropic medication use among all dermatology patients in our practice was relatively high, but there was no statistically significant difference in the rate of psychotropic medication use in cosmetic dermatology patients compared to general dermatology patients.
J Drugs Dermatol. 2016;15(7):858-861.
The Two Faces of Fractionated Photodynamic Therapy: Increasing Efficacy With Light Fractionation or Adjuvant Use of Fractional Laser Technology
Margit L.W. Juhasz MD,a,b Melissa K. Levin MD,a and Ellen S. Marmur MDa,c| |
Jonathan I. Silverberg MD PhD MPH and Nanette B. Silverberg MD| |
Background: Vitiligo vulgaris is a chronic autoimmune depigmenting disorder affecting individuals of all skin colors. Lesions are commonly noted in the periorificial face and over the upper and lower extremities in areas of friction. Although there have been many published reports of successful therapies for vitiligo, few have assessed differential response based on skin color.
Objective: To determine if topical tacrolimus is more effective at treating vitiligo in individuals of color.
Methods: An IRB-approved chart review of patients with a diagnosis of vitiligo was conducted including patients seen between May 2001 and April 2006. Patients with vitiligo were treated with tacrolimus 0.03% for children ages 2-15 years of age and tacrolimus 0.1% ointment for individuals 16 years of age or older, applied twice-daily to all hypopigmented or depigmented lesions. A review of clinical features, Fitzpatrick skin type and response to topical tacrolimus were recorded.
Results: Topical tacrolimus was effective in all Fitzpatrick skin types, with superior efficacy on body lesions in individuals of Fitzpatrick types 3-4 (Fisher exact test, P=0.03). Further, individuals with Fitzpatrick type 3-4 skin had shorter interval to >75 percent improvement of lesions on the body (Kaplan-Meier Log-rank, P=0.03) and head and neck (P=0.016).
Conclusion: Topical tacrolimus is an effective treatment for vitiligo irrespective of skin tone, with greatest benefit in Fitzpatrick type 3-4 skin. Repigmentation of lesions on the head and neck is superior to repigmentation of the body and extremities in all racial subgroups.
J Drugs Dermatol. 2011;10(5):507-510.
Eruptive Squamous Cell Carcinomas With Keratoacanthoma-like Features in a Patient Treated with Sorafenib
J Drugs Dermatol. 2011;10(3):308-310.
Maritza Perez MD, Janiene Luke MD, Anthony Rossi MD| |
Melasma is an acquired skin condition characterized by irregular brown or hyperpigmented patches typically located on the forehead, cheeks, nose, chin and upper lip. The pathogenesis of melasma is not completely understood, but is thought to be influenced by genetics, UV exposure, thyroid dysfunction and hormonal influences from either pregnancy or hormonal therapeutic medications. Peoples of Latin descent comprise a vast array of skin colors and skin phototypes. Similarly, disorders of pigmentation, particularly melasma, occur more frequently in people of Latin descent when compared to the general population. Melasma can be particularly distressing to patients and has been shown to impact a patient's quality of life in several studies. These factors can raise significant quality of life issues and therefore treatment is not only significant for improving patient clinical outcomes, but is crucial in improving important psychological and emotional aspects of patients' overall well being. This article provides a stepwise approach to the treatment of melasma based on current literature recommendations.
J Drugs Dermatol. 2011;10(5):517-523.
Stanislav N. Tolkachjov MD,a Philip Y. Sun MS,b and Alina G. Bridges DOa| |
Pyoderma gangrenosum (PG) is a neutrophilic, ulcerative dermatosis that can develop at sites of cutaneous trauma, including surgical incisions, a phenomenon known as pathergy. The characteristic lesion is a painful, rapidly expanding ulceration with a violaceous undermined border.1 A biopsy taken from the expanding violaceous border shows predominantly neutrophilic dermal inflammation with neutrophilic abscess formation.
The etiology of PG appears to be variable among patients, as about a half of the reported cases are associated with systemic disease such as inflammatory bowel disease, rheumatoid arthritis, or myeloproliferative disorders, while the other half seem to be idiopathic.2 PG is difficult to diagnose as other etiologies, including infectious, vasculitic, and other inflammatory dermatoses, must be excluded.1 Histopathologic and biochemical markers of PG, such as dermal neutrophilic infiltrate or overexpression of interleukin-8,3 respectively, are not pathognomonic. Given that several drugs, such as hydralazine, mesalamine, and sunitinib, are reportedly associated with PG, failure to recognize this association and stop these medications may delay diagnosis and therapy. We report a case of idiopathic postoperative PG following video-assisted thoracic surgery (VATS).
J Drugs Dermatol. 2017;16(7):711-713.
Richard R. Winkelmann DO,a James Del Rosso DO FAOCD,b and Darrell S. Rigel MD MSc| |
J Drugs Dermatol. 2015;14(3):254-259.
Transitioning From Brand to Generic With Topical Products and the Importance of Maintaining the Formulation and Therapeutic Profiles of the Original Product: Focus on Clocortolone Pivalate 0.1% Cream
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2014;13(suppl 7):s77-s83.
Efstathios Rallis MD, Afrodite Economidi MD, Constantinos Verros MD, Pavlos Papadakis MD| |
Richard L. Gallo MD PhD,a Vivian W. Bucay MD,b Ava T. Shamban MD,c Janice Lima-Maribona DO,d Amy B.
Lewis MD,e Cherie M. Ditre MD,f Flor A. Mayoral MD,g Michael H. Gold MDh
J Drugs Dermatol. 2015;14(7):669-674.
Leon Kircik MD| |
Objective: To evaluate the efficacy and safety of treating vitiligo patients with anti-TNF-α agents.
Methods: A total of 6 patients were recruited. All patients had widespread non-segmental vitiligo. Biologics, including infliximab, etanercept, and adalimumab, were given according to treatment regimens used for psoriasis. Photographs were taken at the initial visit, every two months during the therapy and then six months after therapy completion.
Results: All patients completed the treatment; two patients were treated with infliximab, two with etanercept, and two with adalimumab. All of the biologics were well tolerated throughout the treatment period, and none of the patients reported any significant adverse events. Digital images were compared before, during and after treatment. Repigmentation of the vitiliginous areas was not observed in any of the patients. Vitiligo worsened in one patient who was treated with infliximab and developed a psoriasiform rash. However, the remaining patients did not develop any new depigmented patches during treatment or at the six-month follow-up; vitiligo was considered stable in these five patients.
Conclusions: Although the anti-TNF-α agents were well tolerated in all six vitiligo patients, efficacy was not observed. Further evaluation with larger studies may be required.
J Drugs Dermatol. 2012;11(4):534-539.
The Sequence of Inflammation, Relevant Biomarkers, and the Pathogenesis of Acne Vulgaris: What Does Recent Research Show and What Does it Mean to the Clinician?
James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2013;12(suppl 8):s109-s115.
Neil S. Sadick MD, Michel Le Maître MD, Christine Coutanceau MS,Vincent Sibaud MD, Christelle Merial-Kieny PhD| |
Sean D. Doherty MD, Sylvia Hsu MD| |
Methods: The medical records of 48 patients treated with thalidomide at Baylor College of Medicine (Houston, TX) were retrospectively reviewed to determine the conditions treated with thalidomide, dosing, effi cacy, treatment duration, side effects, adverse events, and reason for discontinuing therapy.
Results: Forty-eight patients (men=18, women=30) with a mean age of 49.6 years (range: 20-79) were included in this study. Patients were treated for prurigo nodularis, discoid lupus erythematosus, tumid lupus erythematosus, subacute cutaneous lupus erythematosus, systemic lupus erythematosus, lichen planus, lichen planopilaris, cutaneous sarcoidosis, and prurigo nodularis. All conditions were refractory to standard therapy. Patients were treated for a mean of 7.5 months (range: 3 days to 70 months). In most of the disorders, a majority of patients experienced clinical improvement. The most common reason for discontinuation of therapy was side effects, the most frequent being peripheral neuropathy.
Limitations: This study was limited by being retrospective in nature.
Conclusion: Thalidomide effectively treats some dermatologic conditions that are refractory to standard medications. There are inconveniences associated with obtaining the medication and it is expensive. Physicians must be vigilant for possible side effects, especially peripheral neuropathy.
The Current State of Dermatologists’ Familiarity and Perspectives of Biosimilars for the Treatment of Psoriasis: A Global Cross-Sectional Survey
Iviensan F. Manalo MD,a Kathleen E. Gilbert MD,b and Jashin J. Wu MDc| |
BACKGROUND: Biologic patent expiration, accelerated approval pathways, and business interests of third party payers and the biopharmaceutical industry are driving the development of biosimilars to treat immune-mediated disorders like psoriasis. No studies have investigated dermatologists’ familiarity and perspectives of biosimilars.
OBJECTIVES: To assess: (1) dermatologists’ familiarity with biosimilars and interchangeability and (2) their perspectives toward biosimilar properties, including interchangeability, indication extrapolation, and immunogenicity risk.
METHODS: For this prospective survey study, we distributed electronic and paper questionnaires to dermatologists from selected societies and attendees at the 73rd annual American Academy of Dermatology meeting between March 20, 2015 and May 30, 2015. Primary outcome was dermatologists’ familiarity with biosimilars. Secondary aims included dermatologists’ confidence in biosimilar efficacy and safety, familiarity concerning the concept of interchangeability and perspectives regarding indication extrapolation, interchangeability, and immunogenicity risk.
RESULTS: Of the 116 total dermatologists who completed the questionnaire, 73 (62.9%) were slightly to very unfamiliar with biosimilars. On a 5-point Likert scale, dermatologists were somewhat to very concerned with the practice of interchangeability (3.4±1.1) and slightly uncomfortable to fairly comfortable in prescribing biosimilars for an extrapolated indication (3.3±1.0).
CONCLSUIONS: Our survey identified that the majority of dermatologists were unfamiliar with biosimilars. Dermatologists were consistently concerned regarding safety issues surrounding the practice of interchangeability without provider knowledge.
J Drugs Dermatol. 2017;16(4):336-343.
Ann G. Martin. MD| |
Background: South Asians represent a rapidly growing part of the U.S. population, increasing 188 percent from 1990 to 2000 (0.27% to 0.78%). Studies investigating the epidemiology of skin disorders in South Asian Americans are lacking.
Objective: We sought to determine common skin conditions and concerns among this population.
Methods: This was a community-based survey study. The IRB-approved survey tool was distributed to South Asians adults in the New York City area. All data was self-reported.
Results: 190 surveys were completed. 54 percent of responders were female and 46 percent were male. The age of participants ranged from 18-74 years. The respondents were predominantly foreign born (76%), but a large minority (32%) reported living in the U.S. for over 20 years. Nearly half (49%) of the study population reported having visited a dermatologist in the past. The five most common dermatologic diagnoses included: acne (37%), eczema (22%), fungal infection (11%), warts (8%) and moles (8%). The five most common concerns included: dry skin (25%), hair loss (22%), uneven tone (21%), dark spots (18%) and acne (17%).
Conclusions: Our results suggest that the leading skin conditions and concerns in South Asian Americans are similar to those reported in other populations with skin of color.
J Drugs Dermatol. 2011;10(5):524-528.
Vitamin A and Its Derivatives in Experimental Photocarcinogenesis: Preventive Effects and Relevance to Humans
Stanley S. Shapiro PhD,a Miri Seiberg PhD,b and Curtis A. Cole PhDc| |
J Drugs Dermatol. 2013;12(4):458-463.
Anjana Ray PhD,a,* Breanne Mordorski BA,b,* Angelo Landriscina BA,b Jamie Rosen BA,b Joshua Nosanchuk MD,a,c and Adam Friedman MDd| |
J Drugs Dermatol. 2016;15(7):836-840.
Pearl E. Grimes MD| |
OBJECTIVE: To assess the efficacy and safety of bimatoprost 0.03% alone and in combination with a topical steroid (mometasone) compared with mometasone alone in patients with nonsegmental vitiligo on nonfacial areas in a proof-of-concept study.
METHODS: This randomized, double-blind, controlled study was conducted over a 20-week treatment period. Patients were randomized to 1 of 3 treatment groups: bimatoprost monotherapy (n=11), bimatoprost plus mometasone (n=10), and mometasone plus placebo (n=11). The primary outcome was global response at week 20, based on an investigator’s assessment of improvement score of at least 5 (at least 50%–75% improvement from baseline) on an 8-point scale (0=worse; 7=cleared). Other outcomes included global response at other visits, response by anatomic site, change from baseline lesion severity (overall and by site), and safety.
RESULTS: Because of a lack of response observed for the primary end point, a post hoc analysis with a less stringent definition of response (score of ≥4 [25%–50% improvement]) was conducted. In this analysis, 46% of the bimatoprost plus mometasone group responded overall compared with 18% in the bimatoprost monotherapy group, and no patients in the mometasone plus placebo group. Greater response rates were observed in both bimatoprost groups compared with the mometasone plus placebo group starting at week 12. There were no differences among groups in signs and symptoms of irritation.
CONCLUSIONS: Bimatoprost alone or with mometasone provided greater repigmentation than treatment with mometasone alone. Larger studies that also assess facial lesions are warranted.
J Drugs Dermatol. 2016;15(6):703-710.
Stephanie J. Kang DO,a Scott A. Davis MA,a Steven R. Feldman MD PhD,a,b,c and Amy J. McMichael MDa| |
OBJECTIVE: To determine whether racial or ethnic groups are treated differently for dyschromia. The secondary objective is to discover the main treatments used and determine trends over time in demographics.
METHODS: We searched the 1993-2010 National Ambulatory Medical Care Survey (NAMCS) for visits associated with a diagnosis of dyschromia (ICD-9 codes 709.00 or 709.09). The demographics and leading treatments were tabulated, and trends over time were assessed by linear regression.
RESULTS: There were about 24.7 million visits for dyschromia over the 18-year period. Among 5,531,000 patients with the sole diagnosis of dyschromia, there were 2,800 visits from females and 1,200 visits from males per 100,000 population. Females were more likely to receive prescription combination therapy for dyschromia than males by a ratio of 10 to 1. Leading treatments overall prescribed by dermatologists included hydroquinone, topical corticosteroids, and retinoids. Asians were 27% more likely to receive a combination therapy than non-Asians. African Americans and Hispanics were less likely to have a procedure performed for dyschromia.
LIMITATIONS: Data are based on a number of ambulatory care visits, which does not allow direct estimation of prevalence.
CONCLUSIONS: Dyschromia is a significant concern for many patients, and this is especially true among patients of color. Treatment for dyschromia is influenced by skin type, and thus ethnic or racial groups are treated differently. Studies have shown that combination therapy may offer better results than a single medication for hyperpigmentation disorders. Combination agents may be underutilized in African Americans and Hispanics for dyschromia.
J Drugs Dermatol. 2014;13(4):401-406.
Wendy E. Roberts MD| |
J Drugs Dermatol. 2014;13(4):472-482.
Lawrence F. Eichenfield MD and Sheila Fallon Friedlander MD| |
Fungal infection of the nails is an increasingly recognized disease in infants and children. However, it can be difficult to distinguish clinically from other nail dystrophies. In addition, many mistakenly believe that onychomycosis does not occur in childhood. Under-recognition of this infectious disorder therefore occurs. Although many consider “nail fungus” a trivial cosmetic concern, it can lead to discomfort, risk of secondary infection, and a more significant health threat in immunocompromised or diabetic individuals. It should always be considered in the differential diagnosis of nail plate disorders in children as it is one of the more common causes.
Here we review the latest data on prevalence of the disease, reasons for its relatively low incidence compared with adults, and important predisposing factors. It is important to confirm the clinical diagnosis of onychomycosis in children, and affected individuals should be examined for concomitant tinea pedis. As familial disease often occurs, it is important to check parents and siblings as well for onychomycosis and tinea pedis.
Treatment of onychomycosis is challenging, and recurrence appears to be more common in children than in adults. Prolonged systemic antifungal therapy is commonly required. However, pediatric practitioners and parents alike hesitate when asked to treat young children with a systemic drug that requires laboratory monitoring and can have systemic toxicities. Due to their thinner, faster-growing nails, children are theoretically more likely to respond to topical monotherapy than adults, and therefore good candidates for topical antifungal therapy.
The clinical data on the use of topical antifungals in pediatric onychomycosis is scarce. We review data that exist from case reports and small clinical trials. New topical antifungals are now available that afford better nail penetration and additional delivery routes to the site of infection. Pediatric trials are now on-going, and should clarify the usefulness of these agents in children.
J Drugs Dermatol. 2017;16(2):105-109.
Blockade of Melanin Synthesis, Activation and Distribution Pathway by a Nonprescription Natural Regimen Is Equally Effective to a Multiple Prescription-Based Therapeutic Regimen
Carl Thornfeldt MD,a,b Ronald L. Rizer PhD,c Nathan S. Trookman MDd| |
OBJECTIVE: To measure the effectiveness of a novel blend of primarily natural ingredients that inhibits all but one of the steps in melanin synthesis, activation and distribution. Three common types of HP were treated and compared with one of the most commonly prescribed available regimens. This comprises two prescription products and two nonprescription products containing known depigmenting lightening ingredients.
MATERIALS and METHODS: The initial trial consisted of 56 females of 3 different races were treated in a 3-armed parallel, investigatorblinded prospective controlled clinical trial of 18 weeks duration. The treatment phase was 12 weeks long, followed by a 6 week, nontreatment regression phase. This trial was conducted in the winter at over 6,000 feet above sea level. The natural ingredient (NI) blend consists of two cosmeceutical products together containing 22 ingredients. A second 1-year open trial of 31 panelists of 3 races was instituted to document continual improvement using both NI products without irritation and sensitization.
RESULTS: The novel herbal blend regimens had comparable efficacy in treating HP and preventing rebound of mottled HP, dyschromia and melasma as the commercial regimen containing two prescription products. The 12-month open study demonstrated continued visible improvement of the HP with NI regimens without irritation and sensitization.
CONCLUSION: The novel primarily natural ingredient product regimens are equally effective in treating three types of cutaneous HP as is a regimen containing prescription hydroquinone 4%, tretinoin 0.05% and two nonprescription leave on products.
J Drugs Dermatol. 2013;12(12):1449-1454.
Clinical Efficacy and Safety of a Multimodality Skin Brightener Composition Compared With 4% Hydroquinone
Elizabeth T. Makino BS CCRA MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa| |
J Drugs Dermatol. 2013;12(3 suppl 1):s21-s26.
Methods: This study was conducted to assess the effect of systemic isotretinoin on the serum level of folic acid. Sixty-one patients, including 38 women and 23 men (mean age 23.6 ± 6 years) with severe or moderate acne that was resistant to conventional treatments, were supplemented with 0.5 mg/kg/d of oral isotretinoin for 30 days. They were instructed not to use any other drugs having an effect on the folic acid level nor change their diet. The serum levels of folic acid were measured at the baseline and at the end of the treatment period. Statistical analyses were carried out using the paired t test.
Results: Mean levels of folic acid were 26.75 ± 9.42 nmol/L at baseline, and and 23.6 ± 8.42 nmol/L after 30 days of isotretinoin supplementation. This showed a significant decrease in the serum level of folic acid (P=.008).
Conclusion: Given the significant decrease in the serum level of folic acid following a 30-day use of oral isotretinoin in acne patients, and considering the important role of folic acid in metabolic functions, we recommend further studies to assess the effect of longer periods of isotretinoin treatment, in addition to studies including other relevant factors in folic acid metabolism (e.g., serum homocysteine levels). Moreover, folic acid supplementation in acne patients using isotretinoin is recommended.
J Drugs Dermatol. 2012;11(9):e23-e24.
Clinical Efficacy and Safety of a Multimodality Skin Brightener CompositionCompared With 4% Hydroquinone
Elizabeth T. Makino BS MBA,a James H. Herndon Jr. MD,b Monya L. Sigler PhD,b Vincent Gotz MS MBA,c John Garruto BS,a and Rahul C. Mehta PhDa
aSkinMedica, Inc, Carlsbad, CA bThomas J. Stephens & Associates, Inc, Carrollton, TX cProPharmaCon, LLC, Carlsbad, CA
J Drugs Dermatol. 2012;11(12):1478-1482.
Efficacy and Tolerability of Two Commercial Hyperpigmentation Kits in the Treatment of Facial Hyperpigmentation and Photo-Aging
Objective: This investigator-blinded, randomized trial was undertaken to compare two commercial hyperpigmentation systems (kits) used for the treatment of facial hyperpigmentation and photo-aging.
Methods: Female subjects with at least mild facial hyperpigmentation and photo-aging were randomized to treatment with either the four product SkinMedica (SKM) regimen or the 7-product Obagi (OMP) regimen. Evaluations were conducted at baseline, 4, 8, and 12 weeks. Subjects were evaluated by the blinded investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs were taken at baseline and week 12. Self-assessment questionnaires were completed at week 12. Thirty-five females (SKM=17, OMP=18) completed the 12-week study.
Results: Both treatment regimens showed a significant improvement at week 12 (compared to baseline) for Overall Hyperpigmentation, Global Photo-aging and Sallowness. At week 12, there was no significant difference between treatment groups in Global Response to Treatment. Tolerability was good for both regimens based on investigator assessments. Subject self-assessments showed no consistent differences in efficacy between the two regimens. Similarly, there was no significant difference in subject satisfaction or intent to continue use between the two regimens.
Conclusion: This clinical study demonstrated that both systems were equally effective at reducing hyperpigmentation and global photo-aging in females with mottled pigmentation and photodamaged facial skin.
J Drugs Dermatol. 2012;11(8):964-968.
Suzanne Bruce MD| |
OBJECTIVE: The skin brightening complex was studied for efficacy and tolerability in subjects with moderate to severe facial hyperpigmentation.
METHODS: Subjects were instructed to apply skin brightening complex to the entire face twice daily and to follow a standard skin care regimen (facial cleanser, moisturizer, and sunscreen) during the course of the study. The study was conducted over a 12-week period and consisted of evaluation visits at baseline and at weeks 4, 8, and 12. At each visit, subjects were evaluated by an investigator for clinical efficacy and tolerability using grading scales. Standardized digital photographs and spectrophotometric assessments were also taken. Self-assessment questionnaires were completed at weeks 4, 8, and 12. To assess longer-term safety and efficacy, 10 subjects elected to continue treatment for an additional 12 weeks (24 weeks total), with evaluations at weeks 18 and 24.
RESULTS: Twenty-six subjects completed the 12-week study, and 8 subjects completed treatment for an additional 12 weeks (24 weeks in total). In the 12-week study, the skin brightening complex was shown to be effective and significantly improved Overall Hyperpigmentation at weeks 4, 8, and 12 compared with baseline. The skin brightening complex also significantly improved the Mottled Pigmentation Area and Severity Index ([MoPASI], a modified Melasma Area and Severity Index [MASI] scale) at weeks 8 and 12 compared with baseline. These efficacy benefits continued at 24 weeks. The product was well tolerated at all evaluation visits. Subject questionnaires showed 80% or more of the subjects reporting pigmentation improvement and satisfaction with the skin brightening complex at all evaluation visits.
CONCLUSION: This HQ-free skin brightening complex was effective and well tolerated in subjects with facial hyperpigmentation who were treated for as long as 24 weeks.
J Drugs Dermatol. 2013;12(3 suppl 1):s27-s31.
Home-Based Wrinkle Reduction Using a Novel Handheld Multisource Phase-Controlled Radiofrequency Device
Neil S. Sadick MD,1 Yoram Harth MD,2,3 Andrew S. Dorizas MD,6 Hanna Levy PhD,4 and Avner Shemer MD5| |
PATIENTS AND METHODS: A total of 69 participants (age 54.3 years ± 8.09; age range 37-72 years) were enrolled in the study after meeting all inclusion/exclusion criteria (100%) and providing informed consent. Participants were provided with the tested device together with a user manual and treatment diary, to perform independent treatments at home for 4 weeks. The tested device, (Newa™, EndyMed Medical, Cesarea, Israel) emits 12 W of 1Mhz, RF energy through six electrodes arranged in a linear fashion. Independent control of RF polarity through each one of the 6 electrodes allows significant reduction of energy flow through the epidermis with increased dermal penetration. Participants were instructed to perform at least 5 treatments a week, for one month. Four follow-up visits were scheduled (once a week) during the period of independent treatments at home, following 4 weeks of home treatments, 1 month follow-up visit (1 month after treatment end) and at 3 months follow-up (3 months following treatment end).
Analysis of pre-and post treatment images was conducted by three uninvolved physicians experienced with the Fitzpatrick Wrinkle and Elastosis Scale. Fitzpatrick Wrinkle and Elastosis score of each time point (4 weeks following home use treatments; 1 month follow-up, 3 months follow-up) was compared to baseline.
Participants were asked a series of questions designed to explore usability concerns and level of satisfaction regarding the device use and subjective efficacy.
RESULTS: Altogether, 62 subjects completed the study course and follow-up visits. No unexpected adverse effects were detected or reported throughout the independent treatment. All study participants did not experience any difficulties while operating the tested device for independent wrinkle reduction treatments. Photographic analysis of pre- and post-one month of independent home use treatments, and one and three months follow-up after end of treatment course, was conducted by three uninvolved board certified dermatologists. Analysis of results revealed improvement (downgrade of at least 1 score according to the Fitzpatrick scale) in 91.93%, 96.77%, and 98.39% of study subjects (according to the first, second, and third reviewer, respectively). Results were found to be statistically significant. The majority of study participants were very satisfied from the results of the independent treatment using the tested device for wrinkle reduction.
J Drugs Dermatol. 2014;13(11):1342-1347.
Tina Rendini RN and William Levis MD| |
Christopher S. Hale MDa and William R. Levis MDb| |
Edith Bowers MD PhD| |
Jeffrey F. Scott MD, Danyelle Dawes MD, and Kevin D. Cooper MD| |
Program Spotlight: The USF Department of Dermatology and Cutaneous Surgery Residency Training Program
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the USF Department of Dermatology and Cutaneous Surgery Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi MD PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com.
Nicholas A. Soter MD| |
Joshua W. Hagen MD PhDa and William R. Levis MDb| |
Resident Rounds. Part III B: Tumor Necrosis Factor-α Antagonists and Alopecia Areata: A Class-Wide Adverse Effect
James L. Griffith MS,a Johnathan J. Ledet MD,b Boni E. Elewski MDb| |
J Drugs Dermatol. 2012;11(9):1117-1118.
Charlene Lam MD MPH, Jeffery J. Miller MD MBA, and Joslyn S. Kirby MD| |
The authors report a female patient with recalcitrant ulcerated necrobiosis lipoidica (NL) that was resistant to numerous systemic agents and who responded to treatment with intravenous immunoglobulin (IVIG), leading to resolution of the ulcerated areas for several months. Subsequent treatment with two further courses of IVIG was less effective, but a course of intravenous methylprednisolone led to regression of the lesions. As well as briefly reviewing the literature on treatments used to treat ulcerated NL, we outline the pathological mechanisms thought to be involved in the condition and how the modes of action of IVIG might explain its apparent efficacy in this case. As far as we are aware, the response of ulcerated NL to IVIG or methylprednisolone has not been reported previously, although other systemic preparations of corticosteroids have been used.
J Drugs Dermatol. 2012;11(2):256-259.
Johanna Sheu MS,a Susan V. Kattapuram MD,b James M. Stankiewicz MD,c and Joseph F. Merola MD MMScd| |
OBSERVATIONS: We present a case of a 36-year-old male treated with oral dimethyl fumarate for 16 weeks who developed a bilateral eosinophilic fasciitis-like disorder of the thighs. Magnetic resonance imaging revealed a fluid collection in the fascial plane and histopathologic examination revealed an inflammatory infiltrate with dermal and subcutaneous edema and sclerosis consistent with eosinophilic fasciitis. We discuss studies reporting peripheral eosinophilia with fumaric acid medications as well as the literature exploring possible mechanisms.
CONCLUSIONS: With the anticipated widespread use of dimethyl fumarate for multiple sclerosis patients, it is important for practitioners to recognize the symptoms of eosinophilic fasciitis and be aware of a possible association of oral dimethyl fumarate treatment with the development of an eosinophilic fasciitis-like disorder.
J Drugs Dermatol. 2014;13(9):1144-1147.
Andrew F. Alexis| |
Adam B. Blechman MD,a Christine E. Cabell MD,b Christine H. Weinberger MD,c Anna Duckworth MD,d Justin J. Leitenberger MD,e Fiona O. Zwald MD,f and Mark A. Russell MDg| |
The Food and Drug Administration approved Ruxolitinib in 2011 for the treatment of primary myelofibrosis. Five-year safety data showed a higher incidence of skin cancer in patients treated with Ruxolitinib compared to best available therapy for myelofibrosis. This report presents a series of five patients with history of myelofibrosis treated with Ruxolitinib who subsequently developed numerous skin cancers with aggressive biological behavior. Each patient in this report was treated by a Mohs surgeon affiliated with an academic institution. All patients had a history of myelofibrosis and were exposed to Ruxolitinib. Some patients were exposed to other immunomodulatory medications such as Hydroxyurea and Rituximab. The total number of skin cancers and skin cancers with particularly aggressive behavior were noted. All five patients in this series developed numerous skin cancers with aggressive biological behavior during or after therapy with Ruxolitinib. Also, one patient developed lentigo maligna melanoma and another developed metastatic undifferentiated pleomorphic sarcoma. The repeat observation of skin cancers with aggressive features during JAK inhibitor treatment suggests that these medications may promote cutaneous malignant transformation in at risk patients. Further surveillance and testing of JAK kinases regarding the risk of skin cancers is indicated.
J Drugs Dermatol. 2017;16(5):508-511.
Resident Rounds: Part I: Program Spotlight: The University of California, Irvine Department of Dermatology Residency Training Program
Nazanin Saedi MD, Amy Reinstadler MD, Sam Truong MD, Kristen Kelly MD| |
Resident Rounds is a new section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds will feature three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of California, Irvine Department of Dermatology Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. Dr. Ibrahimi is a recent graduate of the Harvard Combined Program in Dermatology and currently a fellow in Mohs, Laser and Cosmetic Surgery at the University of California Davis. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at email@example.com
Shawn Shetty MD and A. Razzaque Ahmed MD DSc| |
J Drugs Dermatol. 2013;12(6):672-677.
Thomas Lee MD, Julia Schwartz MD| |
Progressive Multifocal Leukoencephalopathy and Reversible Progressive Leukoencephalopathy Syndrome in Dermatologic Therapy
Barry Ladizinski MD,a Misha M. Heller BA,b Tina Bhutani MD,c Kristine B. Zitelli MD,c and John Y. M. Koo MDc| |
J Drugs Dermatol. 2013;12(2):e20-e24.
Joel Wolf BA and William R. Levis MD| |
Daniel Y. Sugai MD,a Cheryl J. Gustafson MD,a Jacqueline F. De Luca MD,a Scott A. Davis MA,aJoseph L. Jorizzo MD,a Kenneth S. O'Rourke MD,b and Steven R. Feldman MD PhDa,c,d| |
OBJECTIVE: The objectives for this study were to evaluate trends in the medications prescribed for the management of lupus erythematosus (LE) and to assess how treatment varies among different specialists.
METHODS: Outpatient visits for treatment of lupus and its comorbidities were identified in the National Ambulatory Medical Care Survey (NAMCS), a representative survey of visits to physician offices in the United States. Data was evaluated to determine patient demographics, treatments prescribed by each specialty, and comorbidities encountered during the study period of 1993-2010.
RESULTS: From 1993-2004, prednisone was the most frequently prescribed medication; however, prednisone became the second most frequently prescribed medication in 2005-2010, as hydroxychloroquine became the leading medication prescribed for LE. In primary care physicians and other non-dermatology specialists, the most frequently prescribed medications for lupus were prednisone and hydroxychloroquine; whereas, hydroxychloroquine and triamcinolone were the top two medications preferred by dermatologists.
LIMITATIONS: The NAMCS collects cross-sectional data, such that individual patients cannot be followed over time. Hence, it does not provide data regarding the incidence of disease, patient age at the time of diagnosis, change in individual patient’s medication regimens over time, or prognosis related to patient demographics. In addition, it is possible that the physician did not always record nonprescription medication use, such as NSAIDS, since these are typically used first line.
CONCLUSION: First-line treatment of LE changed minimally from 1993 to 2010, with prednisone and hydroxychloroquine serving as the primary medications utilized by most physicians for the management of LE.
J Drugs Dermatol. 2014;13(5):545-552.
Material and Methods: sixty AD patients were included in a randomized, double-blind, placebo-controlled trial study. They were randomly divided into two groups and treated for 60 days: group vitamin D (n=30), and placebo group (n=30). The two groups were as follows: Group D, 1600 IU cholecalciferol (vitamin D) and second group placebo. The severity of AD was evaluated based on SCORAD (Scoring Atopic Dermatitis) and TIS (Three Item Severity score) value by the same trained physician before and after the trial.
Results: According to SCORAD and TIS value index in the vitamin D group showed significant improvement in patients with mild, moderate and severe AD (P<0.05) and in patients who the intake placebo, this improvement didn't showed (P>0.05).
Conclusion: Results mention that supplementation with oral vitamin D dramatically improved disease severity in AD patients.
J Drugs Dermatol. 2012;11(3):327-330.
Ali Alikhan MD and Alison J. Bruce MBBS| |
Hussein M. Hassab El Naby MD,a Mohamed R. Alnaggar MD,a Mahmoud F. Abdelhamid MD,b
Khadiga Alsaid MD,c Eslam M. Al Shawadfy MD,b and Mohamed L. Elsaie MD MBAb
J Drugs Dermatol. 2015;14(4):359-364.
Sandeep S. Saluja MD and Scott R. Florell MD| |
Robin Lewallen, MD| |
Pterygium Inversum Unguis: Report of an Extensive Case With Good Therapeutic Response to Hydroxypropyl Chitosan and Review of the Literature
Roberta Marinho Falcão Gondim MD PhD,a,b Pedro Bezerra da Trindade Neto MD PhD,a and Robert Baran MDc| |
J Drugs Dermatol. 2013;12(3):344-346.
Resident Rounds: Part I - Program Spotlight: Department of Dermatology, University Hospitals Case Medical Center
Jeffrey F. Scott MD, Ashley Feneran DO, and Kevin D. Cooper MD| |
J Drugs Dermatol. 2012;11(3):385-389.
Dalia G. Aly MD,a Ihab Y. Abdallah MD,b Noha S. Hanafy MD,a Mohamed L. Elsaie MD,a,c and Neveen A. A. Hafizd| |
Aim: To evaluate the possible relationship between serum leptin in nonobese patients with psoriasis and other randomly selected skin diseases.
Subjects and methods: Eighty subjects (40 patients with psoriasis, 20 patients with other randomly selected skin diseases, and 20 healthy controls) were included in the study. Fasting serum leptin levels of the study groups were examined by sandwich enzyme-linked immunosorbent assay.
Results: Elevated serum leptin levels were detected in both nonobese patients with psoriasis (P=.004) and those with other randomly selected skin diseases (P=.05). Leptin levels failed to correlate to the Psoriasis Area and Severity Index score of psoriatic patients. Both sexes demonstrated comparable levels of serum leptin in psoriatic patients, while female patients suffering from other skin diseases showed higher levels of serum leptin than did males of the same group.
Conclusion: Leptin may play a role in the immunopathogenesis of psoriasis and other skin diseases, even in the absence of obesity as a cofactor.
J Drugs Dermatol. 2013;12(2):e25-e29.
Lawrence F. Eichenfield MD| |
Papulonodular Mucinosis in a Patient With Systemic Lupus Erythematosus and Antiphospholipid Syndrome
Sheetal Desai MD, Dorota Z. Korta PhD, Rishi R. Patel MD, and Miguel R. Sanchez MD| |
J Drugs Dermatol. 2014;13(5):621-623.
Melanie R. Clemenz MD, Joseph Wilson McGowan IV MD, Marshall J. Shuler MD, and Annette W. Lynn MD| |
J Drugs Dermatol. 2013;12(1):111-113.
Meng Chen MD, Michael J. Holland MD, Mohsin R. Mir MD, Michael G.Wong BA, Brian P. Kelley MD, Kelli D. Grim MD, Sunaina S. Bhuchar MD, Sylvia Hsu MD| |
J Drugs Dermatol. 2011;10(3):280-284.
Catherine Warner BS, Young Kwak BA, Mary H.B. Glover MD, and Loretta S. Davis MD| |
J Drugs Dermatol. 2014;13(3):360-362.
A Case of Erythema Elevatum Diutinum With Pancytopenia: Focus on Dapsone-Induced Hematologic Side Effects and Colchicine as a Safe Treatment Option
Emek Kocatürk MD, Bachar Memet MD,
Ilteris Oguz Topal MD, Tülin Yüksel MD,
Pelin Kuteyla Ülkümen MD, Utkan Kızıltaç MD
Alex M. Glazer MD,a Bryan D. Sofen MD,b Darrell S. Rigel MD,c and Jerome L. Shupack MDc| |
Generalized essential telangiectasia (GET) is a notoriously difficult to treat disorder with no current satisfactory treatments. This case and discussion report the use of 6-mercaptopurine (6-MP) as a successful treatment for GET. Moreover, we show that GET may represent a state of increased angiogenesis, a paradigm shift from the current understanding that these telangiectasias represent dilatations of only pre-existing vessels. This new view of GET may drive others to look at novel agents for treatment.
J Drugs Dermatol. 2017;16(3):280-282.
Heather Kiraly Orkwis DO, Craig Cattell MD, and Jessica Ghaferi MD| |
Geoffrey F. S. Lim BS,a Catherine Y. Ding MD,b Katy Burris MDb| |
J Drugs Dermatol. 2014;13(6):755-757.
Adjunctive Trichloroacetic Acid Therapy Enhances Response to Squaric Acid Response to Verruca Vulgaris
J Drugs Dermatol. 2012;11(10):1228-1230.
Reproducible Novel Transcriptional Differences Between Psoriatic Lesional and Non-Lesional Skin Show Increased Inflammation and Metabolism
Daniel J. Aires MD JD,a Graham Rockwell PhD,b Alan Menter MD,c Colton Nielson,d Jo Wick PhD,e Stephanie Sedivy MD,f Ossamma Tawfik MD PhD,g Anne Bowcock PhD,h and Animesh A. Sinha MD PhDi| |
OBJECTIVE: To reproducibly assess single-gene transcriptional changes in psoriatic skin.
METHODS: We evaluated 210 top candidate genes from a first psoriasis study group (population 1), and then confirmed differential expression in a second independent psoriasis study group (population 2).
RESULTS: One hundred and thirty-eight differentially expressed genes were replicated in the 2 studies, of which 57 have not previously been reported as associated with psoriasis. This is significantly greater than the 10 expected false positives. Lesional skin vs uninvolved areas showed inflammatory and cell regulation changes.
CONCLUSION: Previously undescribed psoriasis-associated genes revealed in this study may provide potential future targets for development and assessment of novel therapeutic agents for psoriasis.
J Drugs Dermatol. 2015;14(8):794-800.
Short-Term and Low-Dose Oral FluconazoleTreatment Can Cause Stevens-JohnsonSyndrome in HIV-Negative Patients
Efi Pasmatzi MD, Alexandra Monastirli MD,Sophia Georgiou MD, George Sgouros MD, Dionysios Tsambaos MD PhD| |
Thomas Beachkofsky MD and W. Chad Cragun MD FAAD| |
Anne Goldsberry MD MBA, C. William Hanke MD MPH, Katherine E. Hanke
Laser and Skin Surgery Center of Indiana, Carmel, IN
OBJECTIVE: We also sought to evaluate whether the VISIA Complexion Analysis System (Canfield Imaging Systems, Fairfield, NJ) could be a tool to help patients better understand their skin complaints.
METHODS: Twenty-one consecutive women were recruited for VISIA analysis. Each subject underwent VISIA analysis and completed a follow up survey.
RESULTS: 86% of respondents reported that the VISIA analysis helped them understand their initial concern. 86% noted that the VISIA brought other skin problems to their attention. 100% of the subjects responded that they would recommend VISIA analysis to others. 62% of subjects responded that they would prefer to go to a practice with a VISIA system in comparison to a practice without VISIA.
CONCLUSION: The VISIA Complexion Analysis System is a beneficial tool for dermatology and aesthetic practices with the potential to aid in patient education.
Anna Kurayev MD and Alice B. Gottlieb MD PhD| |
J Drugs Dermatol. 2016;15(10):1267-1269.
Camila Antia MD, Leah Persad DO, Ali Alikhan MD| |
J Drugs Dermatol. 2017;16(10):1043-1046.
Modulation of Cytokine and Nitric Oxide Production by Keratinocytes, Epithelial Cells, and Mononuclear Phagocytes in a Co-Culture Model of Inflammatory Acne
Objective: This study was conducted to quantitatively assess the products secreted by human epithelial keratinocytes in the presence and absence of macrophages/monocytes.
Methods: Cells were exposed to UVB radiation (50 mJ to 200 mJ per cm2) or treated with bacterial lipopolysaccharide (LPS) as stimulator of inflammatory response. Nitric oxide (NO) was measured by modified Griess assay and TNF-α was measured by quantitative ELISA. For the co-culture system, SC monocytes were seeded in a 24-well Transwell tissue culture plate whereas irradiated keratinocytes were seeded in the individual baskets subsequently placed on top of the monocyte cultures, and samples of culture supernatants were collected at 1 to 6 days.
Results: When primary human epidermal keratinocytes (NHEK) were irradiated with UVB, a dose-dependent stimulation of TNF-α production was observed (33% to 200% increase). TNF-α production was not changed significantly in SC monocytes/NHEK co-culture. In contrast, when macrophages were irradiated with UVB, significant inhibition of NO production (40% suppression, P<0.001) was seen.
Conclusion: This improved model of cutaneous inflammation could use multiple cells to study their interactions and to offer convenience, reproducibility, and a closer approximation of in vivo conditions.
J Drugs Dermatol. 2012;11(7):834-836.
Laura Diluvio MDa, Elena Campione PhDa, Cristina Mordenti MDa, Valentina Bagnolo MDb, Caterina Cerminara MDb, Sergio Chimenti MDa, and Luca Bianchi MDa| |
Danielle Tartar PhD,a Tina Bhutani MD,b Monica Huynh BA,c Timothy Berger MD,b and John Koo MDb| |
J Drugs Dermatol. 2014;13(5):564-568.
Erythema Nodosum-like Septal Panniculitis Secondary to Lenalidomide Therapy in a Patient With Janus Kinase 2-Positive Myelofibrosis
Tatyana A. Petukhova MD MS, a,b Danielle M. Tartar MD PhD,a,b Karen Mayo MSN FNP-BC OCN,b Maxwell A. Fung MD,a Joseph Tuscano MD,a,b and Jared Jagdeo MD MSa.b| |
J Drugs Dermatol. 2016;15(8):1024-1025.
Tyler J. Maly MD and James E. Sligh MD PhD| |
Lisa Prussick BSc,a,b Natalia Plotnikova MD,a and Alice Gottlieb MD PhDa,b| |
J Drugs Dermatol. 2016;15(6):715-718.
Pyoderma Gangrenosum Following Breast Reconstructive Surgery: A Case Report of Treatment With Immunosuppression and Adjunctive Xenogeneic Matrix Scaffolds
Generational Dermatology: Model for Prevention and Multi Decade Approach Toward the Evolving, Aging Patient
Wendy E. Roberts MD FAAD| |
J Drugs Dermatol. 2013;12(12):1396-1399.
Pearl E. Grimes MD| |
Six female subjects with Fitzpatrick skin types IV-V in good general health between the ages of 46 and 63 years with moderate epidermal facial melasma are presented herein. Subjects applied the skin brightener twice daily, morning and evening, and returned to the clinic at weeks 4, 8, and 12. By week 12, Investigator Overall Hyperpigmentation scores and MASI scores improved by an average of 22% and 38% from baseline, respectively. Additionally, 100% of subjects showed at least a 25% increase in Global Improvement at week 12. The skin brightener was well tolerated with no reports of erythema, edema, scaling, burning/stinging, or itching.
Results from these case studies suggest that this multimodality skin brightener may provide an alternative treatment to hydroquinone for moderate melasma in skin of color. However additional clinical studies would be needed.
J Drugs Dermatol. 2014;13(3):364-366.
Anna Kurayev MD, Huda Ashkar MBBS, Ami Saraiya MD, and Alice B. Gottlieb MD PhD| |
J Drugs Dermatol. 2016;15(8):1017-1022.
Objective: Review the utility of JAK inhibitors in the treatment of psoriasis.
Methods: A review was performed using PubMed and Google to identify research relevant to the treatment of psoriasis using JAK inhibitors.
Results: In a CD18 mutant PL/J mouse model with T-cell dependent psoriasiform skin disease, the JAK inhibitor R348 reduced skin inflammation, with reductions in CD4+, CD8+, and CD25+ T-cell infiltration and systemic decreases of IL-17, IL-19, IL-22, IL-23 and TNF-α. Two JAK inhibitors, CP-690,550 (tasocitinib) and INCB018424 (ruxolitinib), were effective in psoriasis clinical trials. In a phase 1, randomized, double-blind, dose escalation trial for plaque psoriasis, CP-690,050 led to improvements in Psoriatic Lesion Severity Sum score at doses greater than 5 mg. A phase 2 trial showed CP-690,050 administered at 2, 5, and 15 mg twice daily resulted in a 75% reduction in Psoriasis Area and Severity Index (PASI) in 25%, 40.8%, and 66.7% of patients, respectively, for moderate to severe psoriasis. A phase 3 study of CP-690,550 for plaque psoriasis was begun in September 2010 (NCT01163253). INCB018424, another JAK inhibitor, was used topically at 3 doses (0.5%, 1%, 1.5%) in a phase 2B, double-blind, placebo-controlled trial, resulting in improved total lesion score, global assessment, and PASI for all doses.
Conclusion: Janus Kinase inhibitors are promising potential therapeutic options for psoriasis.
J Drugs Dermatol. 2012;11(8):913-918.
Macrene R. Alexiades-Armenakas MD PhD| |
The Therapeutic Effects of a Topical Tretinoin and Corticosteroid Combination for Vitiligo: A Placebo-Controlled, Paired-Comparison, Left-Right Study
Hyok Bu Kwon MD,a Yunseok Choi MD,a Hwa Jung Kim MD,b and Ai-Young Lee MDa| |
OBJECTIVE: The goal of this study was to determine the efficacy of tretinoin plus topical corticosteroids (tretinoin plus) for repigmentation in patients with vitiligo.
METHODS: A placebo-controlled, paired-comparison, left-right study was conducted for a period of 6 months on tretinoin plus and the vehicle plus the same topical corticosteroid (vehicle plus) treatment in 50 patients diagnosed with generalized vitiligo. Clinical responses were assessed using the computerized analysis, and the results were compared with the visual analysis.
RESULTS: The percentage agreement between the 2 analyses was 91.8%. Among 49 participants who successfully completed this study, 27 (55%) showed a better response to tretinoin plus than to vehicle plus. The improved response was noted at an early stage of treatment, during the first 3 months in 60% of patients.
CONCLUSION: Combined therapy with tretinoin plus topical corticosteroids is safe and effective and provides another option for treatment of patients with vitiligo.
J Drugs Dermatol. 2013;12(4):e63-e67.
Successful Treatment of Patients Previously Labeled as Having Delusions of Parasitosis With Antidepressant Therapy
Ashley Delacerda MD, Jason S. Reichenberg MD, and Michelle Magid MD
Department of Dermatology, University of Texas Southwestern, Austin, TX
J Drugs Dermatol. 2012;11(12):1506-1507.
Paraneoplastic Pityriasis Rubra Pilaris as the Presenting Manifestation of Metastatic Squamous Cell Carcinoma
Isabel M. Remedios MD,a J. Daniel Jensen MD,b Kathleen Beckum MD,b
Kristopher McKay MD,b and Rebecca Kissel MDb
J Drugs Dermatol. 2014;13(5):610-612.
Resident Rounds Part I. The State University of New York Downstate Medical Center Dermatology Residency Training Program
Jaimie B. Glick MD and Ravneet Ruby Kaur MD| |
Noah Goldfarb MD,a,b Steven W. Lin MD,a Juan Jaimes MD,a,c John Fenyk MD,a,c and Peter A. Schlesinger MDd| |
Sara K. Story MD,a Andrej A. Petrov MD,b and Larisa J. Geskin MD FAADa| |
J Drugs Dermatol. 2014;13(6):749-751.
Annular Elastolytic Giant Cell Granuloma Successfully Treated With Adalimumab Subsequently Complicated by Drug-Induced Lupus
Adele Haimovic MD, Hideko Kamino MD, and David E. Cohen MD MPH| |
J Drugs Dermatol. 2017;16(2):169-171.
Noah Goldfarb MD,1,2 Kimberly Bohjanen MD,1,3 and Neal A. Foman MD1,3| |
J Drugs Dermatol. 2012;11(8):1000-1002.
Shannon Famenini BSa and Jashin J. Wu MDb| |
J Drugs Dermatol. 2013;12(3):317-320.
David Schairer BA, Laura Schairer BA, Adam Friedman MD| |
Resident Rounds: Part 1 - Program Spotlight: The University of Colorado Denver Dermatology Residency Program
David A. Norris MD, Ramin Fathi MD| |
Brooke E. Rothstein BA,a,b Brianna McQuade PharmD,a Jacqueline E. Greb BA,a,b Ari M. Goldminz MD,a
and Alice B. Gottlieb MD PhDa,b
J Drugs Dermatol. 2016;15(5):648-649.
Lessons of Leprosy: The Emergence of TH17 Cytokines During Type II Reactions (ENL) Is Teaching Us About T-cell Plasticity
Background: Leprosy was the first disease classified according to the thymus derived T-cell in the 1960s and the first disease classified by the cytokine profile as intact interferon-γ(IFN-γ) and interleukin-2 (IL2) or TH1 (tuberculoid) and deficient IFN-γ and IL2 or TH2
(lepromatous), in the 1980s.
Objective: In the present study, we set out to explore the T helper 17 (TH17) lymphocyte subset, the hallmark of T-cell plasticity, in skin biopsies from patients with erythema nodosum leprosum (ENL) who were treated with thalidomide.
Method: RNA was extracted from paraffin embedded tissue before and after thalidomide treatment of ENL and RT-PCR was performed.
Results: IL17A, the hallmark of TH17, was consistently seen before and after thalidomide treatment, confirming the TH17 subset to be involved in ENL and potentially up-regulated by thalidomide.
Conclusion: A reduction in CD70, GARP, IDO, IL17B (IL-20), and IL17E (IL-25) , coupled with increases in RORγT, ARNT, FoxP3, and IL17C (IL-21) following thalidomide treatment, opens the door to understanding the complexity of the immunomodulatory drug thalidomide, which can operate as an anti-inflammatory while simultaneously stimulating cell-mediated immunity (CMI). We conclude that TH17 is involved in the immunopathogenesis of ENL and that thalidomide suppresses inflammatory components of TH17, while enhancing other components of TH17 that are potentially involved in CMI.
J Drugs Dermatol. 2012;11(5):626-630.
Prospective Evaluation of the Safety and Efficacy of a 1060-nm Large Spot Size, Vacuum-Assisted Hair Removal Diode Laser System in Asian/Pacific Fitzpatrick’s Skin Types IV-V Patients
Sushil T.Tahiliani MD and Harsh S.Tahiliani MD| |
Brandon L. Adler BA and Adam J. Friedman MD| |
Alan R. Shalita MD and Whitney P. Bowe MD| |
Prospective Internally Controlled Blind Reviewed Clinical Evaluation of Cryolipolysis Combined With Multipolar Radiofrequency andVaripulseTechnology for Enhanced Subject Results in Circumferential Fat Reduction and Skin Laxity of the Flanks
Julius Few MD,a Michael Gold MD FAAD,b and Neil Sadick MD FACP FAACS FACPh FAADc| |
Infliximab is a chimeric monoclonal antibody, which acts by binding to both the soluble and membrane-bound tumor necrosis factor-a. In clinical practice, it is used as either monotherapy or in combination with other systemic therapies, particularly methotrexate. This study reviews clinical response and adverse events in 120 psoriasis patients with moderate-to-severe psoriasis who have received infliximab for a minimum of one year. The medical records of 120 infliximab-treated psoriasis patients at our referral psoriasis clinic in Dallas between 2002-2008 were reviewed for response rates, side effects and concomitant therapies. Of 120 charts reviewed, 112 (93%) patients had plaque type psoriasis, six (5%) had recalcitrant palmoplantar disease and two (1.6%) had severe acropustulosis of Hallopeau. Eighty-four (70%) patients had symptomatic psoriatic arthritis. The mean follow-up time was 2.2±1.1 years. One hundred and nine (91%) of the 120 patients had clearance of their psoriasis (response of more than 90% of initial BSA) at a median time of 12 weeks. Concomitant systemic treatments, primarily methotrexate, were given to 62 (52%) patients. Nineteen patients (16%) discontinued infliximab in the post-one-year treatment period for a variety of reasons, primarily failure to maintain adequate response. One hundred and four (87%) of patients required more than the standard dose of 5 mg/kg every eight weeks to maintain clearance. Infliximab either as monotherapy or in combination with traditional antipsoriatic agents is an effective and well-tolerated treatment option for patients with moderate to severe psoriasis and psoriatic arthritis on therapy for over one year and continuing for the long term.
J Drugs Dermatol. 2011;10(5):539-544.
Leon H. Kircik MD| |
While there are a number of products that can help healthy hair look healthier, shampoos or vitamins alone can’t truly regrow thinning hair. As dermatology providers, we realize this not only because we know the science, but because we see patients in the clinic every day who ask us how they can help to reverse hair loss and improve the quality of their hair.
Resident Rounds. Program Spotlight: Wright State University Department of Dermatology Residency Training Program
Rishi K. Gandhi MD and Julian J. Trevino MD| |
Fatal Cutaneous Strongyloidiasis as a Side Effect of Pemphigus Foliaceus Treatment With Mycophenolate Mofetil
Magalys Vitiello MD,b Michael Shelling MD,a Ivan Camacho MD,a Clara Milikowski MD,a Francisco A. Kerdel BSc MBBSb| |
J Drugs Dermatol. 2011;10(4):418-421.
Clinical Trial Review is a JDD department designed to provide physicians with information on drugs and devices undergoing clinical testing. It is our goal to inform the reader of the status of select drug and device studies relevant to the practice of dermatology before this information is available through standard channels. To participate in or learn more about these and additional trials, visit www.clinicaltrials.gov.
Temporal Association of Herpes Zoster Eruption Post-Aminolevulinic Acid Hydrochloride Photodynamic Therapy for Actinic Keratoses
Katie Manno MDa and Joel L. Cohen MD FAADb,c,d| |
Herpes zoster is a common and painful disease caused by the reactivation of the varicella-zoster virus with a higher incidence and severity associated with increasing age as well as compromised immune status. Acute inciting events for this eruption are not always known, but can include illness, stress, and mechanical injury. Photodynamic therapy (PDT) is a widely used treatment modality for precancerous skin lesions that has not been previously associated with provoking a herpes zoster outbreak. We present a case of herpes zoster eruption occurring after PDT for actinic keratoses in a patient with Non-Hodgkin Lymphoma (NHL).
J Drugs Dermatol. 2017;16(8):817-818.
Leon H. Kircik MD| |
Jared Jagdeo MD MS| |
A Retrospective Review of Treatment Results for Patients With Central Centrifugal Cicatrical Alopecia
Ariana Eginli BA, Emily Dothard MD, Courtney W. Bagayoko MD, Karen Huang MS, Alyssa Daniel MD, and Amy J. McMichael MD| |
INTRODUCTION: Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia primarily affecting women of African descent on the crown of the scalp. Limited data exists regarding evidence-based treatment for CCCA.
OBJECTIVE: To examine photos of subjects with CCCA before and after treatment in order to evaluate results of treatment and compare results of different treatment regimens.
METHODS: Photographs of 15 subjects with CCCA before and after treatment were evaluated by two blinded investigators who assigned disease severity scores to photographs based on a published scale: Central Scalp Alopecia Photographic Scale in African American Women.
RESULTS: Median change in severity score (post-treatment severity score – pre-treatment severity score) was 0.5 (P = 0.58) for all 15 subjects receiving a series of 7 to 8 intralesional steroid injections along with topical steroids (Class I/II) +/- minoxidil and +/- anti-dandruff shampoo, indicating worsening of disease after treatment. Subjects receiving minoxidil versus those who did not (0.25 vs 0.5; P = 0.38) and subjects receiving anti-dandruff shampoo versus those who did not (0.0 vs 0.5; P = 0.42) demonstrated no statistically significant difference in pre- and post-treatment severity scores. Of 15 subjects, 5/15 (33.3%) had decreased severity scores, 8/15 (53.3%) had increased severity scores, and 2/15 (13.3%) had no change in severity scores.
CONCLUSIONS: Although no statistically significant difference was found in pre- versus post-treatment disease severity, this may indicate intralesional steroid injections and topical steroids +/- minoxidil and +/- anti-dandruff shampoo halt disease progression.
J Drugs Dermatol. 2017;16(4):317-320.
Systematic Review of Vismodegib Toxicity Profile in the Treatment of Advanced Basal Cell Carcinomas Compared to Other Systemic Therapies in Dermatology
Margit L.W. Juhász MSca and Ellen S. Marmur MDa,b| |
J Drugs Dermatol. 2014;13(6):729-733.
Hector Fernández-Llaca MD,a Pablo de la Cueva MD,b Jesús Luelmo MD,c Jose Carlos Armario-Hita MD,d
M Luz Samaniego,e and Carmen García-Calvo MDf [Representing the RECOR Study Group.],
METHODS: A cross-sectional, multicentre study was made of 477 patients, of whom 238 had moderate to severe psoriasis (cases) and 239 were diagnosed with another dermatological disease (controls).
RESULTS: The proportion of patients with intermediate to high 10-year cardiovascular risk using the Framingham equation was significantly higher among psoriasis patients (38.5%; 80/208) than among the controls with other dermatological diseases (23.4%; 50/214, P<.05). No significant differences were observed between the 2 groups with respect to cardiovascular risk using the SCORE risk charts (P=.591). The case group included a greater proportion of obese and morbidly obese patients, as well as patients with higher triglyceride and low density lipoprotein cholesterol levels (P<.05); while high density lipoprotein cholesterol levels were significantly more favorable in patients in the control group (P<.05).
CONCLUSIONS: Cardiovascular risk was greater in patients with moderate to severe psoriasis than in patients with other dermatological conditions, suggesting that early detection and tailored management of risk factors is essential to reducing cardiovascular morbidity in these patients.
J Drugs Dermatol. 2014;13(10):1240-1247.
A Retrospective Analysis of 72 Patients on Prior Efalizumab Subsequent to the Time of Voluntary Market Withdrawal in 2009
Elizabeth Farley Prater MD,a Antoinette Day BS,b Mahir Patel MD,c and Alan Menter MDc| |
OBJECTIVE: To review the baseline characteristics and psoriasis phenotypes of patients with prior excelled response to efalizumab, and to determine the response of these patients to prior as well as subsequent therapies. By defining this subgroup of patients, particularly relating to palmoplantar psoriasis, future therapeutic considerations could be improved.
DESIGN: A retrospective review of 72 patients who were on efalizumab at the time of market withdrawal was conducted. Data was obtained through chart review of patients at a specialty psoriasis clinic in Dallas, TX.
MAIN OUTCOMES AND MEASURES: Patient characteristics, details of efalizumab use, and efficacy of efalizumab compared with other psoriasis treatment modalities.
RESULTS: Of the 72 patients, 24 (33%) were found to have palmoplantar disease. As a group, these patients were older, more likely to be female, and less likely to have a family history of psoriasis. 48 patients (67%) were on one or more systemic and/or biologic medication prior to starting efalizumab. Their BSA improved from 5.45 to 0.8 as a group. Six patients were identified as having failed TNF alpha antagonist treatment prior to starting efalizumab. All responded well to the medication with an average BSA of 0.54. Five of these six patients had evidence of palmoplantar disease prior to starting efalizumab and five of these six patients were female. Eleven patients (15%) experienced neurologic side effects and 13 (18%) had infections while on efalizumab treatment.
LIMITATIONS: This was a retrospective review. Quality of life issues could not always be fully assessed from the data available.
CONCLUSIONS AND RELEVANCE: Efalizumab was effectively utilized in our clinical practice to treat patients with palmoplantar psoriasis, including six patients who had failed prior treatment with one or more TNF alpha antagonist agents.
J Drugs Dermatol. 2014;13(6):712-718.
Rosacea Fulminans With Extrafacial Lesions in an Elderly Man: Successful Treatment With Subantimicrobial-Dose Doxycycline
Lauren A. Smith MD, Shane A. Meehan MD, and David E. Cohen MD MPH| |
J Drugs Dermatol. 2014;13(6):763-765.
Elizabeth Lazaridou MD PhD, Christina Fotiadou MD, Christina Giannopoulou MD, Demetrios Ioannides MD PhD| |
The painful, erythematous and eroded vulva often proves to be a diagnostic problem both clinically and histologically. Its differential diagnosis includes both non-neoplastic and neoplastic diseases like Bowen's disease and squamous cell carcinoma (SCC). We report the case of a 62-year-old woman diagnosed, after considerable delay, with Bowen's disease of the vulva that eventually progressed to invasive SCC, despite the treatment with imiquimod 5% cream. Our case indicates, on one hand, that dermoscopy could contribute to the accuracy of the pre-operative clinical diagnosis. On the other hand it confirms the fact that treatment of Bowen's disease of the vulva could be rather intriguing. Although imiquimod 5% cream is an effective, non-invasive treatment option for large lesions or poor healing sites, it should be administered with great consideration in carefully selected cases.
J Drugs Dermatol. 2012;11(1):110-112.
Gretchen W. Frieling MD,a Noelle L. Williams BS,b Scott J. M. Lim DO,c and Seth I. Rosenthal MDd| |
J Drugs Dermatol. 2013;12(4):481-484.
Resident Rounds Part I: Program Spotlight: Department of Dermatology, Columbia University Medical Center
Bobby Y. Reddy MD and Cheryl Hutt MD| |
Mona S. Foad MD and Erin Winters BA| |
J Drugs Dermatol. 2013;12(3 suppl 1):s42-s44.
RESIDENT ROUNDS: PART I
Program Spotlight: Department of Dermatology,Oregon Health & Science University
Nazanin Saedi MDa and Anand K. Ganesan MDb| |
MATERIALS/METHODS: With approval from the institutional review board at the University of California, Irvine, an electronic survey was sent to practicing dermatologists that contained 18 questions regarding the approach to evaluating and treating hyperpigmentation under the eyes, in the axilla, and along the neck.
RESULTS: Fifty dermatologists completed the survey, and 46 (92%) reported treating patients with darker skin. The ethnic groups treated were Latino (97.8%), African American (97.8%), Middle Eastern (77.6%), and Asian (88.9%). Thirty-six reported treating patients with hyperpigmentation under the eyes, and 22 (61.1%) thought the hyperpigmentation was a result of idiopathic increase in melanin deposition. Forty-two responded to treating hyperpigmentation in the axilla, most of whom thought it was related to acanthosis nigricans (69.0%) or contact dermatitis (59.5%). Forty responded to treating hyperpigmentation on the neck, most of whom treated the condition with hydroquinone (66%). Treatments for these 3 areas were not found to be effective.
CONCLUSIONS: Hyperpigmentation under the eyes, under the arms, or on the neck is a significant problem in darker-skinned patients that is refractory to currently available treatments, highlighting the necessity of developing treatment approaches directed toward this population. Two cases of hyperpigmentation on the neck are presented, describing a new entity that primarily affects dark-skinned individuals.
J Drugs Dermatol. 2013;12(5):563-567.
Kathleen Sikora Viscusi, MD| |
The Effect of Combined Calcipotriol and Betamethasone Dipropionate Ointment in the Treatment of Vitiligo: An Open, Uncontrolled Trial
Objective: To evaluate the efficacy and safety of calcipotriol 0.005%/betamethasone dipropionate 0.05% ointment in the treatment of vitiligo.
Methods: Thirty-one patients with vitiligo were enrolled in our study. The mean age of the patients was 32.6±11 years (range 18-56 years) and the mean duration of vitiligo was 3.7±5.8 years (range 0.07-30 years). Patients were treated with topical calcipotriol 0.005%/betamethasone dipropionate 0.05% ointment twice a day for at least 12 weeks, and the degree of repigmentation was analyzed using digital photography at baseline and at weeks 4, 8, and 12. The response was evaluated as excellent (76%-100%), moderate (51%-75%), mild (26%-50%), minimal (1%-25%), or no response. Possible adverse effects during the treatment period were also noted.
Results: Three patients (9.7%) had an excellent response, six patients (19.4%) had a moderate response, eight patients (25.8%) had a mild response, seven patients (22.6%) had a minimal response, and seven patients (22.6%) had no response. Patients at a progressive phase responded better to this ointment than patients at a stable phase (P=.005). The correlations between response rate and the duration of the disease were not significant (P=.791). Four adverse events related to the ointment were reported (pruritus, n=2; acne, n=2).
Conclusion: Calcipotriene 0.005%/betamethasone dipropionate 0.05% ointment is effective and well tolerated in the treatment of patients with vitiligo.
J Drugs Dermatol. 2012;11(10):e52-e54.
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the Henry Ford Hospital Department of Dermatology Residency Training Program. The editor of Resident Rounds is Omar A. Ibrahimi MD PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com.
Combination Use of Ustekinumab With Other Systemic Therapies: A Retrospective Study in a Tertiary Referral Center
Gillian M. Heinecke BS, Adam J. Luber BA, Jacob O. Levitt MD, and Mark G. Lebwohl MD| |
OBJECTIVE: To evaluate the prevalence, indications, and response to combination systemic therapy with ustekinumab for psoriasis in a tertiary referral center.
METHODS: This retrospective study comprised 102 psoriasis patients treated with ustekinumab at a single tertiary care center. Data was collected pertaining to history of psoriasis, past and current therapies including use of concomitant psoriasis agents, response to therapy, and side effects while on ustekinumab.
RESULTS: Twenty-two of 102 (22%) patients were identified as receiving combination systemic treatment involving ustekinumab and at least one additional agent. The most common indication for combination therapy was psoriatic arthritis (35%), followed by bridging therapy (26%), inadequate psoriasis control (13%), prevention of non-melanoma skin cancers (17%), and control of palmoplantar disease (9%). Methotrexate was the additional agent in 12 patients, cyclosporine in 7 patients, acitretin in 5 patients, and 1 patient received a second biologic agent, first etanercept and then adalimumab. Overall, the reduction in body surface area (BSA) was 80% for patients on combination therapy. For those patients on combination therapy for psoriatic arthritis, 75% had resolution or stabilization of their symptoms. Only one patient, receiving cyclosporine, discontinued combination therapy due to adverse side effects.
CONCLUSION: Combination systemic therapy with ustekinumab can be effective and well tolerated for patients who cannot be adequately treated with ustekinumab alone.
J Drugs Dermatol. 2013;12(10):1098-1102.
Tumor Necrosis Factor-α Inhibitor Use in Psoriasis Patients With a First-degree Relative With Multiple Sclerosis
Bobbak Mansouri MD, Mary E. Horner MD, Alan Menter MD| |
J Drugs Dermatol. 2015;14(8):876-878
Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel for Rosacea: Summary of a Placebo-Controlled, Double-Blind Trial
J Drugs Dermatol. 2012;11(12):1410-1414.
Fran E. Cook-Bolden MD| |
Program Spotlight - The University of Texas Southwestern Medical Center Dermatology Residency Program
Ponciano D. Cruz Jr. MD| |
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of Texas Southwestern Medical Center Dermatology Residency Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at OIbrahimi@jddonline.com
Kendra Gail Bergstrom MD| |
Flor A. Mayoral MD and Janelle M. Vega| |
J Drugs Dermatol. 2011;10(11):1320-1321.
Deborah S. Sarnoff MD FAAD FACP| |
Dhaval Bhanusali MD, Marcelyn Coley MD, Jonathan I. Silverberg MD MPH PhD, Andrew Alexis MD MPH and Nanette B. Silverberg MD| |
Objective: To determine prevalent fungal species and response to standard antifungal therapy in inner-city children of color.
Methods: An IRB-approved chart review of demographic, clinical, diagnostic, and therapeutic data was conducted for children and young adults (0 to 18 years of age) who had scalp fungal culture performed for scalp hyperkeratosis and/or alopecia over a 2.5 year time-period. Supplemental parental phone interview was performed for missing data points.
Results: A total of 84 patients with final diagnosis of tinea capitis were identified—52% male, 60.6% African-American, 28.2% Hispanic, and 9.9% Caucasian. Complete resolution at 4 weeks was uncommon in all demographic groups (Hispanic: 11.7%, African-American: 41.3%). The Hispanic group and the youngest patients (aged less than 4 years) were less likely to respond to initial therapy, but the results were not significant. Of the 80 tinea capitis patients initially treated with griseofulvin, 41 out of 54 children (76%) had complete response to micronized suspension +/- crushed tablet (33% required shift to tablets from suspension) and 20 out of 26 (76.9%) cleared on crushed tablets alone. Of the 19 griseofulvin failures, 5 cleared on fluconazole suspension, 7 on terbinafine sprinkles, 3 on itraconazole therapy, and 4 were lost to follow-up. Of the 47 patients who could be evaluated long-term after a single course of oral griseofulvin at 6 weeks or greater, 38 had documented long-term mycological cure (80.8%) and 42 had long-term clinical cure (89%). Trichophyton tonsurans (n=40) was the most prevalent causative species identified on culture, followed by Alternaria species (n=10) and Microsporum canis (n=1).
Limitations: Retrospective chart review: patient population has a high rate of usage of over-the-counter antifungal creams and shampoos, affecting culture results.
Conclusions: Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City. Response rates to griseofulvin are similar to rates seen in the 1970s, but require higher dosing and conversion to crushed tablets in partial responders. Usage of crushed ultramicronized griseofulvin, terbinafine sprinkles, itraconazole, and fluconazole are alternative regimens for those children whose tinea capitis does not clear on griseofulvin suspension.
J Drugs Dermatol. 2012;11(7):852-856.
The Effects of a Daily Skincare Regimen on Maintaining the Benefits Obtained from Previous Chemical Resurfacing Treatments
Suzanne Bruce MD,a Wendy Roberts MD,b Craig Teller MD,c and Lora Colvan BSd| |
OBJECTIVES: To evaluate whether a daily skin care regimen used for 12 weeks could maintain the benefits achieved with AGE and MELA chemical resurfacing treatments.
METHODS: Subjects who completed participation in the AGE and MELA skin resurfacing clinical trial were recruited to participate in a continuation trial and used a daily regimen of MDRejuvena facial products for 12 weeks. No other facial products were permitted. Physicians assessed the severity of individual skin parameters at baseline and week 12 and provided global assessment. Subjects assessed improvement of individual skin parameters at week 12 and provided an overall assessment.
RESULTS: Thirteen subjects participated in the 12-week continuation trial. According to the physician’s global assessment, all subjects demonstrated some level of improvement at week 12 compared to baseline. Physician assessment showed a decrease in severity of all skin parameters assessed at week 12 compared to baseline. According to the subject overall assessment at week 12, 11 of 12 subjects noted some level of improvement, 1 subject saw no improvement, and 1 subject did not provide an overall assessment. Mild to moderate improvement was observed by subjects in all individual skin parameters assessed except for skin discoloration.
CONCLUSIONS: The results of the continuation study demonstrate that use of a daily skin care regimen, which include combination of 2 various strengths of MDRejuvena Rejuvaphyl® Rejuvenating Complex: low strength (LS) and high strength (HS), not only maintains but can enhance the beneficial effects of skin resurfacing treatments for at least 12 weeks.
J Drugs Dermatol. 2016;15(9):1145-1150.
The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity
Teo Soleymani MD, Kristen Lo Sicco MD, and Jerry Shapiro MD FAAD FRCPC| |
Biotin, also known as Vitamin B7 or vitamin H, is a water-soluble B vitamin that acts as an essential cofactor for several carboxylases involved in the cellular metabolism of fatty acids, amino acids, and gluconeogenesis. Although there exists an incredible amount of social media hype and market advertising touting its efficacy for the improvement of hair quantity and quality, biotin’s efficacy for hair remains largely unsubstantiated in scientific literature. We reviewed all pertinent scientific literature regarding the efficacy of biotin supplementation for hair growth and quality improvement, and we also investigated its popularity in society defined as a function of market analytics. To date, there have been no clinical trials conducted to investigate the efficacy of biotin supplementation for the treatment of alopecia of any kind, nor has there been any randomized controlled trial to study its effect on hair quality and quantity in human subjects. Because of the lack of clinical evidence, its use to improve hair quantity or quality is not routinely recommended. However, societal infatuation with biotin supplementation is not only propagated by its glamorization in popular media, its popularity is vastly disproportionate to the insufficient clinical evidence supporting it’s efficacy in hair improvement. In other words, biotin supplements are quite “in vogue”, without there being any real reason to be so.
J Drugs Dermatol. 2017;16(5):496-500.
Prospective, Multicenter Study to Determine the Safety and Efficacy of a Unique Radiofrequency Device for Moderate to Severe Hand Wrinkles
Janelle M. Vega MDa, Vivian W. Bucay MDb, and Flor A. Mayoral MDa| |
J Drugs Dermatol. 2013;12(1):24-26.
Psoriasis and Cardiometabolic Disease: A Brief, Focused, Educational Intervention on Cardiometabolic Risks
Courtney J. Burnett BS, Dennis P. West PhD, Alfred W. Rademaker PhD, and Roopal V. Kundu MD| |
J Drugs Dermatol. 2016;15(10):1176-1180.
Cheryl Gray MD,a Sheila M. Greenlaw MD,a Christine Alavian MD,a Karen Wiss MDb| |
Joanna Harp MD,a Joshua M. Schulman MD,a and Jack S. Resneck, Jr MDb| |
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features the University of California, San Francisco, School of Medicine, Dermatology Residency Program. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at firstname.lastname@example.org
Lissy Hu BA,a Christina Alexander BA,b Nicole F. Velez MD,c F. Clarissa Yang MD,c
Alvaro Laga Canales MD MMSc,c,d Stephanie Liu MD,c and Ruth Ann Vleugels MD MPHc,
J Drugs Dermatol. 2015;14(6):628-630.
J Drugs Dermatol. 2012;11(2):160-167.
Novel Nonablative Radio-Frequency Rejuvenation Device Applied to the Neck and Jowls: Clinical Evaluation and 3-Dimensional Image Analysis
Lisa K. Chipps MD MS,a,b,c Jason Bentow MD,c Heidi B. Prather MD,d Jeffrey J. So MS PA-C,a
Jonathan M. Schouest BS,a and David M. Ozog MD,a,e Ronald L. Moy MDa,b
STUDY DESIGN: Forty-nine subjects received a total of two radio-frequency treatments to the face and neck one-month apart. The novel radio-frequency delivery device was used to heat the dermis between 41-43°C for five heat cycles. Primary outcome measures were clinical efficacy quantified by the Global Assessment Improvement Scale (GAIS) and a patient survey that assessed treatment satisfaction.
RESULTS: Assessments of 3D photographs revealed an overall improvement in 74% of study subjects. 85% of patients noted an overall improvement in the appearance of their skin. 81% of patients rated their post-treatment skin laxity as improved, 85% rated their skin smoothness as improved and 62% rated their skin brightness as improved.
CONCLUSION: Subjects in this study demonstrated an overall improvement in face and neck appearance with regard to skin tightening, wrinkles, and skin texture suggested by overall patient satisfaction (85%) and physician-rated GAIS improvement (74%). This study suggests that radiofrequency applied with a continuous thermal treatment device is a safe and efficacious way to improve the overall appearance of aging facial skin.
J Drugs Dermatol. 2013;12(11):1215-1218.
The Effect of Benzoyl Peroxide 9.8% Emollient Foam on Reduction of Propionibacterium acnes on the Back Using a Short Contact Therapy Approach
Benzoyl peroxide (BP) exerts its therapeutic effect for acne vulgaris through reduction of Propionibacterium acnes. A 1.0 to 2.0 log reduction in P acnes has been demonstrated primarily on the face with use of “leave-on” BP formulations, but also with some BP cleansers. In addition to use for facial acne vulgaris, cleanser formulations of BP are commonly used for truncal acne vulgaris due to ease of use on a large body-surface area and to avoid bleaching of fabric. To date, evaluation of P acnes reduction on the trunk has not been well studied with BP formulations, especially with the use of recognized and standardized methods to accurately determine P acnes colony counts. A previous study demonstrated that a BP 8% cleanser did not reduce counts of P acnes on the back when subjects were instructed to apply the cleanser in the shower, allow it to dry for 20 seconds on the skin, and then rinse off the cleanser. Evaluation of specified time intervals between application on the back and rinsing with BP formulations would help to better define the necessary skin contact time associated with high reductions of P acnes (>90%), recognizing also the potential roles of BP concentration and vehicle. This 2 week study using quantitative bacteriologic cultures evaluates the effectiveness of BP 9.8% emollient foam in reducing P acnes levels on the back with 2 minutes of skin contact time and compares results with a BP 5.3% “leave-on” emollient foam formulation. Short contact therapy utilizing a 2 minute skin contact time with BP 9.8% emollient foam used once daily over a 2 week duration was highly effective in reducing the quantity of P acnes organisms on the back and provided comparable colony count reduction to “leave on” therapy using BP 5.3% emollient foam.
J Drugs Dermatol. 2012;11(7):830-833.
Kenneth Beer MD PA,a Michael S. Beer,a and Danielle Applebaum MS IVb| |
J Drugs Dermatol. 2013;12(6):694-697.
A Pilot Study Using Reflectance Confocal Microscopy (RCM) in the Assessment of a Novel Formulation for the Treatment of Melasma
Katerina Tsilika,a Jean Luc Levy MD,c Hee Young Kang MD PhD,a Luc Duteil PhD,a Abdallah Khemis MD,a Rosalind Hughes MD,a Thierry Passeron MD PhD,a,b Jean Paul Ortonne MD,a Philippe Bahadoran MD PhDa,b| |
Introduction:Melasma is a common pigmentary disorder caused by abnormal melanin deposits within the skin. Hydroquinone (HQ)
is presently the most popular depigmenting agent, however the treatment of melasma remains unsatisfactory, resulting in a need
to evaluate new depigmenting agents.
Objective: The objective of this study was to assess, using standard methods and a novel technique, in vivo Reflectance Confocal Microscopy (RCM), the efficacy and safety of a new non-HQ bleaching agent Dermamelan® (Mesoestetic, Barcelona, Spain) in the treatment of melasma.
Methods: Ten women with melasma were enrolled in an open-label trial lasting four months. Patients were of Fitzpatrick skin types II–IV. A non-HQ depigmenting agent (Dermamelan) was applied once-daily for three months. Melasma Area and Severity Indices (MASI) were measured. Standard and UV-light photographs were taken and in vivo RCM, which detects pigmentary changes at a cellular level, was done. Evaluations were performed before treatment, on the first, second and third month of treatment and one month after treatment. Upon cessation of the trial, patients completed a questionnaire regarding efficacy and tolerance.
Results: At baseline, RCM detected hyperpigmented keratinocytes in all patients, dendritic cells in 2/10 patients, and melanophages in 2/10 patients. Based on the MASI score, Dermamelan treatment improved melasma by 50 percent. This was confirmed by standard and UV-light photography. Maximum therapeutic effect was usually reached by one month of treatment and was maintained at one month following its completion. Interestingly Dermamelan treatment also induced a statistically significant decrease of pigmented epidermal keratinocytes as detected by RCM. Patients with melanophages on RCM at baseline had a poorer outcome, but not those with dendritic cells. Mild irritation was the only adverse event observed during treatment. The majority of patients were satisfied with the result.
Conclusion: This study suggests that Dermamelan produces significant rapid improvement of melasma at a clinical and cellular level and demonstrates the potential of RCM to monitor and possibly predict efficacy of a new depigmenting agent in the treatment of melasma.
J Drugs Dermatol. 2011;10(11):1260-1264.
Alina Markova MD,a Rene Duquesnoy PhD,b and William Levis MDc| |
Methods:10 women aged 40 to 60 years were not preselected but were the first 10 women willing to undergo the study who fit the inclusion and exclusion criteria. Prior to receiving the filler, participants were asked to rate on a visual analog scale (VAS) from 1 to 6 how they felt about their appearance. Each woman received 1.0 cc of hyaluronic acid filler (Perlane, Medicis Corporation, Phoenix, AZ) into each cheek. Two weeks later they returned for photos and to complete the same VAS scale.
Results: Seven of ten women felt 0.5 to 2 points better about their appearance as measured by their VAS responses.
Conclusion:Cheek augmentation improves how a woman feels about her attractiveness.
J Drugs Dermatol. 2012;11(9):1077-1080.
News, Views, & Reviews
Manifestations and Treatment of Cutaneous Lupus Erythematosus (Part II of II)
David Schairer BA and Adam Friedman MD| |
Jeffrey F. Scott MD, Barbara Reichert MD, Miesha Merati DO, Kord Honda MD, and Kevin D. Cooper MD| |
Pharmacokinetic Comparison of Once-Daily Topical Minocycline Foam 4% vs Oral Minocycline for Moderate-to-Severe Acne
Terry M Jones MD,a Herman Ellman MD,b Tina deVries PhDb| |
J Drugs Dermatol. 2017;16(10):1022-1028.
Central Serous Chorioretinopathy Associated With Topical Corticosteroids in a Patient With Psoriasis
Navid Ezra MD,a Mehran Taban MD,b Daniel Behroozan MDa,c,d| |
Background: Central serous chorioretinopathy (CSC), also known as central serous retinopathy (CSR), is a visual impairment, often temporary, usually in a single eye, which mostly affects males in the age group of 20 to 50 but may also affect women. CSC occurring after prolonged use of topical steroids in a patient with psoriasis is a novel complication in the English literature.
Observations: We describe a case of a 25-year-old male, with a 15-year history of corticoid ointment use for psoriasis, who presented with loss of vision secondary to CSR.
Conclusions: All topical steroid treatments were discontinued and the patient recovered his vision completely. Although topical corticosteroids are frequently utilized for psoriasis management with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (e.g., those with Cushing's syndrome, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy following prolonged use of topical corticosteroids
J Drugs Dermatol. 2011;10(8):930-933.
Topical Amitriptyline Combined With Ketamine for the Treatment of Erythromelalgia: A Retrospective Study of 36 Patients at Mayo Clinic
Timothy J. Poterucha BS,a Sinead L. Murphy BS,b Mark D. P. Davis MD,c Paola Sandroni MD PhD,d Richard H. Rho MD,e Roger A. Warndahl RPh,f and William T. Weiss RPhf| |
METHODS: We retrospectively evaluated 36 patients with erythromelalgia who were treated with compounded topical amitriptyline-ketamine from January 1, 2004, through January 31, 2011.
RESULTS: Thirty-two patients (89%) were female. Mean (standard deviation) age was 44.7 (15.8) years (range, 5-74 years). Patients applied the medication 1 to 6 times per day (median, 5 times). One patient (3%) had complete relief from symptoms, 14 (39%) had substantial relief, 12 (33%) had some relief, 7 (19%) had no relief, and 2 (6%) had local worsening of symptoms. No patients had systemic adverse effects.
CONCLUSIONS: A majority of patients with erythromelalgia (75%) reported improvement in pain with topical application of a compounded amitriptyline-ketamine formulation. The medication was well tolerated.
J Drugs Dermatol. 2013;12(3):308-310.
Comparison of Guidelines for the Use of Cyclosporine for Psoriasis: A Critical Appraisal and Comprehensive Review
Teo Soleymani MD,a Janna M. Vassantachart MS4,b and Jashin J. Wu MD FAADc| |
The purpose of this article is to review and compare the current evidence-based guideline recommendations for the use of cyclosporine in the treatment of psoriasis.
Although the various guidelines are similar in their initial treatment recommendations, significant differences exist in recommendations on maximal treatment duration (1 year versus 2 years), intermittent short-term versus continuous therapy, use in erythrodermic and palmoplantar psoriasis, as well as recommendations on managing cyclosporine-associated side effects. By following guideline recommendations, cyclosporine remains an excellent and indispensable tool for the dermatologist treating moderate-to-severe psoriasis.
J Drugs Dermatol. 2016;15(3):293-301.
Jeremy Hugh, MD| |
Jason Chouake BS and Adam Friedman MD| |
Macrene Alexiades MD PhD| |
Interferon- α has been associated with a wide range of adverse events (AEs). A lupus-like reaction at the injection site of subcutaneous (SC) interferon-α is exceptionally rare. A 60-year-old woman with recurrent metastatic melanoma repeatedly developed cutaneous lupus-like reactions at the SC interferon-α-2b injection sites on her thighs. Known features of lupus-like reactions at SC interferon-α injection sites are reviewed, and cutaneous injection site reactions to SC interferon-α are summarized.
J Drugs Dermatol. 2012;11(3):393-398.
Nicholas B. Countryman MD MBA,a* Ross M. Levy MD,b, C.William Hanke MDa| |
J Drugs Dermatol. 2013;12(6):668-671.
Rupatadine and Levocetirizine in Chronic Idiopathic Urticaria: A Comparative Study of Efficacy and Safety
Background: Chronic Idiopathic Urticaria is difficult to treat due to its persistent debilitating symptoms. New generation anti-histaminics are first line treatment for this condition. The aim of this study is to compare efficacy and safety of rupatadine and levocetirizine in chronic idiopathic urticaria.
Methods:A randomized, single blinded, single-centred, parallel group outdoor based clinical study was conducted in 70 patients of CIU to compare the two drugs. After initial clinical assessment and baseline investigations, rupatadine was prescribed to 35 patients and levocetirizine to another 35 patients for 4 weeks. At follow-up, the patients were re-evaluated and then compared using different statistical tools. Main outcome measures were DC eosinophil, Absolute Eosinophil Count (AEC), serum IgE, Total Symptom Score, Aerius Quality of Life Questionnaire score, and Global efficacy score.
Results:Rupatadine significantly improved patients′ clinical condition including symptom score from baseline to day 28. In rupatadine group, there was 27.9 percent decrease (P=0.027) in DC eosinophil, 35.6 percent decrease (P=0.036) in AEC, 15.3 percent decrease (P=0.024) in serum IgE, 28.2 percent decrease (P=0.02) in Total Symptom Scoring, and 27.3 percent decrease (P=0.006) in Aerius Quality of Life Questionnaire score. Global efficacy score of rupatadine was found to be significantly greater (P=0.009) than levocetirizine. The overall incidence of adverse drug reactions was also found to be less in rupatadine group
Conclusion: Rupatadine is a better choice in CIU in comparison to levocetirizine due to better efficacy and safety profile.
J Drugs Dermatol. 2011;10(12):1444-1450.
Efficacy of Benzoyl Peroxide (5.3%) Emollient Foam and Benzoyl Peroxide (8%) Wash in Reducing Propionibacterium acnes on the Back
James J. Leyden MD| |
Objectives: To evaluate the effectiveness of BP (5.3%) emollient foam and BP (8%) wash in reducing P. acnes levels on the back.
Methods: Five-week open-label single-center study of 20 healthy subjects (>18 years old), colonized with P. acnes on their backs (>10,000 colonies per cm2). Subjects were treated once daily with BP (5.3%) foam for two weeks; no treatment in week 3, and BP (8%) wash once daily for two further weeks. Quantitative bacteriologic cultures obtained at baseline and weeks 1, 2, 3, 5 and 6. Results: Nineteen evaluable patients. Total P. acnes counts were reduced by 1.9 log (one week) and 2.1 log (two weeks) with BP (5.3%) emollient foam. BP (8%) wash did not reduce P. acnes counts after two weeks.
Discussion: BP (5.3%) emollient foam was superior to BP (8%) wash in reducing P. acnes on the back. The lack of effect of BP (8%) wash is surprising in view of the demonstrated results on the face and warrants further study.
Evaluation of Moisturizing Effect of Methanolic Extract of Five Medicinal Plants Incorporated Into Cream Bases Using Impedance and Extensiometry Methods
Background: Skin moisturizing is an important issue due to its impact on skin function. Adverse reactions to herbal extracts have been rarely reported and can be used in moisturizers. This study was conduct to evaluate moisturizing effect of a methanolic extract of five medicinal plants incorporated into cream bases.
Methods: Methanolic extract of five medicinal plants including olive, burdock, licorice, mallow and marsh horsetail was prepared. The extracts were dissolved in distilled water completely and freeze-dried to a dry powder. These extracts were added separately to the cream based formulation that has been suggested to be appropriate for adding herbal extracts. Moisturizing effects of these creams with herbal extracts were assessed using the impedance method on 12 rats equally divided into six groups (one control and five cases), as well as the extensiometry method on 25 mice divided into five groups (in each group one cream with herbal extract and control cream were tested concurrently). Obtained results were compared with the control cream based.
Results: The maximum moisturizing effect was observed with the marsh horsetail. Other creams with herbal extracts, except the one with the licorice, also exerted significantly higher moisturizing effect compared to the controls (P<0.05). Regarding the force for skin tearing, the differences were statistically significant in all groups when compared to the control group (P<0.05) and the highest difference was seen in the marsh horsetail group (2.0832 ± 0.6811 kgN).
Conclusions: The highest moisturizing activity was observed using marsh horsetail extract that can be explained by flavonoids content of marsh horsetail.
J Drugs Dermatol. 2011;10(10):1116-1121.
Jason Chouake and Adam Friedman| |
George F. Cohen MD and Christopher M. Wolfe DO| |
Recalcitrant cutaneous sarcoidosis with perianal involvement is rare. To our knowledge we present the first documented case of cutaneous sarcoidosis with perianal involvement successfully treated with adalimumab.
J Drugs Dermatol. 2017;16(12):1305-1306.
A Retrospective Study to Investigate Racial and Ethnic Variations in the Treatment of Psoriasis With Etanercept
Objectives: Psoriasis is a chronic inflammatory condition that occurs worldwide; however, few studies have examined this condition in non-Caucasian populations. The purpose of this study was to investigate racial/ethnic differences in demographics, psoriasis severity,
efficacy, safety, and health-related quality of life in patients treated with etanercept using data from the Etanercept Assessment of Safety and Effectiveness (EASE) in Psoriasis trial.
Patients and Methods: This is an investigator-initiated evaluation of data from the EASE study.
Results:The study included 2511 patients (Caucasian n=2164; Hispanic/Latino n=173; African American n=98; Asian n=76). Although baseline Physicians' Global Assessment (PGA) scores were similar, we found significant baseline differences in patient characteristics, prior therapy, percentage of body surface area (%BSA) affected and Dermatology Life Quality Index (DLQI) scores between the groups. At baseline, the Caucasian group had the longest disease duration (19 years), but the lowest percentage of BSA involvement (28%). The Asian group had the highest percentage of BSA involvement (41%). Baseline DLQI score was lowest for Caucasians (12.0) and highest for Hispanic/Latinos (14.6).
At week 12, response to therapy was similar in all ethnic/racial groups. The BSA involvement was reduced by more than 50 percent for all groups, but remained significantly higher for the Asian group (17%) than for the Caucasian (13%; P=0.0105) and African American groups (13%; P=0.0461).
At week 12, the mean Asian DLQI score of 5.2 was significantly higher (worse) than scores for the Caucasian (3.5; P=0.0001) and Hispanic/Latino groups (3.8; P=0.028). For both percentage of BSA and DLQI, differences among racial/ethnic groups in the percentage improvement from baseline were not statistically significant. Adverse event rates were similar for the groups.
Conclusions:Patient characteristics at enrollment differed among ethnic groups, but no significant racial/ethnic differences were found in safety or efficacy of etanercept. However, racial/ethnic differences in the impact of psoriasis on quality of life were observed.
J Drugs Dermatol. 2011;10(8):862-868.
Sarit Itenberg DO,a Ryan Turner MD,a Bijal Amin MD,a Mark Jacobson MD,a Karthik Krishnamurthy DOa| |
Khalifa E. Sharquie MD PhD,a Adil A. Noaimi MD DDV FICMS,b and Hana A. Al-Mudaris MDc| |
OBJECTIVES: To perform melanocytes transplantion in patients with vitiligo using a new needling micrografting technique.
PATIENTS and METHODS: This interventional case study took place at the Department of Dermatology and Venereology at Baghdad Teaching Hospital from December 2010 to September 2011. Twelve patients with vitiligo were included. A split-thickness skin graft was taken from the normal area and cut into micropieces ranging from 0.1 mm to 0.3 mm in diameter. The recipient area was anesthetized, and the micrografts were then implanted into the dermis using the needling technique. The number of implanted micrografts depended on the size of the recipient area. Follow-up was conducted every 2 weeks for the first month and then every 4 weeks for a further 16 weeks.
RESULTS: The intake rate of grafting at week 2 ranged from 90% to 100%. The micrografts started producing noticeable pigmentation at week 2, and pigmentation was obvious at week 4. At week 8, the rate of pigmentation ranged from 10% to 90% (25.24%), and at week 16 it ranged from 10% to 100% (61.36%).
CONCLUSION: This new approach to the treatment of vitiligo delivers rapid and satisfactory pigmentation.
J Drugs Dermatol. 2013;12(5):e74-e78.
An Update on the Long-Term Safety Experience of Ustekinumab: Results From the Psoriasis Clinical Development Program With up to Four Years of Follow-Up
Objective: To evaluate the safety of ustekinumab in patients with moderate to severe psoriasis treated for up to four years.
Methods: Safety data were pooled across four Phase II/III randomized controlled trials. Rates over time and cumulative rates of adverse events (AEs), AEs leading to treatment discontinuation, serious adverse events (SAEs), serious infections, malignancies, and major adverse cardiovascular events (MACE) (i.e., cardiovascular death, myocardial infarction [MI], or stroke as adjudicated by an independent panel of academic cardiologists) were evaluated. Observed rates of AEs of interest were compared with those expected in the general (malignancies, MI, and stroke) and psoriasis (serious infections, MI, and stroke) populations.
Results: Overall, 3,117 patients were followed for up to four years (6,791 patient-years). Rates of AEs, AEs leading to treatment discontinuation, and SAEs remained stable over time, whereas cumulative rates were generally comparable between patients who received 45 mg and 90 mg of ustekinumab. The rates of AEs of interest also remained stable over time, and cumulative rates per 100 patient-years were 0.80 and 1.32 (serious infections), 0.70 and 0.53 (nonmelanoma skin cancer), 0.63 and 0.61 (other malignancies), and 0.56 and 0.46 (MACE) in patients treated with 45 mg and 90 mg, respectively. Rates of AEs of interest were consistent with those in the general and psoriasis populations.
Conclusion: The safety profile of long-term ustekinumab treatment with up to four years of continuous use remains consistent with previous reports, with no evidence of cumulative toxicity.
J Drugs Dermatol. 2012;11(3):300-312
Sustained Clinical Resolution of Acquired Epidermodysplasia Verruciformis in an Immunocompromised Patient After Discontinuation of Oral Acitretin With Topical Imiquimod
Rajiv I. Nijhawan MD,a Jeremy M. Hugh MD,b and Achiamah Osei-Tutu MDa| |
J Drugs Dermatol. 2013;12(3):348-349.
Effectiveness of a Nutraceutical During Non-Ablative 1927 nm Fractional Laser on Patients With Facial Hyperpigmentation and Photoaging
Joely Kaufman-Janette MD, Alex Cazzaniga BS MBA, Annelyse Ballin MD and Rachel Swanson-Garcell MSN ARNP| |
Background: Fractional lasers have been proven to treat hyperpigmentation and photoaging. Little research has been done on the effects of supplements on healing post-laser resurfacing. A nutraceutical could offer the benefit of faster healing of the skin and fewer side effects.
Objective: Evaluate the effectiveness of a nutraceutical associated with fractional 1927 nm laser in healing time and effectiveness on hyperpigmentation and photoaging.
Methods & Materials: A prospective, randomized, evaluator-blinded, pilot study included Fitzpatrick skin types I-III patients with hyperpigmentation and photoaging randomly assigned to two groups. Group 1 was laser treatment and Group 2 was laser treatment and nutraceutical. Results were compared with objective biometric TEWL (transepidermal water loss), mexameter, corneometer, and cutometer parameters. A blinded physician-evaluator and the subjects completed questionnaires to evaluate skin improvements.
Results: Twenty women were included. Eight in Group 1 and 10 in Group 2 completed the study. Group 2 presented a faster recovery of the skin barrier function post procedure. Three months after the procedure, Group 2 presented with significantly improved skin glossiness, hydration, and melanin rebound levels. Group 2 presented more overall aesthetic improvement determined by the patient and the blinded physician-evaluator.
Conclusion: The nutraceutical improved the results of the laser treatment.
J Drugs Dermatol. 2017;16(5):501-506.
Jennifer V. Nguyen MD| |
J Drugs Dermatol. 2014;13(suppl 1):s12-s16.
Objective: We describe one patient who developed sarcoidosis while being treated for psoriasis with etanercept. We sought to review to previously reported cases and further characterize the nature of this reaction.
Methods: A literature search was performed with the key words "sarcoidosis, sarcoid, etanercept, infliximab, adalimumab, granulomatous, and drug reaction." All relevant cases in the English language were included and evaluated for demographic data, duration of therapy prior to developing sarcoid, duration of sarcoid signs/symptoms, treatments used and time to resolution after discontinuation of the drug.
Results: Including the present case, there are 34 cases of sarcoidosis developing during anti-tumor necrosis factor therapy. All previously reported cases were patients with a primarily rheumatologic diagnosis. In all but one case, discontinuation of the drug resulted in complete resolution of symptoms. The lung and surrounding lymph nodes were the areas most commonly affected. The average amount of time between initiation of therapy and onset of symptoms was 22 months. The average time to resolution of symptoms after discontinuation of the drug was 5.2 months.
Limitations: This is a retrospective case review.
Conclusions: These data indicated that sarcoid is a possible adverse effect of tumor necrosis factor inhibitor therapy that should be noted by dermatologists using these drugs. While it has been reported in the rheumatology literature, it may be under-recognized by dermatologists.
J Drugs Dermatol. 2012;11(5):609-612.
Effect of Calcipotriene Plus Betamethasone Dipropionate Topical Suspension on the Hypothalamic-Pituitary-Adrenal Axis and Calcium Homeostasis in Subjects With Extensive Psoriasis Vulgaris: An Open, Non-Controlled, 8-week Trial
Shane Silver MD,a Raj Tuppal MD,b Aditya K Gupta MD,c Fabrice Clonier MSc,d
Martin Olesen MD,e Randy Leeder PhD,e and Victoria Taraska MDf
OBJECTIVE: To evaluate the systemic effects of once-daily use of two-compound topical suspension/gel on the hypothalamic-pituitary-adrenal (HPA) axis and calcium homeostasis in subjects with extensive psoriasis vulgaris.
METHODS: An open-label, single-group, 8-week trial in 43 subjects with extensive psoriasis covering 15–30% of the body surface area. Blood and 24-hour urine samples were collected and a standard-dose adrenocorticotropic hormone (ACTH) stimulation test was performed at baseline, weeks 4 and 8. Primary endpoints were serum cortisol 30 minutes after ACTH injection (HPA axis response abnormal at serum cortisol ≤18 μg/dL) and changes from baseline in albumin-corrected serum calcium (sCa), 24-hour urinary calcium excretion (24hCa) and urine calcium:creatinine ratio (Ca:Crea).
RESULTS: Two (4.7%) subjects showed signs of adrenal suppression based on the ACTH stimulation test results at week 4; both were withdrawn from treatment and had normal serum cortisol 30-minute values at follow-up 4 weeks later. None of the subjects who continued treatment to week 8 showed signs of adrenal suppression. There were no clinically relevant mean changes from baseline to weeks 4 and 8 in sCa, 24hCa or Ca:Crea and no subject had sCa above the reference range.
CONCLUSION: The two-compound topical suspension/gel containing calcipotriene plus betamethasone dipropionate may be applied once daily to extensive psoriasis vulgaris without generally causing adrenal suppression or disturbance of calcium homeostasis, consistent with previous findings. In a small number of patients with extensive psoriasis treated with large volumes of topical suspension, adrenal suppression may be observed. In the real-world setting, it is anticipated that systemic side-effects would occur in only a few cases within the general psoriasis patient population.
J Drugs Dermatol. 2013;12(8):882-887.
ClinicalTrials.gov Identifier: NCT 01229098
Breanne Mordorski BA,a Adam Friedman MD,b George Han MD PhDc| |
J Drugs Dermatol. 2016;15(9):1132-1135.
Is Chronic Cutaneous Discoid Lupus Protective Against Severe Renal Disease in Patients With Systemic Lupus Erythematosus?
Joseph F. Merola MD,a Caroline A. Chang MD,b Miguel R. Sanchez MD,c Stephen D. Prystowsky MDc| |
Methods: Over three years, sixteen patients met the diagnostic criteria of discoid lupus, positive anti-nuclear-antibody, and at least one extracutaneous manifestation.
Results: Most patients (14/16) were female, between 26 to 66 years old. Arthritis was the most common extracutaneous manifestation followed by Raynaud's phenomenon. The anti-nuclear-antibody was speckled in ten patients with titers ranging from 1:40 to 1:1280 IU/mL. Elevated levels of double-stranded-DNA in low titers were found in four patients, anti-Smith-antibody in four; anti-Sjogren-syndrome-A-antibody in seven, and anti-ribonucleoprotein-antibody in seven. Renal function markers were transiently high in some patients but normalized over time. Hematuria and/or proteinuria were present at some time in seven patients. The highest BUN and creatinine levels were 42 mg/dL and 1.5 mg/dL, respectively. One patient had membranous glomerulonephropathy class 5; however, discoid lupus developed well after the onset of renal disease during a time when renal function had returned to normal.
Conclusion: Our observational data supports previous reports suggesting that patients with active discoid lupus rarely have progressive renal insufficiency. The mechanism for the development of discoid lupus may involve an immunologic mechanism that differs from that which produces severe organ involvement, especially advanced immune-complex-mediated renal disease. Patients with discoid lupus rarely have sustained high levels of antibodies to double-stranded-DNA. Discoid lupus appears to be a marker for a more benign lupus course. This clinical observation lays the groundwork for a larger prospective, longitudinal cohort study for further validation.
J Drugs Dermatol. 2011;10(12):1413-1420.
A Prospective Split-Face Study of the Picosecond Alexandrite Laser With Specialized Lens Array for Facial Photoaging in Chinese
Yiping Ge MD, Lifang Guo MD, Qiuju Wu MD, Mengli Zhang MD, Rong Zeng MD, and Tong Lin MD PhD| |
Ramsin Joseph Yadgar BS,a and Adam J. Friedman MDa,b| |
Fractionated Carbon Dioxide Laser Treatment of Fibroelastolytic Papulosis With Excellent Cosmetic Result and Resolution of Pruritus
Derek Ho BSa and Jared Jagdeo MD MSa,b,c| |
J Drugs Dermatol. 2015;14(11):1354-1357.
Treatment of Moderate to Severe Acne Vulgaris in a Hispanic Population: A Post-Hoc Analysis of Efficacy and Tolerability of Clindamycin Phosphate 1.2%/Benzoyl Peroxide 2.5% Gel
Background: Acne in Hispanics is an increasing problem, presenting unique challenges. Although combination therapy is now a standard of care in acne, concerns exist with the increased potential irritation and dryness in this population and the potential for hyperpigmentation. There is a paucity of clinical studies that evaluate the efficacy and tolerability of acne medications in Hispanics.
Methods: A post-hoc analysis of efficacy and cutaneous tolerability in 458 Hispanic subjects receiving clindamycin phosphate 1.2%/BPO 2.5% gel, individual active ingredients and vehicle from two 12-week multicenter double-blind studies that enrolled 2813 subjects with moderate to severe acne.
Results: Median reductions in inflammatory lesions, noninflammatory, and total lesions (71.6%, 50.9% and 55.1%, respectively) were significantly greater with clindamycin phosphate 1.2%/BPO 2.5% gel versus the individual active ingredients and vehicle. Treatment success (35.6% "clear/almost clear") and patient satisfaction (83.2%) were also significantly greater than vehicle at week 12. Cutaneous tolerability was excellent with all mean scores less than or equal to 0.2 at week 12 (where 1=mild).
Conclusions: Overall efficacy and tolerability with clindamycin phosphate 1.2%/BPO 2.5% gel were better in the Hispanic population compared to the total study population. Hispanic acne subjects were not found to be more susceptible to cutaneous irritation from treatment with clindamycin phosphate 1.2%/BPO 2.5% gel and both efficacy and tolerability was excellent. J Drugs Dermatol.
J Drugs Dermatol. 2012;11(4):455-459.
Open Label Study to Evaluate the Efficacy of Re-Treatment With Etanercept in Patients With Psoriasis
Objective: To evaluate the efficacy of the re-treatment with etanercept in patients with a history of etanercept use with good response and secondary loss of efficacy.
Methods: This is an open label prospective study involving 20 patients with moderate to severe plaque psoriasis, who had been initially treated with etanercept and were re-treated after a variable interval with 50 mg BIW for 12 weeks.
Results: At week 12 of etanercept re-treatment, 13 of 20 patients (65%) achieved a PGA score of 2 or less and 40% (8 of 20), achieved a PGA score of 0 to 1. Etanercept was well tolerated and no serious adverse events were reported.
Limitations: Our study involved a small number of patients. Failure of etanercept was establish by patient's history. However we were able to correlate such failure from our medical records in 17 patients.
Conclusions: Re-treatment with etanercept, after secondary loss of efficacy should be considered in patients with psoriasis if satisfactory therapy cannot be achieved with other therapeutic regimens.
J Drugs Dermatol. 2012;11(8):950-954.
Kendra Gail Bergstrom MD FAAD| |
Comparative Study of Hydroquinone-Free and Hydroquinone-Based Hyperpigmentation Regimens in Treating Facial Hyperpigmentation and Photoaging
Sabrina G. Fabi MD and Mitchel P. Goldman MD| |
OBJECTIVE: This investigator-blinded, randomized trial was conducted to compare a new hydroquinone (HQ)-free hyperpigmentation regimen against a leading HQ-based hyperpigmentation regimen for the treatment of facial hyperpigmentation and photoaging.
METHODS: Subjects with mottled pigmentation and photodamaged facial skin were randomized to treatment with either the new 4-product (HQ-free) SkinMedica® Hyperpigmentation System (SKM; SkinMedica, an Allergan Company, Carlsbad, CA) kit or the 7-product (HQ-containing) Obagi Nu-Derm System (OMP; Obagi Medical Products, Long Beach, CA) kit. Subjects were evaluated by a blinded investigator for clinical efficacy and tolerability using grading scales at baseline and at weeks 4, 8, and 12. Standardized digital photographs were taken at baseline and week 12. Self-assessment questionnaires were completed at week 12.
RESULTS: Thirty-six female subjects (16: SKM; 20: OMP) completed the 12-week comparative study. Both hyperpigmentation regimens significantly reduced Overall Hyperpigmentation, Mottled Pigmentation Area and Severity Index (MoPASI), global photoaging, and sallowness at week 12 compared to baseline. Significant reductions in tactile roughness were seen with the OMP regimen at week 12. In these investigator-blinded assessments, there were no significant differences between treatment groups, nor was there a difference in global response to treatment. Investigator assessments of tolerability showed mean scores were mild or below for all parameters with both treatment regimens.
CONCLUSION: A new 4-product (HQ-free) regimen was shown to be as effective and tolerable as a 7-product (HQ-based) regimen in reducing facial hyperpigmentation and photoaging in females with mottled pigmentation and photodamaged facial skin.
J Drugs Dermatol. 2013;12(3 suppl 1):s32-s37.
Lindsey A. Brodell MD and Lynn A. Cornelius MD| |
Effective Topical Combination Therapy for Treatment of Lichen Striatus in Children: A Case Series and Review
J Drugs Dermatol. 2012;11(7):872-875.
Aanand N. Geria MD, Christina N. Lawson MD, Rebat M. Halder MD| |
J Drugs Dermatol. 2011;10(5):483-489.
J Drugs Dermatol. 2011;10(7):799-801.
Clinical Trial Safety and Mortality Analyses in Patients Receiving EtanerceptAcross Approved Indications
Alice B. Gottlieb MD PhD,a Kenneth Gordon MD,b Edward H. Giannini MSc DrPH,c Philip Mease MD,d Juan Li PhD,e Yun Chon PhD,e Judy Maddox DO,e Haoling H. Weng MD MHS,e Joseph Wajdula PhD,f Shao-Lee Lin MD PhD,e Scott W. Baumgartner MDe| |
Patients and Methods: Forty-nine U.S. and non-U.S. trials of etanercept, involving up to 13,977 patients for approved indications, with final trial reports as of May 2006, were selected from the Amgen Inc. clinical trials database. Exposure-adjusted rates of serious infections, opportunistic infections, malignancies and deaths were reported by trial, indication and dosage.
Results: Rates of serious infections were generally similar between etanercept and controls. Overall rates of opportunistic infections and tuberculosis were low. The standardized incidence ratio (SIR) (95% CI) for malignancy was 1.00 (0.83–1.19) for all etanercept patients across all indications. The SIR for lymphoma for patients with rheumatoid arthritis was 3.45 (1.83-5.89); all other indications reported SIRs similar to those observed in the general population. The SIRs for cutaneous squamous cell carcinoma in patients with psoriasis relative to the general population with high or low sun exposure were 2.09 (1.27-3.22) and 4.96 (3.03-7.66), respectively. SIRs were less than 1.0 for all other indications regardless of sun exposure. Rates of melanoma and basal cell carcinoma were not significantly different from those in the general population. There was no increase in mortality associated with etanercept use relative to control populations.
Conclusion: These data support the overall tolerability of etanercept across approved indications.
J Drugs Dermatol. 2011;10(3):289-300.
J Drugs Dermatol. 2012;11(2):247-249.
Background: Melasma is a cutaneous disorder associated with an overproduction of melanin by the tyrosinase enzyme. A proprietary oligopeptide (Lumixyl TM ) was previously shown to competitively inhibit mushroom and human tyrosinase in vitro without the
associated cytotoxicity of hydroquinone and to diminish the appearance of facial melasma.
Objective: The aim of this case study was to determine if the Lumixyl Topical Brightening System (0.01% oligopeptide cream, an antioxidant cleanser, 20% glycolic acid lotion and physical sunscreen) accelerates clearance of mild-to-moderate melasma.
Results: All patients showed improvement in their facial melasma with 1 of 4 patients showing complete clearance after just 6 weeks.
Conclusions: Results suggest that this regimen may be a useful new tool to treat mild to moderate melasma.
J Drugs Dermatol.2012;11(5):660-662.
Effectiveness and Safety of Once-Daily Doxycycline Capsules as Monotherapy in Patients With Rosacea: An Analysis by Fitzpatrick Skin Type
J Drugs Dermatol. 2012;11(10):1219-1222.
What More Can We Learn About Acne and Rosacea? Just Keep Reading, Questioning, and Searching for Clinical Relevance Beyond the Limitations of Clinical Trials
James Q. Del Rosso DO FAOCD| |
A Comparison of Psoriasis Drug Failure Rates and Reasons for Discontinuation in Biologics vs Conventional Systemic Therapies
Adriane A. Levin BA,a,b Alice B. Gottlieb MD PhD,b,c and Shiu-chung Au MDb| |
DESIGN: Retrospective, cross-sectional.
METHODS: All patient visits coded for psoriasis (ICD-0 696.1) in the clinical practice of 2 dermatologists from January 1 2008 through January 4 2012 were included in this retrospective data analysis. The practice is a comprehensive psoriasis care center in the northeastern United States serving a metropolitan population of over 4 million people. Patients were divided by treatment type: biologic or traditional systemic. Treatment failure was defined as discontinuation of treatment course for any reason. Patient time to failure for each therapy was calculated, as were previous treatments and reasons for treatment discontinuation.
RESULTS: One hundred and fifty-nine patients who underwent 284 courses of treatment were studied. Forty-eight percent of biologics failed in an average of 242 days, compared with 75% of traditional systemics (P<.0001), which failed in an average of 143 days (P<.0001). Infliximab had the longest survival time (292 days), and ustekinumab had the smallest failure rate (39%). Reasons for discontinuation differed significantly between biologics and systemics, with biologics being discontinued more often due to loss of efficacy (P=.0014), and systemics failing significantly more frequently due to adverse events (P<.001). Adverse events were observed most frequently with methotrexate and infliximab, while golimumab had the highest rates of both loss and lack of efficacy.
CONCLUSION: Biologics had longer survival times and lower failure rates than traditional systemics in the treatment of psoriasis. Biologics were more likely to be discontinued due to loss of efficacy, and systemics were more likely to fail due to adverse events.
J Drugs Dermatol. 2014;13(7):848-853.
Efficacy and Tolerability of a New Monophasic, Double-Crosslinked Hyaluronic Acid Filler for Correction of Deep Lines and Wrinkles
Tatjana Pavicic PhD
Clinic and Polyclinic for Dermatology and Allergology, Ludwig-Maximilians-University, Munich, Germany
Objective: To investigate the efficacy and tolerability of Belotero.
Methods and Materials: A total of 149 patients received injections. Efficacy was assessed on the Wrinkle Severity Rating Scale (WSRS) and the Global Aesthetic Improvement Scale (GAIS). Adverse events were recorded at each evaluation session.
Results: Mean WSRS improved significantly (P<0.001) by 1.9 score points without any decline throughout the 12-week period. Improvement was found in 89.9 percent of patients on the (GAIS), 59.7 percent of whom were designated as very much/much improved. Investigator and patient satisfaction was stated in more than 90 percent of cases as excellent/good. Adverse events, exclusively localized to the injection area, occurred in 85.9 percent of patients immediately after injection and declined to 12.8 percent in week 2. None were serious.
Conclusion: The findings indicate the benefit of the highly cross-linked, monophasic hyaluronic acid dermal filler, especially in the treatment of patients with deep and extremely deep folds. Overall, the filler appears to be well tolerated. This evaluation raised no major safety concerns.
J Drugs Dermatol. 2011;10(2):134-139.
Objective: To evaluate their therapeutic regimen of 8% and 10% topical precipitated sulfur in petrolatum ointment for single day, three successive nights or three successive days in management of scabies.
Patients and Methods: This single-blinded, comparative study was conducted in the Department of Dermatology-Baghdad Teaching Hospital from April 2008 through October 2009. A total of 97 patients with scabies were enrolled in this study. The diagnosis was established on clinical basis. The patients treated with 8% and 10% topical sulfur in petrolatum ointment were divided randomly into three groups: Group A: 33 patients treated for single day (24 hours); Group B: 32 patients treated for three successive nights (from 6 p.m. to 8 p.m. to 6 a.m. to 8 a.m. and bathing every day); and Group C: 32 patients treated for three successive days (bathing every 24 hours). The patients were seen regularly every two weeks for the duration of four weeks.
Results: Study included 58 (59.8%) males and 39 (40.2%) females, with a male to female ratio 1.4:1. The age range of males at presentation from 3 to 64 (26.74±15.98) years, while the females age ranged at presentation from 3 to 60 (24.05±14.53) years of age. At the end of the study, the response to treatment was: Group A, response in 14 (42.4%) patients and no response in 19 (57.6%); Group B, response in 29 (90.6%) patients and no response in 3 (9.4%); and Group C, response in 31 (96.9%) patients and no response in 1 (3.1%). There is significant statistical difference among the response of 3 groups with (P=0.00000011), but no statistically significant difference between the response of Group C and Group B, (P=0.6055). Mild burning sensation and irritating (sulfur) dermatitis were the only side effects of 8% and 10% sulfur. Pruritic rash occurred in Group C mainly, in 11 (34.4%) patients, 8 (25%) in Group B and 4 (12.1%) in Group A, with no significance (P=0.1058). Recurrence or relapse occurred in Group A mainly, with 4 (12.1%) patients, and in Group B, 1 patient, (3.1%), with no recurrence in group C, with significance (P=0.0060).
Conclusion: Three successive days and three successive nights of 8% and 10% sulfur ointment were effective regimens with no statistical difference in favor of three successive days, while single-day application was much less effective but with fewer side effects.
J Drugs Dermatol. 2012;11(3):357-364.
Tumor Necrosis Factor Inhibitor Primary Failure Predicts Decreased Ustekinumab Efficacy in Psoriasis Patients
Eric P. Sorensen BS,ab Kristina A. Fanucci BS,ac Ami Saraiya MD,a Eva Volf MD,a Shiu-chung Au MD,a Yahya Argobi MD,a Ryan Mansfield AS,a and Alice B. Gottlieb MD PhDa,c| |
OBJECTIVE: To examine the predictive effect of TNFi primary failure and the number of TNFi exposures on the efficacy of ustekinumab in psoriasis treatment.
METHODS: This retrospective study examined 44 psoriasis patients treated at the Tufts Medical Center Department of Dermatology between January 2008 and July 2014. Patients were selected if they were treated with ustekinumab and had ≥ 1 previous TNFi exposure. The following subgroups were compared: patients with vs without a previous TNFi primary failure, and patients with one vs multiple previous TNFi exposures. The efficacy measure used was the previously validated Simple Measure for Assessing Psoriasis Activity (S-MAPA), which is calculated by the product of the body surface area and physician global assessment. The primary outcome was the percentage improvement S-MAPA from course baseline at week 12 of ustekinumab treatment. Secondary outcomes were the psoriasis clearance, primary failure, and secondary failure rates with ustekinumab treatment.
RESULTS: Patients with a previous TNFi primary failure had a significantly lower percentage improvement in S-MAPA score at week 12 of ustekinumab treatment compared with patients without TNFi primary failure (36.2% vs 61.1%, P=.027). Multivariate analysis demonstrated that this relationship was independent of patient demographics and medical comorbidities. Patients with multiple TNFi exposures had a non-statistically significant lower percentage S-MAPA improvement at week 12 (40.5% vs 52.9%, P=.294) of ustekinumab treatment compared with patients with a single TNFi exposure.
CONCLUSIONS: Among psoriasis patients previously exposed to TNFi, a history of a previous TNFi primary failure predicts a decreased response to ustekinumab independent of patient demographics and medical comorbidities.
J Drugs Dermatol. 2015;14(8):893-898.
Twenty-Nail Transverse Melanonychia Induced by Hydroxyurea: Case Report and Review of the Literature
Osamuede Osemwota MD,a John Uhlemann MD,a and Adam Rubin MDb| |
Twenty-nail transverse melanonychia from hydroxyurea is a rare phenomenon, only reported four times previously. Here we describe a 51-year-old female who presented with 20-nail transverse melanonychia 3 months after initiating hydroxyurea therapy. Transverse melanonychia is a benign process but can cause patients significant distress, and thus is an entity with which dermatologists should recognize. We then review the cutaneous manifestations, differential diagnosis, and clinical considerations when evaluating patients with transverse melanonychia from hydroxyurea or other causes.
J Drugs Dermatol. 2017;16(8):814-815.
Andrew S. Dorizas MD,a Amer H. Nassar MD,a and David J. Goldberg MDb,c| |
EVIDENCE REVIEW: Evidence gathered from a pivotal study involving 1,383 patients with 1,831-pigmented lesions. The isolated use of the pediatric population within this study was used to determine the specificity and sensitivity of such a device with comparison to a dermatologists evaluation.
FINDINGS: For all lesions from the assessed pediatric population the biopsy ratio was equivalent for the Multispectral Digital Skin Lesion Analysis device as for the dermatologists when performing as independent reviewers. Furthermore analyzed data suggests that dermatologists who incorporate the Multispectral Digital Skin Lesion Analysis device perform better than they would independently or if they were to follow the device blindly without incorporating their own judgment.
CONCLUSION AND RELEVANCE: An approach that integrates automated imaging technology like the Multispectral Digital Skin Lesion Analysis device, along with another diagnostic aid, with the end result being cost-effective, easy to use by even non-experts and comforting for the pediatric patient is likely to compete to be the new gold standard in successful early diagnosis and management of melanoma.
J Drugs Dermatol. 2014;13(10):1269-1273.
The Treatment of Inflammatory Facial Dermatoses With Topical Corticosteroids:Focus on Clocortolone Pivalate 0.1% Cream
Methods: Clocortolone pivalate 0.01% cream was applied to affected facial skin in subjects presenting with seborrheic dermatitis, contact dermatitis, atopic dermatitis, or psoriasis. Application was completed three times daily for 21 days. Assessments of erythema, edema, transudation, lichenification, scaling, pruritus and/or pain were completed at baseline and Days 4, 7, 14, and 21. Overall therapeutic response was assessed at all follow-up visits. Forty-nine subjects were entered, ranging in age from 1 month to 88 years of age. Thirty-eight subjects completed the studies, with 11 subjects lost to follow-up after the first visit. Individuals between the ages of 13 and 19 years were pre-emptively excluded to avoid potential application of a corticosteroid to acne-affected or acne-prone skin.
Results: Treatment with clocortolone pivalate 0.1% cream resulted in decreases in erythema, edema, transudation, lichenification, scaling, and pruritus/pain in 76% of treated study subjects. The overall therapeutic response in approximately two-thirds of the subjects (68%) was rated as good to excellent. There were 7 adverse events noted over the course of the study that were judged to be related to treatment, all of which were cutaneous and localized to the site of application (acneiform eruptions, burning, and folliculitis).
Conclusion: Clocortolone pivalate 0.1% cream was effective in relieving the signs and symptoms of corticosteroid-responsive inflammatory dermatoses involving facial skin, including seborrheic dermatitis, contact dermatitis, atopic dermatitis, and psoriasis. Overall, the safety profile was favorable and devoid of any treatment-related serious adverse events.
J Drugs Dermatol. 2012;11(10):1194-1198.
Kristen Lo Sicco MD, Mona Sadeghpour MD, Laura K. Ferris MD PhD| |
Leslie Baumann MDa and Brian Zelickson MDb| |
OBJECTIVE: The following study was performed to test the hypothesis that customized application of MFU-V at two focal depths will produce clinical results that are superior to treatment at a single focal depth.
METHODS AND MATERIALS: Adult subjects (N=71) with skin laxity in the lower face and neck were enrolled; 64 met all entrance criteria and received treatment. On the basis of physical and anatomical characteristics, patients were assigned in nonrandomized fashion to one of three treatment groups to undergo treatment on the submental, submandibular, lower neck, and platysmal areas with MFU-V at single or dual depths.
RESULTS: Among evaluable subjects (N=64), investigator-assessment and subject-self-assessment demonstrated improved aesthetic changes at 60, 90, and 180 days after treatment. Overall, subjects that received MFU-V at two focal depths to the entire treatment area achieved slightly greater aesthetic improvement than subjects receiving MFU-V at single focal depths. There were no unexpected adverse events.
CONCLUSION: Applying treatment with MFU-V at two focal depths may provide improved aesthetic results in some subjects.
J Drugs Dermatol. 2016;15(5):607-614.
Arpan V. Prabhu BS,a Kristin Bibee MD PhD,b and Joseph C. English III MDb| |
Eruptive melanocytic nevi (EMN) are a rare clinical finding characterized by sudden-onset nevi that often present in a grouped distribution. They have been associated with chemotherapy, immunosuppression, bullous diseases, and medications including multikinase and BRAF inhibitors. It is important for dermatologists to be able to identify patients with sudden development of new melanocytic nevi secondary to particular medications. Herein, we describe a case of eruptive melanocytic acral nevi secondary to 6-mercaptopurine therapy.
J Drugs Dermatol. 2017;16(5):516-518.
Benjamin Farahnik BA,a Kourosh Beroukhim BS,b Mio Nakamura MD,c Michael Abrouk BS,d Tian Hao Zhu BA,e Rasnik Singh BS,b Kristina Lee BA,c Tina Bhutani MD,c and John Koo MDc| |
METHODS: We reviewed the results of the phase III clinical trials for the anti-IL-17 agents secukinumab, ixekizumab and brodalumab in order to assess the efficacy and safety profile of each agent.
RESULTS: By week 12, the proportion of patients reaching a 75% improvement from baseline Psoriasis Area and Severity Index (PASI 75) was comparable between the different agents (secukinumab 83%, ixekizumab 89%, and brodalumab 85%). The safety profiles of the agents were similar with the most frequently reported adverse events of nasopharyngitis, upper respiratory infections, headache, and injection site reaction.
CONCLUSION: The anti-IL-17 agents demonstrated a rapid and robust clinical improvement accompanied by a favorable short-term safety profile. The results of the phase III trials continue to reinforce the theory that the IL-17 pathway is an essential target in psoriasis treatment.
J Drugs Dermatol. 2016;15(3):311-316.
Sarina B. Elmariah MD PhDa and Roopal V. Kundu MDb| |
Progressive macular hypomelanosis is an under-recognized disorder characterized by the presence of numerous ill-defined hypopigmented macules and patches on the trunk of young adults. Although common, particularly in Fitzpatrick skin types IV-VI, this condition is frequently misdiagnosed and treated inadequately with antifungals or topical steroids resulting in patient frustration. The exact pathogenesis of progressive macular hypomelanosis is unknown; however, recent studies suggest hypopigmentation results from decreased melanin formation and altered melanosome distribution in response to Proprionibacterium. While there are no well-established or consistently effective therapies for progressive macular hypomelanosis, our growing understanding of its pathogenesis urges consideration of alternative treatment strategies. Here, we report five patients with progressive macular hypomelanosis who benefitted from topical and systemic antimicrobial therapy and summarize the current clinical, pathological and treatment paradigms of this disorder.
J Drugs Dermatol. 2011;10(5):502-506.
A Randomized, Prospective, Sham-Controlled Study of Localized Narrow-Band UVB Phototherapy in the Treatment of Plaque Psoriasis
Adriane A. Levin BA,a,b Saud Aleissa MD,a Nicole Dumont,a Francisca Martinez,a Courtney Donovan RN,a
Shiu-chung Au MD,a Afnan Hasanain MD,a and Alice B. Gottlieb MD PhDa,c
OBJECTIVE: We aimed to evaluate the efficacy of the Levia® localized NB-UVB phototherapy machine in the treatment of patients with symmetrical psoriatic lesions.
DESIGN: We performed a prospective, double-blinded, sham-treatment controlled study of this device beginning March 2012 through April 2014.
SETTING: a comprehensive dermatology clinic in the northeastern United States.
PARTICIPANTS: 21 subjects with chronic plaque psoriasis.
INTERVENTIONS: Each patient had one lesion randomized to receive the Levia treatment and one lesion (the control) treated with visible light. Treatment was administered three times a week for twelve weeks. Target lesion score (TLS), a rating of 0-4 each of erythema, scaling, and thickness, was measured biweekly by a blinded assessor, and visual analogue scale of pruritus was recorded by subjects.
MAIN OUTCOMES AND MEASURES: The primary outcome, formulated prior to study initiation, was the percentage of lesions achieving clear or almost clear TLS after 12 weeks of treatment. Secondary endpoints included changes in target lesion pruritus VAS, percentage improvement in TLS, and the percentage of subjects achieving 50% improvement in TLS (TLS-50).
RESULTS: The primary endpoint, TLS of three or less, was not achieved (P=0.118), but the secondary endpoints of percentage improvement in TLS (P=0.043) and TLS-50 (P=0.0195) were significantly superior in treated compared to sham-treated lesions. Percentage improvement in pruritus VAS was not significant (P=0.0565).
CONCLUSIONS AND RELEVANCE: This device was found to be efficacious, though not necessarily to the point of clearance, in the treatment of psoriasis over a 12-week period.
TRIAL REGISTRATION: www.clinicaltrials.gov, identifier: NCT02107482, http://clinicaltrials.gov/show/NCT02107482
J Drugs Dermatol. 2014;13(8):922-926.
Apremilast and Narrowband Ultraviolet-B Combination Therapy for Treating Moderate-to-Severe Plaque Psoriasis
Jerry Bagel MD MS, Elise Nelson LPN, Brian R. Keegan MD PhD| |
J Drugs Dermatol. 2017;16(10):957-962.
Jessica El-Kehdy MD,a Eckart Haneke MD,b and Paula G. Karam MDc| |
J Drugs Dermatol. 2013;12(2):228-230.
Ustekinumab Treatment for Psoriasis in 119 Patients Maintained on Therapy for a Minimum of One Year: A Review
Elizabeth G. Wilder MD,a Mahir Patel MD,a Katherine Hebeler BA,b and Alan Menter MDa| |
J Drugs Dermatol. 2014;13(8):905-910.
Leon Kircik MD,a,b,c Mark G. Lebwohl MD,c James Q. Del Rosso DO,d
Jerry Bagel MD,eLinda Stein Gold MD,f Jonathan S. Weiss MDg
In both Phase 3 studies, a statistically significantly greater percentage of subjects in the desoximetasone spray 0.25% compared to vehicle group achieved both Clinical Success and Treatment Success at Day 28. These results, which were the primary efficacy variables, demonstrated superior efficacy in the active study group for both overall improvement of plaque psoriasis (by PGA) and in the individual psoriasis lesion (by TLSS) designated at baseline as the most severely involved plaque (target lesion). Assessment of secondary efficacy variables in both Phase 3 studies showed that subjects receiving desoximetasone Spray 0.25% twice daily exhibited statistically significantly mean changes from Baseline to Day 28 in PGA, TLSS, and % BSA affected when compared to subjects receiving vehicle spray twice daily.
Tolerability and safety were assessed at all study visits. No statistically significant differences were observed between study arms and no major safety signals related to AEs were noted. No stinging and burning were reported with the spray formulation. This Class I topical corticosteroid has shown to be safe and efficacious in moderate to severe plaque psoriasis.
J Drugs Dermatol. 2013;12(12):1404-1410.
Anne Goldsberry MD MBA, C. William Hanke MD MPH, and Nicholas B. Countryman MD MBA| |
J Drugs Dermatol. 2014;13(12):1463-1465.
Schnitzler Syndrome With Delirium and Vertigo: The Utility of Neurologic Manifestations in Diagnosis
Stanislav N. Tolkachjov MDa and David A. Wetter MDb| |
Schnitzler syndrome (SS) is an autoinflammatory dermatosis that often goes undiagnosed for 5-6 years. Patients typically carry a diagnosis of urticaria; however, their cutaneous symptoms fail to respond to typical urticaria therapies and lack symptoms such as pruritus. Additionally, patients with SS may see multiple providers for nonspecific complaints of fever, lymphadenopathy, arthralgias, and bone pain. A correct diagnosis is paramount, as close to 20% of patients may develop a lymphoproliferative disorder and appropriate treatment may ameliorate all symptoms.1 We report 2 cases of SS misdiagnosed as urticaria for years in order to illuminate diagnostic pearls, histopathological findings, and treatment modalities. Additionally, we highlight the importance of neurologic disturbances in this rare but important differential diagnosis of urticaria.
J Drugs Dermatol. 2017;16(6):625-627.
Two Multicenter, Randomized, Double-Blind, Parallel Group Comparison Studies of a Novel Enhanced Lotion Formulation of Halobetasol Propionate, 0.05% Versus Its Vehicle in Adult Subjects With Plaque Psoriasis
David Pariser MD,a Michael Bukhalo MD,b Scott Guenthner MD,c Steven Kempers MD,d Stephen Shideler MD,e Linda Stein Gold MD,f Eduardo Tschen MD MBA,g Jim Berg,h Mary Beth Ferdon PhD,h and Syd Dromgoole PhDh| |
BACKGROUND: A novel lotion formulation of halobetasol propionate, 0.05% (HBP Lotion) with enhanced vehicle characteristics of a cream while preserving the ease of use and cosmetic elegance of a lotion has been developed to treat plaque psoriasis. OBJECTIVE: Determine the safety and effectiveness of HBP Lotion in patients with plaque psoriasis. METHODS: Two prospective, randomized, vehicle-controlled clinical studies were conducted in 443 adult subjects with moderate-severe plaque psoriasis. Subjects applied the test article to psoriatic plaques within the treatment area twice daily for 14 days. Efficacy data are based upon treatment “success” defined as those subjects that achieved scores of 0=clear or 1=almost clear with at least a two-grade improvement relative to baseline for an Investigator’s Global Assessment (IGA) and clinical signs (plaque elevation, erythema, scaling). Safety data are presented as adverse events and local skin reactions. RESULTS: After two weeks of treatment with HBP Lotion, 44.5% of the HBP Lotion treated subjects in each study achieved (a) treatment “success” (ie, an IGA score of 0=clear or 1=almost clear and >2 grade improvement compared to baseline) and (b) a notable reduction in plaque elevation, erythema, scaling, and pruritus. In contrast, only 6.3% and 7.1% of VEH subjects in Studies 1 and 2, respectively, achieved treatment success and the reduction of disease related signs was materially lower. Statistically, at day 15 in both Phase 3 studies, treatment success with HBP Lotion was superior to VEH (P less than 0.001). From a safety perspective the outcomes were in general unremarkable with similar findings in the HBP Lotion and VEH treatment groups. CONCLUSIONS: The results demonstrate the safety and effectiveness of HBP Lotion in the treatment of plaque psoriasis. Furthermore, this novel HBP lotion formulation is also distinguished by its moisturization qualities and ease of use.
J Drugs Dermatol. 2017;16(3):234-240.
This article focuses on such findings in selected multiple cutaneous lesions that may be classified according to the primary cutaneous feature as vascular, pigmentary, nevoid hamartomas, and tumors/neoplastic conditions. The clinical presentation of each entity and its significance, appropriate diagnostic evaluation, therapeutic and prognostic considerations and pertinent differential diagnoses will be reviewed.
J Drugs Dermatol. 2012;11(7):812-817.
Fitzpatrick Skin Types and Clindamycin Phosphate 1.2%/Benzoyl Peroxide Gel: Efficacy and Tolerability of Treatment in Moderate to Severe Acne
Background: Acne in skin of color is an increasing problem, presenting unique challenges. Although combination therapy is now standard of care in acne, concerns exist with the increased potential irritation and dryness in skin of color. Although individual medications
can be titrated or applied at different times of the day to minimize irritation, this is not always practical or desirable. There is a paucity of
clinical studies that evaluate the safety and efficacy of acne medications in skin of color.
Methods: A post-hoc analysis of efficacy and cutaneous tolerability in 797 subjects receiving clindamycin phosphate 1.2% benzoyl peroxide (BPO) 2.5% gel from two 12-week, multi-center, double-blind studies that enrolled 2,813 subjects with moderate to severe acne. Efficacy, tolerability, and subject satisfaction in Fitzpatrick skin types I-III subjects were compared to subjects with Fitzpatrick skin types IV-VI.
Results: Median reductions in inflammatory lesions were comparable between the two groups. There was a small difference in non - inflammatory and total lesions in favor of those patients with Fitzpatrick skin types I-III (P=0.013 and P=0.024, respectively). Median reductions in inflammatory, noninflammatory, and total lesions at week 12 were 63%, 50%, and 52.4%, respectively for Fitzpatrick skin types I-III and 65%, 47%, and 51.4%, respectively for Fitzpatrick skin types IV-VI. Treatment success was comparable between the two groups and both groups had a high level of subject satisfaction at week 12. Cutaneous tolerability was excellent, with all mean scores less than or equal to 0.2 at week 12 (where 1=mild). Results in the two groups were comparable, although there was slightly more erythema reported in the Fitzpatrick skin types I-III subjects (0.2 versus 0.1). This could be due to the difficulty in vis ualizing erythema in subjects with darker skin.
Conclusions: Acne subjects with Fitzpatrick skin types IV-VI were not found to be more susceptible to cutaneous irritation from treatment with clindamycin phosphate 1.2%/BPO 2.5% gel and both efficacy and tolerability was comparable across the two treatment groups.
J Drugs Dermatol. 2012;11(5):643-648.
Immune Response to Pneumococcus and Tetanus Toxoid in Patients With Moderate-to-Severe Psoriasis Following Long-Term Ustekinumab Use
Carrie Brodmerkel PhD,a Eric Wadman BA,a Richard G. Langley MD,b Kim A. Papp MD,c Marc Bourcier
MD,d Yves Poulin MD,e Vincent Ho MD,f Lyn Guenther MD,g Rod Kunynetz MD,h Simon Nigen MD,i
Ronald Vender MD,j Norman Wasel MD,k Ming-Chun Hsu PhD,a and Philippe Szapary MD MSCEa
OBJECTIVES: Assess the impact of continuous maintenance ustekinumab treatment on patients' ability to mount immune responses to pneumococcal (T-cell-independent) and tetanus toxoid (T-cell-dependent) vaccines.
PATIENTS and METHODS: Ustekinumab-treated patients with moderate-to-severe psoriasis treated in the long-term extension of the Phase 3 PHOENIX 2 trial (n=60) were compared with control psoriasis patients not receiving systemic therapy (n=56). Patients were vaccinated with both 23-valent pneumococcal and tetanus toxoid vaccines. Serum samples collected pre-vaccination and 4 weeks post-vaccination were assessed for antibody responses.
RESULTS: No differences in the ability of ustekinumab-treated patients to respond to pneumococcal or tetanus toxoid vaccinations were observed compared with controls. A ≥2-fold increase in antibody levels in ≥7 of 14 serotypes of the pneumococcal vaccine was observed in ustekinumab-treated (96.6%) and untreated control (92.6%) patients following vaccination. Ustekinumab-treated patients achieved a ≥4-fold increase (84.7%) in anti-tetanus antibody vs. 77.8% in the control group. No differences were detected in ex-vivo responses to anti-CD3/CD28 or tetanus toxoid between ustekinumab-treated and control groups.
CONCLUSION: Long-term treatment (≥3 years) with ustekinumab does not compromise the immune response to T-cell-dependent/-independent vaccines in patients with moderate-to-severe psoriasis.
J Drugs Dermatol. 2013;12(10):1122-1129.
Tiago Torres MD, Teresa Pinto Almeida MD, Rosario Alves MD, Madalena Sanches MD, Manuela Selores MD| |
Granuloma annulare is a benign, usually self-limited, dermatosis of unknown cause. Generalized lesions occur in approximately 15 percent of patients with GA and may cause mild to severe cosmetic disfigurement. The treatment of generalized granuloma annulare can be challenging. We report the case of a 36-year-old male patient with a generalized granuloma annulare who had failed topical and systemic glucocorticoids, systemic retinoids, dapsone, minocycline, PUVA therapy, and hydroxicloroquine and was successfully treated with adalimumab, an anti-TNF-α monoclonal antibody. Adalimumab may be an additional option in the treatment of recalcitrant forms of granuloma annulare.
J Drugs Dermatol. 2011;10(12):1466-1468.
Background: Scalp hyperkeratosis and/or alopecia are common pediatric dermatologic findings. In Caucasian children, scalp hyperkeratosis
of childhood is most often associated with atopic and seborrheic dermatides. Recent data is lacking on the clinical meaning of scalp hyperkeratosis and alopecia in children of color.
Objective: To determine diagnosis associated with scalp hyperkeratosis and/or alopecia in a predominately Black and Hispanic pediatric patient population.
Methods: A retrospective chart review was conducted for all children (0-17 years of age) seen at our institution who had a scalp fungal culture for the evaluation of scalp hyperkeratosis and/or alopecia from January 2007 to September 2009. Fungal culture was performed using cotton swab technique, plating onto Sabouraud's and Mycosel media. Demographic features, fungal culture results, clinical symptoms, physical findings and final diagnosis were reviewed.
Results: 164 children were identified who were eligible for inclusion in the study, 75 of whom were Black and 56 Hispanic/Latino. Scalp hyperkeratosis was noted in 106 patients and alopecia was noted in 71 subjects. Tinea capitis was the final diagnosis in 50 out of 80 children who had hyperkeratosis without alopecia (60%), 16 of 43 children with alopecia alone (37.2%) and 23 of 28 children with both hyperkeratosis and alopecia (82.1%, P=0.0007). The odds ratio of tinea capitis in the presence of hyperkeratosis with alopecia was 7.49 with a 95 percent confidence limit of 2.19-25.70.
Conclusion: Scalp hyperkeratosis, especially when accompanied by alopecia, is usually associated with tinea capitis in Black and Hispanic children. Fungal culture and empirical anti-fungal therapy are warranted in children of color with scalp hyperkeratosis.
J Drugs Dermatol. 2011;10(5):511-516.
An Open-Label Pilot Study of Naftifine 1% Gel in the Treatment of Seborrheic Dermatitis of the Scalp
Topical antifungal treatment is a mainstay of therapy for Seborrehic Dermatitis (SD). Although the amidazole and ciclopyridine antifungals have been extensively studied, few clinical efficacy data are available for topical allylamine therapy in SD. The objective of this open-label exploratory study was to evaluate the efficacy and safety of natifine HCl 1% gel applied twice daily for 4 weeks, as topical treatment of moderate SD of the scalp. Nine subjects (5 men, 4 women) with a mean age of 56 (33-81) years with SD of the scalp were enrolled and made 4 visits to the site. At Visit 1 (Week 0), subjects were screened, enrolled, baseline efficacy data were obtained, and treatment was initiated. Subjects returned at Week 2, Week 4 (end of treatment), and Week 6 for efficacy and safety assessments. Efficacy was evaluated by changes from baseline in investigator-rated scores on 0-5-grade scales: (1) SD Global Evaluation Scale (SDGES), (2) Erythema Severity Scale, (3) Scaling Severity Scale, (4) % Scalp Involvement Scale, and subject-rated scores on the (4) Itching Severity Scale, and (5) Global Improvement Scale, where 0=none and 5=most severe. Mean severity scores for the SDGES and % Scalp Involvement scales progressively declined (improved) 66% and 54% from respective baseline levels at Week 6. Mean erythema rating decreased 38% from baseline and scaling decreased 50% from baseline by Weeks 4 and 6. Itching improved in 5 of 9 (56%) subjects by the end of treatment. A total of 8 of 9 (89%) subjects rated their symptoms as improved from baseline at the end of treatment and Week 6. There were no treatment-related adverse events during the study. These results suggest that naftifine 1% gel applied twice daily for 4 weeks is effective and safe topical treatment for moderate SD of the scalp.
J Drugs Dermatol.2012;11(4):514-518.
Safety and Efficacy Comparison of Minocycline Microgranules vs Lymecycline in the Treatment of Mild to Moderate Acne: Randomized, Evaluator-blinded, Parallel, and Prospective Clinical Trial for 8 Weeks
Jorge Ocampo-Candiani MD,a Luis Leobardo Velázquez-Arenas MD,a Alberto de la Fuente-García MD,a
Carlos Treviño-Gómezharper MD,b and Arturo Berber MD PhDc
METHODS: 170 participants from 14 to 34 years old with mild to moderate facial acne vulgaris were recruited. 84 had 100 mg of minocycline in a single daily dose for 8 weeks and 86 had 300 mg of lymecycline in a single daily dose for 8 weeks. Participants were evaluated at baseline, week 4 and week 8.
RESULTS: 65 minocycline and 60 lymecycline patients were evaluable. The last observation carried forward for the count of non-inflammatory lesions changed from 37.5 ± 17.8 to 37.7 ± 17.8 in the minocycline group and from 36.9 ± 15.5 to 33.4 ± 19.3 in the lymecycline group (no significant changes); corresponding changes in inflammatory lesions were from 19.4 ± 12.4 to 12.2 ± 10.0 in the minocycline group and from 20.1 ± 11.3 to 12.6 ± 8.4 in lymecycline group (P< 0.05 comparing baseline vs. final in both groups). Porphyrin counts varied from 899.5 ± 613.9 to 233.5 ± 219.5 in the minocycline group and from 956.9 ± 661.8 to 411.8 ± 411.5 in the lymecycline group (P<0.05 between the groups at study end). 36 (42.9%) patients receiving minocycline suffered 55 adverse events (22 of them gastrointestinal), while 28 (33.3%) lymecycline patients had 37 adverse events (15 of them gastrointestinal). One patient in the lymecycline group withdrew the study due to gastritis, and one more patient in the same group experienced eosinophilia.
CONCLUSIONS: There were no differences between the groups in non-inflammatory and inflammatory lesion counts, and in the safety profile. Treatment with minocycline induced statistically significant decrease in facial porphyrin counts compared to the group treated with lymecycline (ClinicalTrials.gov number, NCT00988026).
J Drugs Dermatol. 2014;13(6):671-676.
Calcium Hydroxylapatite for Augmentation of Face and Hands: A Retrospective Analysis in Italian Subjects
Gabriele F. Muti MD,a Giorgio Astolfi MD,b Massimo Renzi MD,c and Pier P. Rovatti MDd| |
J Drugs Dermatol. 2015;14(9):948-954.
Program Spotlight: The Unified Division of Dermatology Residency Program of Albert Einstein College of Medicine
Adam Friedman MDa and Steven Cohen MD MPHa| |
Resident Rounds is a section of the JDD dedicated to highlighting various dermatology departments with residency training programs. Resident Rounds includes three sections: (1) a program spotlight, highlighting pertinent information about the department and residency training program; (2) a section presenting study materials used by residents at the program; and (3) a section designed to highlight recent interesting cases seen at the institution. This issue of Resident Rounds features The Unified Division of Dermatology Residency Program of Albert Einstein College of Medicine. The editor of Resident Rounds is Omar A. Ibrahimi, MD, PhD. He is currently the Director of Cutaneous Laser and Cosmetic Surgery and a Mohs surgeon at the University of Connecticut. Dr. Ibrahimi is also a Visiting Scientist at the Wellman Center for Photomedicine at Massachusetts General Hospital/Harvard Medical School. If you are interested in highlighting your training program in a future issue, please contact Dr. Ibrahimi at email@example.com
Evaluation of a Low Energy, Low Density, Non-Ablative Fractional 1927nm Wavelength Laser for Facial Skin Resurfacing
Jeremy A. Brauer MD,a,b Hamad Alabdulrazzaq MBChB,a Yoon-Soo Cindy Bae MD,a,b
and Roy G. Geronemus MDa,b
DESIGN: Prospective non-randomized trial.
SETTING: Single center, private practice with a dedicated research department.
PARTICIPANTS: Subjects with clinically diagnosed facial photodamage, melasma, or post inflammatory hyperpigmentation
INTERVENTIONS: Subjects received four to six treatments at 14-day intervals (+/- 3days) with a low energy low density non-ablative fractional 1,927-nm laser (Solta Hayward, CA) with an energy level of 5 mJ, and density coverage of either 5%, 7.5%, or 10%, with a total of up to 8 passes.
MAIN OUTCOME AND MEASURES: Blinded assessment of clinical photos for overall improvement at one and three months post final treatment. Investigator improvement scores, and subject pain and satisfaction scores for overall improvement were recorded as well.
RESULTS: We enrolled 23 subjects, average age 45.0 years (range, 25-64 years), 22 with Fitzpatrick Skin Types I-IV and 1 with Type VI, with facial photodamage, melasma, or post inflammatory hyperpigmentation. Approximately 55% of subjects reported marked to very significant improvement at one and three months post final treatment. Blinded assessment of photography of 20 subjects revealed an average of moderate improvement at one-month follow up and mild to moderate improvement at three months. Average subject pain score was 3.4/10 during treatment.
CONCLUSIONS AND RELEVANCE: Favorable outcomes were demonstrated using the low energy low density, non-ablative fractional 1,927-nm laser in facial resurfacing for photodamage, melasma, and post inflammatory hyperpigmentation. Results were maintained at the 3-month follow up, as demonstrated by investigator and subject assessments, as well as blinded evaluations by three independent dermatologists utilizing photographs obtained from a standardized facial imaging device.
J Drugs Dermatol. 2015;14(11):1262-1267.
The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments
Carl S. Hornfeldt PhD RPha and Mark Hollandb
Panel Discussion with Vivian W. Bucay MD,c Wendy E. Roberts MD,d Heidi A. Waldorf MD,e
and Steven H. Dayan MDf
J Drugs Dermatol. 2015;14(suppl 9):s15-s22.
Wallace Nozile MS, Cheri N. Adgerson MD, and George F. Cohen MD| |
J Drugs Dermatol. 2015;14(4):343-349.
No Association Between TNF Inhibitor and Methotrexate Therapy Versus Methotrexate in Changes in Hemoglobin A1C and Fasting Glucose Among Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis Patients
Jashin J. Wu MD,a Christopher G. Rowan PhD,b Judith D. Bebchuk ScD,c and Mary S. Anthony PhDd| |
OBJECTIVE: To compare changes in hemoglobin A1C and fasting glucose for patients exposed to TNFi.
METHODS: In this retrospective cohort study, patients with at least 3 recorded diagnosis codes for psoriasis, psoriatic arthritis, or rheumatoid arthritis between January 1, 2004 and July 31, 2011. Patients were Kaiser Permanente Southern California members for at least 1 year prior to the index date.
RESULTS: For hemoglobin A1C, there were 344 patients in the MTX cohort, and 118 patients in the TNFi+MTX cohort. In the covariate adjusted main effects ANCOVA model, the TNFi+MTX cohort had a lower mean change in hemoglobin A1C of -0.18mg/dL (95% CI: -0.35, -0.01) compared to the MTX cohort, although the difference is small and this model was not complete as there were significant interactions. For fasting glucose, there were 524 patients in the MTX cohort, and 121 patients in the TNFi+MTX cohort. In the covariate adjusted main effects ANCOVA model, change in fasting glucose was not significantly different between groups: -0.58 mg/dL (95% CI: -5.05, 3.88) for the TNFi+MTX cohort compared to the MTX cohort, although this model was not complete as there was a significant interaction.
CONCLUSIONS: The use of TNF inhibitors with MTX was not associated with a significant difference in the change of hemoglobin A1C or fasting glucose compared to MTX alone.
J Drugs Dermatol. 2015;14(2):159-166.
Ixekizumab Is Effective in Subjects With Moderate to Severe Plaque Psoriasis With Significant Nail Involvement: Results From UNCOVER 3
Ellen B. Dennehy PhD,a Lu Zhang MS,a David Amato DO,a Orin Goldblum MD,a and Phoebe Rich MDb| |
MATERIALS AND METHODS: The design of UNCOVER-3, a Phase 3, multicenter, double-blind, placebo- and active-controlled trial that evaluated the efficacy and safety of ixekizumab for moderate to severe psoriasis, has been published previously. Patients were randomized to receive blinded placebo, etanercept (50 mg twice weekly) or 80 mg ixekizumab every 2 weeks (IXEQ2W) or every 4 weeks (IXEQ4W) for 12 weeks. At week 12, all patients were assigned to open-label ixekizumab 80 mg every 4 weeks through week 60. In this 60-week post hoc subset analysis, we evaluated only those patients with significant baseline nail involvement, defined as fingernail NAPSI ≥16 and at least 4 fingernails involved.
RESULTS: Ixekizumab Q2W or Q4W resulted in greater improvement in nail psoriasis than placebo or etanercept by week 12 of administration, as measured by percent NAPSI reduction (IXEQ2W 39% improvement, IXEQ4W 40%, etanercept 28%, placebo -4.7%). At week 24, significantly more patients receiving ixekizumab exhibited no signs of nail involvement (IXEQ2W/Q4W 34%, IXEQ4W/Q4W 30%). Similar gains were observed at 60 weeks in all treatment groups.
CONCLUSION: Ixekizumab led to improvement in fingernail psoriasis by week 12 compared with placebo. Continued improvement in fingernail psoriasis with ixekizumab was observed, with >50% of patients achieving complete fingernail psoriasis resolution (NAPSI=0) at week 60.
J Drugs Dermatol. 2016;15(8):958-961.
Topical Formulation Engendered Alteration in p53 and Cyclobutane Pyrimidine Dimer Expression in Chronic Photodamaged Patients
James M. Spencer MD MS,a Summer D. Moon BS,b Kara M. Trapp BA,c and Michael B. Morgan MDd-f| |
J Drugs Dermatol. 2013;12(3):336-340.
Combination of In-Office Chemical Peels With a Topical Comprehensive Pigmentation Control Product in Skin of Color Subjects With Facial Hyperpigmentation
Jeanine Downie MD, a Katie Schneider BS, b Lisa Goberdhan BA, b Elizabeth T. Makino BS CCRA MBA, b and Rahul C. Mehta PhD b| |
Dyschromia is one of the primary complaints for patients with skin of color. Treatments need to achieve a balance between tolerability and efficacy to address existing hyperpigmentation without causing additional damage that could trigger post-inflammatory hyperpigmentation (PIH). An open-label, single-center study was conducted to assess the efficacy of a novel comprehensive pigmentation control serum (LYT2) combined with a series of three very superficial chemical peels (VP) in skin of color subjects. Seventeen female and male subjects aged 36 to 69 years with Fitzpatrick Skin Types III-VI and moderate to severe facial hyperpigmentation were enrolled in the 12-week clinical study. Subjects identified as Asian, Hispanic, African American, or Caucasian ethnicities. Subjects received a series of 3 VP treatments every 4 weeks. LYT2 was applied twice-daily in between VP treatments. Investigator assessments for overall hyperpigmentation, overall photodamage, and skin tone unevenness, as well as standardized digital photography and subject self-assessment questionnaires were conducted at all visits (baseline and weeks 4, 8, and 12). In vivo reflectance confocal microscopy (RCM) of a target lesion was conducted (in a subset of subjects) at baseline and week 12. Fourteen subjects completed the study. The treatment regimen provided statistically significant improvements in all efficacy parameters at weeks 8 and 12 (all P less than equal to 0.03, student’s t-test). Standardized digital photography and RCM images support the improvements in overall hyperpigmentation observed by the investigator. At the end of treatment, the regimen was highly rated by subjects with 100% of subjects (strongly agree/agree) that the combination “decreased the appearance of uneven skin tone and discolorations” and “reduced the appearance of sun damage.” In addition to this clinical study, independent case studies with this combination treatment regimen at a separate study site were also conducted with results that corroborate the formal clinical study findings. The comprehensive results from these studies suggest that the combination of a comprehensive pigmentation control serum with a series of 3 very superficial chemical peels may provide an effective treatment approach for hyperpigmentation in skin of color patients.
J Drugs Dermatol. 2017;16(4):301-306.
Objective: The aim of this prospective study was to identify possible characteristic trichoscopy patterns of diseases leading to primary cicatricial alopecia.
Methods: Trichoscopy was performed in a total of 1,884 consecutive patients presenting with hair loss. In this group, 84 patients were diagnosed with cicatricial alopecia and 1,800 patients with non-cicatricial alopecia. Sixty healthy persons served as healthy controls. Trichoscopy was performed with the use of Fotofinder II videodermoscopy system. Following unique or characteristic features were identified: scattered dark-brown discoloration of the skin, large yellow dots and thick arborizing vessels in cutaneous (discoid) lupus erythematosus (n=20), tubular perifollicular scaling and elongated blood vessels in lichen planopilaris (n=28), minor perifollicular scaling in frontal fibrosing alopecia (n=19), tufted hairs with starburst pattern perifollicular hyperplasia in folliculitis decalvans (n=9) and large, "3D" yellow dots imposed over dystrophic hairs in dissecting cellulitis (n=8).
Results: All patients with cicatricial alopecia trichoscopy showed white and milky-red areas lacking follicular openings. These features were not found in patients with non-cicatricial alopecia or healthy controls.
Conclusion: These results indicate that trichoscopy may be applied as a quick and non-invasive auxiliary method in differential diagnosis of diverse diseases leading to cicatricial alopecia, such as cutaneous lupus erythematosus, classic lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, and dissecting cellulitis.
J Drugs Dermatol. 2012;11(6):753-758
Charlotte Bezzina PharmD, Emmanuelle Bondon-Guitton PharmD PhD, and Jean-Louis Montastruc MD PhD| |
J Drugs Dermatol. 2013;12(1):119-120.
Spotlight on the Use of Nitric Oxide in Dermatology: What Is It? What Does It Do? Can It Become an Important Addition to the Therapeutic Armamentarium for Skin Disease?
James Q. Del Rosso DO FAOCD FAADa,b,c and Leon Kircik MDd,e,f,g| |
Elephantiasis nostras verrucosa is a rare disorder characterized by dermal fibrosis, hyperkeratotic, verrucous, and papillomatous le- sions that result from both chronic filarial and nonfilarial lymphedema. Various treatment options have been reported for this disease. We present a 64-year-old man with erythrodermic psoriasis and elephantiasis nostras verrucosa in whom the lesions were resolved almost completely after acitretin treatment.
J Drugs Dermatol. 2012;11(3):402-405.
Maria Rita Nasca MD PhD,a Francesco Lacarrubba MD,a Francesco Ferraù MD,b and Giuseppe Micali MDa| |
J Drugs Dermatol. 2016;15(6):766-768.
In Vivo Antibacterial Effects of Tretinoin-Clindamycin and Clindamycin Aloneon Propionibacterium acnes With Varying Clindamycin Minimum InhibitoryConcentration Levels
James J. Leyden MD
Department of Dermatology, University of Pennsylvania, Philadelphia, PA
Objective: To quantify the antimicrobial effect of clindamycin phosphate 1.2% and tretinoin 0.025% gel and 1% clindamycin phosphate
gel in patients with Propionibacterium acnes of varying sensitivity to clindamycin.
Design: Study 1 was an initial range-finding study that was neither blinded nor randomized. Study 2 was an open-label, randomized, splitface, single-center study. Both studies were conducted in Pennsylvania.
Patients: Study 1 (n=20) and study 2 (n=22) involved healthy patients aged 18 years or older with initial P acnes levels ≥104/cm2 and minimum inhibitory concentrations (MICs) ≥8 µg/mL for clindamycin.
Interventions: Study 1, clindamycin gel applied twice daily for 6 weeks. Study 2; once-daily application with the combination gel to one cheek and clindamycin gel to the other side for 6 weeks.
Main Outcome Measure: The comparative effectiveness of each product vs P acnes of varying sensitivity to clindamycin at 3 and 6 weeks posttreatment.
Results: For study 1, at 3 and 6 weeks, clindamycin-treated patients with MICs of ≤256 µg/mL showed greater reductions than those with MICs ≥512 µg/mL (P=.0001). Study 2 showed a significant reduction in P acnes for both products, with no differences found. Clindamycin alone was more effective in vivo in patients with MIC levels of ≤256 µg/mL than patients with higher MIC levels. The combination product produced a greater reduction than clindamycin alone after 6 weeks in patients with high MICs >512 µg/mL (P=.0047).
Conclusion: These studies suggest that 1% clindamycin alone produces a varying in vivo antimicrobial effect, with a breakpoint at ≤256 µg/mL. Use of clindamycin phosphate 1.2% and tretinoin 0.025% gel resulted in a significantly greater in vivo antimicrobial effect than clindamycin alone in patients carrying P acnes with MICs of ≥512 µg/mL (P=.0047).
J Drugs Dermatol. 2012;11(12):1434-1438.
Ryan M. Trowbridgea and Mark R. Pittelkow MDb| |
J Drugs Dermatol. 2014;13(2):111-118.
Gita Faghihi MD,a Parastoo Khosravani MD,a Mohammad Ali Nilforoushzadeh MD,a,b Sayyed Mohsen
Hosseini PhD,a Fatemeh Assaf MD,a Naser Zeinali MD,a and Abbas Smiley MD MScc
METHODS: In a double-blind randomized clinical trial, 56 adult patients with papulopustular rosacea were enrolled. The severity of disorder was determined by the patient according to visual analogue score (VAS). Investigator’s global assessment (IGA) scores and number of inflammatory lesions were recorded. 5% dapsone gel was administered for group D and 0.75% metronidazole gel was administered for group M. Systemic doxycycline was administered for all patients. Follow-up assessments were done at 4, 8, and 12 weeks. Changes in VAS, IGA scores and number of lesions were evaluated. Intention to treat analysis was carried out using SPSS version 17 (Chicago, IL).
RESULTS: There was no significant difference in sex and age distribution between the two groups. Mean (SD) IGA score before and after intervention in group D was 3.9 (0.9) and 3.3 (0.9), respectively (P<0.0001). Mean (SD) IGA score before and after intervention in group M was 4.2 (1.2) and 3.6 (1.3), respectively (P<0.0001). Mean (SD) number of lesions before and after intervention in group D was 15 (7.4) and 11.1 (6), respectively (P<0.0001). Mean (SD) number of lesions before and after intervention in group M was 17.6 (7.7) and 12.5 (7.4), respectively (P<0.0001). Mean (SD) VAS score before and after intervention in group D was 6.6 (1.8) and 5.7 (1.9), respectively (P<0.0001). Mean (SD) VAS score before and after intervention in group M was 6.9 (2.0) and 5.3 (2.1), respectively (P<0.0001). Mean IGA score, mean number of lesions and mean VAS score were not significantly different between the two groups, whether before, during or after intervention.
CONCLUSION: Dapsone gel was as effective as metronidazole gel in the treatment of papulopustular rosacea.
J Drugs Dermatol. 2015;14(6):602-606.
Efficacy and Safety of Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam in Patients With Psoriasis Vulgaris – a Randomized Phase III Study (PSO-FAST)
Craig Leonardi MD,a Jerry Bagel MD,b Paul Yamauchi MD,c David Pariser MD,d Zhenyi Xu MD,e Martin Olesen MD,e* Marie Louise østerdal MSc,e and Linda Stein Gold MDf| |
OBJECTIVE: To compare the efficacy and safety of Cal/BD aerosol foam with aerosol foam vehicle in patients with psoriasis.
DESIGN: Phase III, double-blind, randomized PSO-FAST (Cal/BD foam in PSOriasis vulgaris, a Four-week, vehicle-controlled, efficacy And Safety Trial) study recruited patients with ≥ mild severity psoriasis of the trunk and/or limbs from 27 US outpatient sites (NCT01866163). Patients were randomized (3:1) to Cal/BD foam or vehicle once-daily for 4 weeks. Primary outcome: proportion of patients at week 4 who achieved treatment success according to physician’s global assessment. Secondary outcomes: modified (excluding head) psoriasis area and severity index (mPASI) and patient's assessment of itch (visual analog scale). Safety was monitored by adverse events/calcium homeostasis.
RESULTS: 426 patients enrolled between June and October 2013 (Cal/BD foam, n=323; vehicle, n=103). At week 4, significantly more patients using Cal/BD foam achieved treatment success versus vehicle (53.3 versus 4.8%; OR 30.3, 95% CI 9.7,94.3; P < .001) and mean mPASI score was significantly lower for patients using Cal/BD foam than vehicle (2.0 versus 5.5; adjusted difference –3.3, P <.001). Significantly greater itch relief was observed for patients using Cal/BD foam than vehicle (P = .010 at day 3, P < .001 from day 5). Adverse drug reactions were reported in 10 Cal/BD foam patients (3.1%) and two vehicle patients (1.9%); events occurred in one patient each except application site pain (Cal/BD foam, two patients; vehicle, one patient). There were no clinically significant changes in calcium homeostasis.
CONCLUSIONS: Cal/BD foam was efficacious, achieved rapid itch relief and was well tolerated in patients with body psoriasis. This innovative aerosol foam formulation is expected to become a valuable treatment option.
J Drugs Dermatol. 2015;14(12):1468-1477.
Stuart Maddin MD,a John Quiring PhD,b and Lynne Bulgerc| |
METHODS: This phase 3, randomized, placebo-controlled trial investigated the noninferiority of 1 itraconazole 200-mg tablet to 2 itraconazole 100-mg capsules dosed QD for 12 weeks, with a 40-week follow-up period. Clinical Cure (Investigator’s Global Assessment plus mycological examination) was the primary outcome measure and Clinical Improvement was a secondary endpoint. Safety and efficacy of itraconazole 200-mg tablets were also compared with placebo.
RESULTS: Significantly more patients in the intent-to-treat per-protocol populations on itraconazole (200-mg tablet or 2 100-mg capsules) achieved Complete Cure and Clinical Improvement compared with placebo. For both endpoints, itraconazole 200-mg tablet QD was noninferior to itraconazole 100-mg capsules and superior to placebo. All treatment groups demonstrated a similar safety profile with no new safety signals identified.
LIMITATIONS: Absolute patient blinding was not possible; the number of tablets versus capsules differed, and the appearance of the active drugs could not be masked. However, efficacy was based on objective assessments from blinded investigators.
CONCLUSIONS: Once-daily itraconazole 200-mg was well-tolerated, and may be an effective alternative to 2 itraconazole 100-mg capsules for the treatment of toenail onychomycosis. The convenience of a simpler dosing regimen may improve patient compliance (ClinicalTrials.gov number, NCT00356915).
J Drugs Dermatol. 2013;12(7):758-763.
Aikaterini I. Liakou MD,a Michael J. Theodorakis MD,b Bodo C. Melnik MD PhD,c
Apostolos Pappas PhD,d and Christos C. Zouboulis MD PhDa
METHODS: Nutritional clinical studies in dermatology have been reviewed using the MedLine literature source and the terms "diet" or "nutrition" and "skin".
RESULTS & CONCLUSIONS: The data on the relationship between nutrition and skin are until now controversial and much more work is needed to be done to clarify possible etiological correlations.
J Drugs Dermatol. 2013;12(10):1104-1109.
J Drugs Dermatol. 2012;11(10):1158-1165.
Infliximab-Induced Psoriasis in Treatment of Crohn's Disease-Associated Ankylosing Spondylitis: Case Report and Review of 142 Cases
Shannon Famenini BSa and Jashin J. Wu MDb| |
J Drugs Dermatol. 2013;12(8):939-943.
Savita Chaudhary MD Fellow ISDa and Surabhi Dayal MDb| |
OBJECTIVE: To assess the efficacy of combination of topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling in the treatment of melasma in Indian patients.
METHODS: Forty Indian patients of moderate to severe epidermal variety melasma were divided into two groups of 20 each. One Group i.e. peel group received topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling and other group i.e. control group received topical regimen (2% hydroquinone, 1% hydrocortisone, 0.05% tretinoin).
RESULTS: There was an overall decrease in MASI from baseline in 24 weeks of therapy in both the groups (P value < 0.05). The group receiving the glycolic acid peel with topical regimen showed early and greater improvement than the group which was receiving topical regimen only.
CONCLUSION: This study concluded that combining topical regimen (2% hydroquinone, 1% hydrocortisone and 0.05% tretinoin) with serial glycolic acid peeling significantly enhances the therapeutic efficacy of glycolic acid peeling. The combination of glycolic acid peeling with the topical regimen is a highly effective, safe and promising therapeutic option in treatment of melasma.
J Drugs Dermatol. 2013;12(10):1149-1153.
Current Understanding of Seborrheic Keratosis: Prevalence, Etiology, Clinical Presentation, Diagnosis, and Management
J. Mark Jackson MD FAAD,a Andrew Alexis FAAD MPH FAAD,b Brian Berman MD PhD FAAD,c Diane S. Berson MD FAAD,d Susan Taylor MD FAAD,e Jonathan S. Weiss MD FAADf| |
J Drugs Dermatol. 2015;14(10):1119-1125.
Pipeline Previews brings to you information on the newest drugs and medical products as they become available to the dermatologic community. This department may include additional information from the manufacturers, plus reports from physicians who wish to share their clinical experience with these new products. In addition, we will inform our readers about the latest drugs receiving Food and Drug Administration (FDA) approval. We trust you will find this information beneficial to your practice and research.
News, Views, and Reviews. Cutaneous Hyperandrogenism: Role of AntiandrogenTherapy in Acne, Hirsutism, and Androgenetic Alopecia
Aimee Krausz BA and Adam J. Friedman MD| |
Saba Zabetian MD, Gordon Jacobson MS, Henry W. Lim MD, Melody J. Eide MD, and Richard H. Huggins MD| |
BACKGROUND: No study has examined the impact of vitiligo support group membership on vitiligo patient quality of life (QoL).
OBJECTIVE: We sought to examine the QoL impact of vitiligo support groups by comparing QoL and associated patient characteristics between vitiligo patients who are and are not members of a vitiligo support group.
METHODS: Members of a Henry Ford Hospital-sponsored, Southeast Michigan Vitiligo Support Group were compared to non-member vitiligo patients recruited from a previous study cohort.17 Eligible patients were asked to complete the Dermatology Life Quality Index (DLQI) and a study-specific questionnaire designed to collect relevant patient characteristics.
RESULTS: The mean DLQI scores for the support group members and non-members were similar (7.1 ± 5.4 and 6.0 ± 6.5, respectively; P-value 0.2), despite the support group members reporting more severe overall disease and increased disease severity in exposed portions of the body. The African-American: Caucasian ratio and the prevalence of unemployment were both significantly higher among the support group participants. Limitations: Small sample size may have limited the study’s ability to demonstrate the differences between the support group participants and the controls.
CONCLUSIONS: The similar QoL despite an increased prevalence of poorer QoL indicators among the support group participants suggests a protective effect of support group membership.
J Drugs Dermatol. 2017;16(4):344-350.
Varun Kalhana and Neil Sadick MDb| |
Biologic drugs, a novel class of agents engineered to target specifc mediators of infammation, and small-molecule inhibitors that pen-etrate the cell membrane to interact with targets inside a cell represent the cutting-edge of pharmacological biomedical therapeutics. Clinical studies have already demonstrated the effectiveness of this new generation of drugs in treating a variety of medical illnesses and conditions that were refractory to traditional treatments. This review aims to describe the latest available or currently in-develop-ment drugs, biologic agents, and small molecule inhibitors for treatment of psoriasis, rosacea, alopecia areata, and atopic dermatitis.
J Drugs Dermatol. 2017;16(12):1224-1228
An Open Label, Phase 2 Study of MABp1 Monotherapy for the Treatment of Acne Vulgaris and Psychiatric Comorbidity
Daniel Carrasco MD,a Michael Stecher MD,b Gigi Claire Lefebvre MD,c Alan C. Logan ND,d Ronald Moy MDe| |
OBJECTIVE: To assess the efficacy of interleukin 1 alpha blockade in patients with moderate to severe acne vulgaris using the true human monoclonal antibody MABp1.
METHODS: Eleven patients were administered open-label, subcutaneous injections of MABp1 over a six-week period. Objectives were assessment of safety, change in inflammatory lesion count and change in psychosocial functioning using two validated questionnaires.
RESULTS: There were no serious adverse events, or adverse events greater than grade I. Median inflammatory lesion counts decreased 36% (IQR -44% to 1%). Anxiety scores improved (from median 6 to 1) as well as self-image assessment (2.3±0.9 to 2.1±0.1) as measured by the Hospital Anxiety and Depression Scale and the modified Body Image Disturbance Questionnaire.
CONCLUSION: Patients had rapid improvement of skin lesions, as well as psychosocial functioning and anxiety. MABp1 may provide a safe and effective means for treating inflammatory acne lesions and. Further studies using this antibody are warranted in this patient population.
J Drugs Dermatol. 2015;14(6):560-564.
Nicholas Ross, Michele Farber MD, and Joya Sahu MD| |
Of the many tattoo reactions the most common are allergic, granulomatous, lichenoid, photosensitive, pseudolymphomatous, and infectious. Eruptive milia are a rare complication with only three prior reports in the English literature. A 19-year-old African American female presented with tiny, white papules confined within the margins of a tattoo. She denied trauma or associated symptoms at the site. Biopsy demonstrated deposits of black granular material within the dermis and a small infundibular cyst; a diagnosis of eruptive milia within tattoo was made. The milia responded to treatment with urea 40% cream and tretinoin 0.1% cream. Given its rarity, it is important to recognize the presentation of this disorder as other tattoo reactions require more aggressive management. While further research is necessary to determine the exact pathogenesis of this condition, the authors propose a mechanism along with a review of the literature to discuss management.
J Drugs Dermatol. 2017;16(6):621-624.
A Comparative Study of the Safety and Efficacy of 75% Mulberry (Morus alba) Extract Oil Versus Placebo as a Topical Treatment for Melasma: A Randomized, Single-Blind, Placebo-Controlled Trial
Glen Alvin MD, Nino Catambay MD, Ailynne Vergara MD, Maria Jasmin Jamora MD| |
Background: Melasma is an aesthetically undesirable skin condition which remains difficult to treat. Mulberry is a whitening agent with antioxidant properties.
Objective: To evaluate the safety and efficacy of 75% mulberry extract oil as a treatment for melasma versus placebo.
Patients and Methods: 50 patients were recruited and randomly assigned into two groups, with 25 treated with 75% mulberry extract oil and the other 25 treated with placebo. All patients had a negative repeat open application test (ROAT) to both mulberry extract and placebo. Patients were followed up regularly at four-week intervals for a total of eight weeks. The severity of the melasma was assessed using the melasma area and severity score (MASI), Mexameter reading, melasma quality of life score (MelasQOL) and any adverse events noted.
Results: The mean MASI score significantly improved from 4.076 (±0.24) at baseline to 2.884 (±0.25) at week 8 for the 75% mulberry extract oil group while the placebo group showed an improvement of a lesser magnitude. Mexameter readings for the mulberry group showed a significant drop from 355.56 (±59.51) at baseline to 312.52 (±57.03) at week 8 compared to the placebo group, whose Mexameter readings deteriorated from 368.24 (±46.62) at baseline to 372.12 (±44.47) at week 8. The MelasQOL score also improved tremendously for the 75% mulberry extract oil group, falling from 58.84 (SD: ±3.18) at baseline to 44.16 (SD: ±4.29) at week 8, unlike the placebo group that showed a less dramatic improvement from 57.44 (SD: ±4.66) at baseline to 54.28 (SD: ±4.79) at week 8. With regards to the adverse events, only mild itching was reported in four patients from the 75% mulberry extract oil group while there were 12 cases of either itching or erythema reported from the placebo group.
J Drugs Dermatol. 2011;10(9):1025-1031.
Mark A. Strom BS,a Girish C. Mohan MD,b and Peter A. Lio MDa| |
J Drugs Dermatol. 2016;15(10):1203-1207.
Clinical Evaluation of a 4% Hydroquinone + 1% Retinol Treatment Regimen for Improving Melasma and Photodamage in Fitzpatrick Skin Types III-VI
Marta I. Rendon MD FAADa and Sylvia Barkovic BAb| |
Michèle Verschoore MDa,b and Marion Nielsen PharmDa| |
Anti-aging cosmetics are a mainstay in the skin care regimen irrespective of gender or human ethnics. Skin aging involves functional slowdown combined with environmental induced alterations. This paper focuses on cosmetic ingredients that aim at alleviating the signs of skin aging, with proven/controlled results of efficacy. Anti-aging skin care widely benefits from new ingredients and modern evaluation methods that can substantiate the effects of innovative products in a perceivable and sensitive manner. Our approach in controlling skin aging consists of following steps: 1) Developing novel testing methods; 2) Preventing photo-aging by sunscreens that protect from UV damage; 3) Protecting and restoring skin from damage induced by environmental exposure through active ingredients; 4) Boosting the cell metabolism and cell renewal to restore skin mechanical properties and improved appearance.
J Drugs Dermatol. 2017;16(6 Suppl):s94-97.
The Presence of an Air Gap Between the Nail Plate and Nail Bed in Onychomycosis Patients: Treatment Implications for Topical Therapy
Aditya K. Gupta MD PhD FRCPC FAADa,b and Radhakrishnan Pillai PhDc| |
OBJECTIVE: To evaluate the ability of efinaconazole vehicle solution to reach the site of toenail onychomycosis through application to the hyponychium or hyponychium and dorsal nail surface, and assess the impact of the air gap between the nail plate and nail bed.
METHODS: Twenty-three participants with moderate to severe, mycologically-confirmed onychomycosis were enrolled (mean age, 48.5 years). Two separate applications of vehicle solution containing fluorescein for visualization were applied at the hyponychium or hyponychium and dorsal nail surface. Affected nails were later clipped to allow examination of the nail bed and further examination of the ventral surface of the nail. Spread of formulation was assessed under visible and UV light conditions by photographing target toenails after vehicle application and after nail clipping.
RESULTS: There was a positive correlation between the size of the air gap and degree of affected nail involvement (R2=0.064). Assessments under both visible and UV light indicated that the vehicle had spread to the site of infection, with deposition of fluorescein wherever vehicle had reached, irrespective of application methodology or size of air gap. Nail clippings also indicated absorption into the ventral surface of the nail plate.
LIMITATIONS: The relative contributions of subungual versus transungual application of drug to the nail plate to the efficacy of efinaconazole topical solution, 10% in treating onychomycosis were not assessed.
CONCLUSIONS: This study suggests that the low surface tension vehicle developed for efinaconazole topical solution, 10% can reach the site of infection by application to the hyponychium, dorsal or ventral nail surface and nail folds. This multidirectional approach to drug delivery at the site of fungal infection may contribute to the magnitude of efficacy seen in clinical trials.
J Drugs Dermatol. 2015;14(8):859-863.
J Drugs Dermatol. 2012;11(9):e10-e17.
Why Are Dermatologists Still Talking About Acne? Because So Many People Have It... and We Are Always Seeking Better Ways to Manage It
James Q. Del Rosso, DO| |
Improved Neocollagenesis and Skin Mechanical Properties After Injection of Diluted Calcium Hydroxylapatite in the Neck and Décolletage:A Pilot Study
Yana Alexandrovna Yutskovskaya MD PhDa and Evgeniya Alexandrovna Kogan MD PhDb| |
Emerging Oral Immunomodulators for the Treatment of Psoriasis: A Review of Phase III Clinical Trials for Apremilast and Tofacitinib
Rachel McAndrew MD,a,b Ethan Levin MD,b and John Koo MDb| |
METHODS: We reviewed phase III randomized, placebo-controlled clinical trial results for apremilast and tofacitinib for efficacy and safety in psoriasis.
RESULTS: Psoriasis Area and Severity Index (PASI) 75 after 16 weeks for apremilast was between 28.8% and 33.1%. PASI 75 was 39.5% after 12 weeks on tofacitinib 5 mg, and 63.6% after 12 weeks on tofacitinib 10 mg. Common side effects for both drugs included nasopharyngitis and upper respiratory tract infections. Gastrointestinal disturbance was common for apremilast. Dyslipidemia and infections were more common with tofacitinib than placebo.
CONCLUSION: Both new oral medications, apremilast and tofacitinib, appear to be effective in treating psoriasis.
J Drugs Dermatol. 2015;14(8):786-792.
Evaluation of a Hydroquinone-Free Skin Brightening Product Using In Vitro Inhibition of Melanogenesis and Clinical Reduction of Ultraviolet-Induced Hyperpigmentation
Elizabeth T. Makino BS CCRA MBA,a Sujatha Sonti PhD,a Monya L. Sigler PhD,b Piyush Jain PhD,c Ajay Banga PhD,c and Rahul C. Mehta PhDa| |
METHODS: Select formulations were tested in several studies using the MelanoDerm™ Skin Model (MatTek Corporation, Ashland, MA) to assess the ability of the product to reduce melanin production and distribution. A single-center, double-blind comparison clinical study of 18 subjects was conducted to evaluate the efficacy of the product in reducing ultraviolet-induced hyperpigmentation. Test sites were irradiated with 1.0, 1.5, 2.0, and 2.5 minimal erythema doses. After 5 days, to allow for pigmentation development, the product or 4% HQ cream was applied to the respective test sites, once daily for 4 weeks. Chroma Meter measurements (L* brightness) and standardized digital photographs were taken of the test sites twice a week.
RESULTS: The test product resulted in greater reduction in melanin as measured by melanin content and histological staining compared with the positive control in the MelanoDerm Skin Model. The product also demonstrated statistically significant reductions in pigmentation compared with baseline (all P≤.0001) at the end of the clinical study, and produced greater increases in L*, compared with 4% HQ. Results from these studies indicate that a product designed to affect multiple pathways of melanogenesis and melanin distribution may provide an additional treatment option beyond HQ for hyperpigmentation.
J Drugs Dermatol. 2013;12(3 suppl 1):s16-s20.
Reversible Posterior Leukoencephalopathy Syndrome (RPLS) in a Psoriasis Patient Treated With Ustekinumab
Lauren Dickson MD and Alan Menter MD| |
J Drugs Dermatol. 2017;16(2):177-179.
Efficacy and Safety of Once-Daily Dapsone Gel, 7.5% for Treatment of Adolescents and Adults With Acne Vulgaris: First of Two Identically Designed, Large, Multicenter, Randomized, Vehicle-controlled Trials
Linda F. Stein Gold MD,a Michael T. Jarratt MD,b Alicia D. Bucko DO,c Steven K. Grekin DO,d
Joshua M. Berlin MD,e Michael Bukhalo MD,f Jonathan S. Weiss MD,g David R. Berk MD,h
Joan–En Chang–Lin PhD,h Vince Lin PhD,h and Alexandre Kaoukhov MDh
OBJECTIVE: The objective of this study was to assess the efficacy and safety of a new, once-daily formulation of dapsone gel, 7.5%, with a 50% higher dapsone concentration, versus vehicle over 12 weeks in patients with acne.
METHODS: This 12-week, randomized, double-blind, vehicle-controlled, multicenter clinical trial enrolled patients with moderate acne aged 12 years and older with 20 to 50 inflammatory lesions and 30 to 100 noninflammatory lesions on the face, and an acne grade of 3 (moderate) on the Global Acne Assessment Score (GAAS). Patients were randomized to receive topical dapsone gel, 7.5% or vehicle once daily for 12 weeks. Investigators assessed GAAS success rate (proportion of patients with GAAS of 0 or 1) and percent change from baseline in inflammatory, noninflammatory, and total lesions.
RESULTS: The intent-to-treat population comprised 2102 patients, 1044 in the dapsone gel, 7.5% group and 1058 in the vehicle group. At week 12, 29.9% of patients in the dapsone gel, 7.5% group and 21.2% in the vehicle group (P<.001) had GAAS success. Mean inflammatory lesions decreased by 55.5% and 49.0%, noninflammatory lesions decreased by 44.4% and 38.4%, and total lesions decreased by 48.7% and 42.4% in the dapsone gel, 7.5% and vehicle groups (all P<.001), respectively, at week 12. The incidence of adverse events was similar in the dapsone gel, 7.5% (19.1%) and vehicle (20.6%) groups. Most events in both groups were mild or moderate in severity. Most patients receiving dapsone gel, 7.5% and vehicle had a severity rating of “none” for stinging/burning, dryness, scaling, and erythema scales at all time points.
CONCLUSIONS: Dapsone gel, 7.5% applied topically once daily is an effective, safe, and well-tolerated treatment for acne.
J Drugs Dermatol. 2016;15(5):553-561.
aPeter K. Lee MD PhD and bAndrew Kloser PhD| |
J Drugs Dermatol. 2013;12(8):925-930.
Kristin Totoraitis BS,a Cynthia M. Magro MD,b Adam Friedman MDc| |
J Drugs Dermatol. 2017;16(10):1036-1038.
Calcipotriene Plus Betamethasone Dipropionate Topical Suspension for the Treatment of Mild to Moderate Psoriasis Vulgaris on the Body: A Randomized, Double-Blind, Vehicle-Controlled Trial
Alan Menter MD,a Linda Stein Gold MD,b Michael Bukhalo MD,c Steven Grekin DO,d Steven Kempers MD,e Brent M. Boyce MD,f Cecilia Ganslandt MD, gJohn Villumsen MSc,h and Mark Lebwohl MDi| |
Methods: This was a randomized, double-blind, vehicle-controlled, 4-arm trial in 1,152 subjects. The co-primary efficacy end points were the proportion of subjects achieving controlled disease based on the Investigators' Global Assessment of disease severity at weeks 4 and 8. Adverse events, vital signs, and clinical laboratory measurements were also assessed.
Results: At week 4, a greater proportion of subjects in the calcipotriene plus betamethasone group achieved controlled disease compared with subjects in the calcipotriene-only and vehicle-only treatment groups. At week 8, a statistically significantly (P<.01) greater proportion of subjects in the calcipotriene plus betamethasone group achieved controlled disease compared with subjects in the 3 other treatment groups. Adverse events and other safety assessments were similar between the groups.
Conclusion: The topical suspension containing calcipotriene plus betamethasone dipropionate traditionally used for scalp psoriasis is also a safe and effective once-daily treatment for psoriasis vulgaris on the body.
J Drugs Dermatol. 2013;12(1):92-98.
Next-generation Biologics in the Management of Plaque Psoriasis: A Literature Review of IL-17 Inhibition
Paul S. Yamauchi MD PhDa and Jerry Bagel MDb| |
J Drugs Dermatol. 2015;14(3):244-250.
Ted Rosen MD| |
J Drugs Dermatol. 2016;15(6):775-777.
Kendra Gail Bergstrom MD FAAD| |
Kristin K. Marcum MD,a Neal D. Goldman MD,c and Laura F. Sandoval DOb| |
OBJECTIVE: To use various methods of photography including standard photography, cross polarized light, parallel polarized light and ultraviolet passing photography to assess which method most effectively captures skin features such as texture, pigment, and/ or vascularity.
METHODS: A prospective analysis comparing advanced photographic techniques including standard photography, polarized light photography, cross-polarized light photography and ultraviolet light passing photography. The photos were then evaluated and scored by two experts and a blinded observer to characterize the differences visualized in each type of photography compared to standard photography in terms of subsurface skin features, hypopigmentation, hyperpigmentation, and rhytids.
RESULTS: 9 subjects completed the study. Overall, of the 3 photographic methods compared to standard photography, UV passing most enhanced the visualization of subsurface features and hypopigmentation, with increased hyperpigmentation as well. Enhancement of these features made UV passing best for capturing photodamage. Cross-polarized photography was best for visualizing hyperpigmentation, but also heightened visualization of hypopigmentation and subsurface features such as vascularity. Parallel-polarized photography enhanced visualization of skin texture.
CONCLUSIONS: These methods of photography show a quantifiable and reproducible selective ability to evaluate and document elements such as skin texture, vascularity, and pigmentation. Each of these techniques has unique properties that can add to the precision of the clinical evaluation and can be of particular value to providers of cosmetic procedures where photo documentation has become increasingly important in providing an objective means of evaluating outcomes.
J Drugs Dermatol. 2015;14(2):134-139.
Leflunomide: An Immune Modulating Drug That May Have a Role in Controlling Secondary Infections With Review of Its Mechanisms of Action
Kathleen J. Smith MDa and Marguerite Germain MDb| |
OBSERVATIONS: We present three patients with atopic dermatitis on azathioprine therapy who had multiple verrucae and in two molluscum contagiosum (MC) that were resistant to repeated conventional therapies. These patients were switched to LEF, and all the patients showed complete resolution of their verrucae and MC within 2 months of starting therapy. In addition, all three patients showed equivalent to better control of their atopic dermatitis with LEF.
CONCLUSIONS: LEF has previously been reported to be a useful immune modulator for the treatment of severe atopic dermatitis. The spectrum of anti-viral effects previously seen with leflunomide did appear beneficial in these patients in clearing verrucae and MC, which had been resistant to conventional therapies while the patients were on azathioprine.
J Drugs Dermatol. 2015;14(3):230-234.
The projections of increases in the number of skin of color patients over the next several decades, necessitates expertise in cultural competence for health care providers. Acquiring competency begins with practitioners reflecting on their self identity and personal beliefs. Additionally, understanding African-American cultural habits and practices and their impact on disease is critically important. We review, in this article, the fundamentals of becoming cultural competent. Patients are best served when their physician embraces their culture, their view of the health care system as well as habits and practices.
J Drugs Dermatol. 2012;11(4):460-465.
Treatment Response With Once-Daily Topical Dapsone Gel, 7.5% for Acne Vulgaris: Subgroup Analysis of Pooled Data from Two Randomized, Double-Blind Stu
Zoe Diana Draelos MD,a David A. Rodriguez MD,b Steven E. Kempers MD,c Suzanne Bruce MD,d Marina I. Peredo MD PC,e Jeanine Downie MD,f Joan-En Chang-Lin PhD,g David R. Berk MD,g Shiling Ruan PhD,g and Alexandre Kaoukhov MDg| |
BACKGROUND: Acne vulgaris has varying physical and psychological effects in men and women of different ages, races, and ethnicities.
OBJECTIVE: This analysis assessed the relationship of age, sex, and race to treatment response with once-daily topical dapsone gel, 7.5%.
METHODS: We conducted a pooled subgroup analysis of 2 randomized, double-blind, vehicle-controlled clinical trials conducted in the US and Canada. The studies included patients with 20 to 50 inflammatory and 30 to 100 noninflammatory facial lesions, and a Global Acne Assessment Score (GAAS) of 3 (moderate). Pooled data (N=4340) were analyzed by age (12–17 and ≥18 years), sex, and race (Caucasian and non-Caucasian) for GAAS success (score of 0 [none] or 1 [minimal]) and mean percent change from baseline in inflammatory, noninflammatory, and total lesion counts. The impact of age and sex on treatment response was examined using multivariate analysis. Adverse events were analyzed by subgroups.
RESULTS: Treatment responses with dapsone gel, 7.5% were greater overall and for all subgroups versus vehicle. GAAS success rates and mean decrease in all lesion counts with dapsone gel, 7.5% were greater in older (aged ≥18 years) versus younger patients, and for females versus males. Treatment response with dapsone gel, 7.5% in racial subgroups was similar. Multivariate analysis showed statistical significance for age group and sex as predictors of GAAS success (P less than equal to .005) and reduction in lesion counts (P less than equal to .025). Adverse events were similar across subgroups.
CONCLUSIONS: Older age (≥18 years) and female sex were predictors of treatment response. These subgroups tended to have greater acne improvement in subgroup comparisons. Caucasian and non-Caucasian patients had similar responses. The safety profile of dapsone gel, 7.5% was similar across subgroups.
J Drugs Dermatol. 2017;16(6):591-598.
Improvement of Atrophic Acne Scars in Skin of Color Using Topical Synthetic Epidermal Growth Factor (EGF) Serum: A Pilot Study
Marie Alexia Stoddard BS,a Jennifer Herrmann MD,b,c,d Lauren Moy MD,e and Ronald Moy MDb,f| |
BACKGROUND: Atrophic scarring in skin of color is a common, permanent, and distressing result of uncontrolled acne vulgaris. Ablative lasers and chemical peels are frequently used to improve the appearance of atrophic scars, primarily through the stimulation of collagen and elastin; however, these treatment modalities are associated with risks, such as dyspigmentation and hypertrophic scarring, especially in patients with darker skin.
OBJECTIVE: We evaluated the efficacy of topically applied synthetic epidermal growth factor (EGF) serum in reducing the appearance of atrophic acne scars in skin of color.
METHODS: A single-center clinical trial was performed on twelve healthy men and women (average age 32.5) with Fitzpatrick Type IV-V skin and evidence of facial grade II-IV atrophic acne scars. Subjects applied topical EGF serum to the full-face twice daily for 12 weeks. Scar improvement was investigated at each visit using an Investigator Global Assessment (IGA), a Goodman grade, clinical photography, and patient self-assessment.
RESULTS: Eleven subjects completed the trial. Compared to baseline, there was an improvement in mean IGA score from 3.36 (SEM = 0.15) to 2.18 (SEM = 0.33). Mean Goodman grade was reduced from 2.73 (SEM = 0.19) to 2.55 (SEM = 0.21). Of the eleven pairs of before and after photographs, nine were correctly chosen as the post-treatment image by a blind investigator. On self-assessment, 81% reported a “good” to “excellent” improvement in their scars compared to baseline (P = 0.004).
CONCLUSION: Topical EGF may improve the appearance of atrophic acne scars in skin of color. Additional, larger studies should be conducted to better characterize improvement.
J Drugs Dermatol. 2017;16(4):322-326.
Shari R. Lipner MD PhD and Richard K. Scher MD FACP| |
J Drugs Dermatol. 2015;14(5):492-494.
Julia Schwartz MDa and Adam J. Friedman MDa,b| |
Tejaswi Mudigonda BS, William Kaufman MD, and Steven R. Feldman MD PhD| |
J Drugs Dermatol. 2016;15(1):114-115.
J Drugs Dermatol. 2012;11(10):1174-1178.
Whitney P. Bowe MDa and Leon H. Kircik MDb| |
J Drugs Dermatol. 2014;13(suppl 7):s89-s94.
Management of Rosacea-Prone Skin: Evaluation of a Skincare Product Containing Ambophenol, Neurosensine, and La Roche-PosayThermal Spring Water as Monotherapy or Adjunctive Therapy
Sophie Seité PhD,a Florence Benech PharmD,b Sandrine Berdah PhD,b Muriel Bayer PharmD,b Sophie Veyrat PharmD,b Evelyne Segot PharmD PhD,b Marcela Sakalikova Mgr,c Lucia Gibejova Mgr,c Hana Zelenkova MD PhDc| |
METHODS: Several studies were performed to evaluate the efficacy of this product in the management of rosacea prone skin, as either monotherapy or adjunctive therapy or to maintain the efficacy of a Metronidazole treatment. The first study was performed on 37 women aged 18-45 with added stage 2 erythro-couperosis, who applied test formula as monotherapy twice a day for 4 weeks. During a second study, a dermatological evaluation was performed on patients with stage I or II rosacea, a questionnaire containing information about patient characteristics, tolerance, clinical signs, symptoms and skin reactivity to “trigger factors” was completed by dermatologists at baseline and 2 months after treatment with the test formula as either monotherapy or adjunctive therapy. Finally, in a third study, 65 patients finishing a Metronidazole treatment applied once daily and the tested formula twice daily were divided into 2 groups using the test formula or vehicle control, twice a day for 8 weeks for the evaluation of efficacy as adjunctive therapy.
RESULTS: We noted that the test formula, as an adjunctive therapy, helped prolong the efficacy of a Metronidazole treatment. In monotherapy, there was a significant efficacy of the test formula associated with an excellent tolerance. A significant improvement of all the clinical signs and symptoms of rosacea and a reduction of the skin reactivity to "trigger factors" were shown.
CONCLUSIONS: These studies highlight the interest value and impact of a skincare product containing Ambophenol, Neurosensine, and La Roche-Posay thermal spring water formulated in a highly protective packaging in monotherapy or in combination with or after a therapeutic treatment in the management of patients suffering from rosacea.
J Drugs Dermatol. 2013;12(8):920-924.
Alan R. Shalita MD, Guy F. Webster MD PhD, Mitchell S. Wortzman PhD, Diane Nelson BSN MPH| |
Leon H. Kircik MD| |
The Efficacy and Safety of Topical Dapsone Gel, 5% for the Treatment of Acne Vulgaris in Adult Females With Skin of Color
Andrew F. Alexis MD MPH,a Cheryl Burgess MD,b Valerie D. Callender MD,c Jo L. Herzog MD,d Wendy E. Roberts MD,e Eric S. Schweiger MD,f Toni C. Stockton MD,g and Conor J. Gallagher PhDh| |
OBJECTIVE: Evaluate safety and efficacy of dapsone gel, 5% applied topically twice daily for 12 weeks in women with SOC.
METHODS: Females with SOC aged 18 years and older with facial acne participated in a multicenter, open-label, single-group, 12-week pilot study of twice-daily monotherapy with dapsone gel, 5%. The investigator-rated 5-point Global Acne Assessment Score (GAAS) was used to assess efficacy. The impact of acne on subjects was assessed using the validated Acne Symptom and Impact Scale (ASIS).
RESULTS: The study enrolled and treated 68 women with SOC and facial acne. GAAS decreased significantly from baseline to week 12 (mean, -1.2 [95% CI, -1.4, -1.0]; P<.001), a 39.0% improvement. Overall, 42.9% of subjects were responders based on a GAAS of 0 or 1 at week 12. Subjects also experienced significant reductions in mean total lesions (52% decrease), inflammatory lesions (65%), and comedo counts (41%; all P<.001). Dapsone gel, 5% monotherapy was associated with significant improvement in subject-assessed acne signs (P<.001) and impact on quality of life (QOL; P<.001), based on ASIS. Dapsone gel, 5% used twice daily was well tolerated, with no treatment-related adverse events. The local dermal tolerability scores tended to remain stable or decrease from baseline to week 12.
CONCLUSIONS: Monotherapy with dapsone gel, 5% administered twice daily was safe and effective for treatment of facial acne in women with SOC. Significant improvement in overall acne severity and both inflammatory lesions and comedones was observed. Further, study subjects reported considerable improvement in both acne signs and impact on QOL.
J Drugs Dermatol. 2016;15(2):197-204.
Shannon Famenini BS,a Nima M. Gharavi MD PhD,b and David P. Beynet MDb| |
J Drugs Dermatol. 2014;13(4):484-486.
Effect of Systemic Isotretinoin Therapy on Mucociliary Clearance and Nasal Surface Mucosa in Acne Patients
Zennure Takci MD,a Gulcin Guler Simsek MD,b Hayriye Karabulut MD,c
Yunus Buran MD,c and Ayse Serap Karadag MDd
METHODS: A total of 30 patients with severe or moderate acne were enrolled in this study. The median prescribed dose of isotretinoin was 0.75 mg per kg per day. Clinical and biochemical examinations were carried out periodically. The ST and nasal cytology were performed before treatment and during the third month of therapy.
RESULTS: Of the 30 patients who initially agreed to participate in the research, 21 completed the study (18 female and 3 male, mean ± standard deviation (SD) aged 20.9 ± 4.7 years, range 15-32 years). There was a significant difference between the mucociliary clearance time for subjects in the pre- and post-treatment periods (173.8 ± 89.2 seconds vs 245.2 ± 191.6 seconds, respectively; P=.009). Cytological examination revealed that the squamous cell ratio was significantly lower and the reactive changes of the respiratory epithelium were significantly higher 3 months after isotretinoin therapy than before therapy (P=.010, P=.002, respectively). There were mild signs of inflammation according to the number of neutrophilic leukocytes (8.3% vs 26.6%, P=.06) after 3 months of isotretinoin therapy.
CONCLUSION: Systemic isotretinoin alters the mucociliary transport, decreases the squamous cell ratio, increases the reactive changes in the respiratory epithelium significantly, and increases neutrophils in the nasal surface mucosa in the third month of treatment.
J Drugs Dermatol. 2013;12(8):e124-e128.
Divya Sharma BS,a Mary-Margaret Kober MD,b and Whitney P. Bowe MDc| |
J Drugs Dermatol. 2016;15(1):9-12.
Sara M. James BS,a Dane E. Hill MD,a and Steven R. Feldman MD PhDa,b,c| |
OBJECTIVE: To identify the most common and most costly (from the payer perspective) drugs used in the treatment of psoriasis.
METHODS: We analyzed patient data from a large claims-based database in order to identify the most common and most costly medications used in the treatment of psoriasis from 2010 to 2014.
RESULTS: The three most common psoriasis medications, accounting for 81.1% of all psoriasis medications, were topical corticosteroids. The three most costly drugs, accounting for only 9.6% of all psoriasis medications, were biologics, accounting for 86% of the cost of psoriasis medications.
CONCLUSIONS: Biologic agents are used far less commonly in the treatment of psoriasis than topical treatments. Despite the relatively small number of patients using biologic agents, biologics are responsible for a large proportion of the cost of psoriasis pharmacotherapy.
J Drugs Dermatol. 2016;15(3):305-308.
Brian Berman MD PhD,a,b Charles Ellis MD,c and Craig Elmets MDd,*| |
J Drugs Dermatol. 2016;15(2):224-228.
Complementary Antioxidant Function of Caffeine and Green Tea Polyphenols in Normal Human Skin Fibroblasts
Jared Jagdeo MD MS and Neil Brody MD PhD| |
The study of free radicals is particularly relevant in the context of human skin carcinogenesis and photoaging because of these oxidants´ ability to induce DNA mutations and produce lipid peroxidation byproducts, including 4-hydroxy-2-nonenal (HNE). Therefore, it is important to identify and evaluate agents with the ability to modulate intracellular free radicals and HNE. The purpose of this research is to investigate the ability of antioxidants green tea polyphenols (GTPs) and caffeine, alone and in combination, to modulate the hydrogen peroxide (H2O2)-induced upregulation of reactive oxygen species (ROS) free radicals and HNE in normal human skin fibroblast WS-1 cells in vitro. GTPs and caffeine were selected for evaluation because these compounds have demonstrated antioxidative properties in various skin models. Furthermore, GTPs and caffeine share a close natural botanical association as caffeine is present in green tea, as well. Hydrogen peroxide is a well-known generator of free radicals that is produced during endogenous and UV-induced oxidation processes in human skin and was used to upregulate ROS and HNE in normal human fibroblast WS-1 cells. Using a flow cytometry-based assay, the results demonstrate that at 0.001% concentration, green tea polyphenols alone, and in combination with 0.1 mM caffeine, inhibited the upregulation of H2O2-generated free radicals and HNE in human skin fibroblasts in vitro. Caffeine alone demonstrated limited anti-oxidant properties.
J Drugs Dermatol. 2011;10(7):753-761.
Efficacy of a Moisturizing Foam in Skin Barrier Regeneration and Itch Relief in Subjects Prone to Atopic Dermatitis
Peter A. Lio MD| |
Efficacy of a Hand Regimen in Skin Barrier Protection in Individuals With Occupational Irritant Contact Dermatitis
Laura Jordan DO MS| |
The Diagnostic Role of Optical Coherence Tomography (OCT) in Measuring the Depth of Burn and Traumatic Scars for More Accurate Laser Dosimetry: Pilot Study
Jill S.Waibel MD,a Ashley C. Rudnick,a Adam J.Wulkan MD,b and Jon D. Holmesc| |
Kassandra E. Holzem MD,a Beatrice Nardone MD PhD,a Jon W. Lomasney MD,b Pedram Yazdan MD,a Pedram Gerami MD,a,c Dennis P. West PhD,a Anne E. Laumann MBChB MRCP (UK)a| |
J Drugs Dermatol. 2014;13(5):615-618.
Kathleen M. Casamiquela BAa and Philip R. Cohen MDa-c| |
J Drugs Dermatol. 2013;12(2):223-226.
A Randomized, Double-Blind, Vehicle-Controlled Crossover Study to Determine the Anti-Pruritic Efficacy, Safety and Local Dermal Tolerability of a Topical Formulation (SRD174 Cream) of the Long-Acting Opiod Antagonist Nalmefene in Subjects With Atopic Dermatitis
Jo Lynne Herzog MD,a James A.Solomon MD PhD,b Zoe Draelos MD,c Alan Fleischer Jr. MD,d Dow Stough MD,e David I.Wolf MD,f William Abramovits MD,g William Werschler MD,h Emma Green BSc,i Maeve Duffy PhD,i Alan Rothaul PhD,i Robert Tansley MBBSi| |
Objective: To investigate the efficacy, safety and tolerability of topical nalmefene (SRD174), a long acting opioid antagonist for the management of pruritus associated with atopic dermatitis (AD).
Design: Double-blind, vehicle-controlled, randomized, cross-over trial.
Setting: Eleven dermatology outpatient clinics in the U.S.
Patients: Sixty-two out of 136 screened adult subjects with confirmed AD affecting ≤20% of body surface area and with moderate-to-severe pruritus.
Interventions: SRD174 cream or matching vehicle cream applied as required during two 7-day periods separated by a wash-out period.
Main Outcome Measure(s): The primary efficacy variable was the period mean of the sum of pruritus intensity difference (SPID) from 0 to 4 hours (SPID0-4) where pruritus was measured on a 0-100 scale Visual Analog Scale (VAS) at seven pre-specified time-points following study drug application. A range of secondary efficacy, safety and tolerance endpoints were included.
Results: The LS means for the SPID0-4 (±SD) for SRD174 cream and Vehicle were 210.7 (20.4) and 212.1 (20.2), respectively (Difference = -1.3 (95% CI: -25.9, 23.3). None of the secondary efficacy endpoints tested demonstrated a statistically significant or clinically important difference between the test product and the vehicle. Overall, the SRD174 cream was well tolerated although there was a higher incidence of AEs when subjects took SRD174 cream (22, 36.7 percent of subjects) compared with when they were taking vehicle (14, 23.3 percent of subjects).
Conclusions: SRD174 cream did not demonstrate efficacy in the treatment of pruritus associated with atopic dermatitis raising questions on the role of peripheral opioid receptors as a target for the treatment of pruritus in this population. NCT00838708
J Drugs Dermatol. 2011;10(8):853-860.
Comparison of a Skin-Lightening Cream Targeting Melanogenesis on Multiple Levels to Triple Combination Cream for Melasma
Gary D. Monheit MDa and Frank Dreher PhDb| |
J Drugs Dermatol. 2013;12(3):270-274.
Skin Barrier Health: Regulation and Repair of the Stratum Corneum and the Role of Over-the-Counter Skin Care
Thomas Lee MD and Adam Friedman MD| |
J Drugs Dermatol. 2016;15(9):1047-1051.
Erin Courtney RN BSN and David J. Goldberg MD JD| |
Deborah S. Sarnoff MD FAAD FACP| |
Regression of Internal Melanoma Metastases Following Application of Topical Imiquimod to Overlying Skin
Anne K. Miller BS, Reginald Dusing MD, Aaron Meggison MD, Daniel Aires MD| |
The prognosis for metastatic melanoma is grim, and treatment options are limited. Imiquimod is a topically applied immunemodulatorthat has been used to treat superficial cutaneous melanoma, but has not been reported to treat metastatic melanoma. We report a patient whose liver and iliac fossa melanoma metastases regressed after topical application of imiquimod cream to overlying skin. This supports further investigation of the potential use of imiquimod for metastatic melanoma.
J Drugs Dermatol. 2011;10(3):302-305.
Comparison of the Effects of Contractubex® Gel in an Experimental Model of Scar Formation in Rats: An Immunohistochemical and Ultrastructural Study
Mustafa T. Sahin MD,a Sevinc Inan MD,b Serap Ozturkcan MD,a Elif Guzel MDc Cemal Bilac MD,a Gülsen Giray MD,b Sevda Muftuoglu MDd| |
Background: Contractubex® gel, a commercial treatment for scars, consists of a mixture of onion extract (cepea extract), heparin sodium,
and allantoin. It exerts a softening and smoothing effect on indurated, hypertrophic, painful, and cosmetically-disfiguring scar tissue.
Aim: To compare and discuss the immunohistochemical and ultrastructural effects of treatment of an experimental scar in a rat model with Contractubex gel.
Methods: Thirty-two Sprague-Dawley rats were divided into four groups. Skin biopsies were taken to develop full thickness wounds. After 10 days, Contractubex gel, heparin, and allantoin were topically applied daily to groups 2, 3, and 4, respectively. Group 1 was the control group. On the 30th day, scar tissues were excised to investigate the immunohistochemical and ultrastructural effects of these agents. For this purpose we used TGF-beta, laminin, and fibronectin primary antibodies.
Results: Increased immunoreactivities of laminin, fibronectin, and TGF-beta in control group, moderate immunoreactivities in heparin and allantoin groups, and mild immunoreactivities in the Contractubex gel group were observed. In semi-thin sections, Group 2 showed the thinnest epidermis of the four groups. In electron micrographs of Group 2, completely keratinized and normally appearing cells could be seen.
Conclusions: Immunohistochemical and ultrastructural observations demonstrated that the Contractubex gel significantly improved the quality of wound healing and reduction of scar formation. Also, it was a more appropriate treatment choice than heparin monotherapy and allantoin monotherapy in keloidal and hypertrophic scars.
J Drugs Dermatol. 2012;11(1):74-81.
Cindy Wassef BA,a Adriana Lombardi MD,b Sairah Khokher MD,c and Babar K. Rao MDc| |
OBJECTIVE: The objective of this review was to describe the various surgical, laser, and alternative therapies available for vitiligo. A literature review was conducted through Pubmed and Ovid using the search terms "Vitiligo treatment”, “Vitiligo surgery”, “Vitiligo laser”. Since no articles were available about needling on both Pubmed and Ovid using the search criteria, individual articles were sought out through Google.
RESULTS: The literature review yielded many possible surgical interventions including autologous mini-punch grafting, suction epidermal blister grafting, split-thickness grafting, and cultured and noncultured melanocyte keratinocyte transfer. Laser options included the helium-neon and xenon-chloride lasers, with tattooing and needling serving as other options. While all the above techniques can provide improvement to pigmentation in vitiliginous patches, physician comfort and experience are important factors with regards to outcome. Our case series of four patients treated with the needling method yielded favorable results, with repigmentation rates ranging from 25-50%, with one patient having 90% repigmentation.
CONCLUSION: There are many surgical, laser, and alternative treatment options available for vitiligo when conventional medical therapy fails or for use in conjunction with medical therapies. Autologous mini punch grafting and needling both have minimal equipment requirements and are easy to learn. Physician experience and comfort play a large role in outcome and availability of services.
J Drugs Dermatol. 2013;12(6):685-691.
Giuseppe Ricci MD, Monica Martinelli BS, Stefania Luppi PhD, Leila Lo Bello MD, Michela De Santis MD,Kristina Skerk MD, and Gabriella Zito MD| |
J Drugs Dermatol. 2012;11(12):1511-1513.
Managing Assessments and Expectations: Patient Responses Following Therapy With Efinaconazole Topical Solution, 10%
Neal Bhatia MD| |
METHODS: A post hoc analysis of two multicenter, randomized, double-blind, vehicle-controlled studies evaluating the efficacy and safety of efinaconazole topical solution, 10% in mild to moderate onychomycosis. Outcomes were assessed based on baseline severity (20%-29%, 30%-39%, 40%-49%, and ≥50% affected target toenail).
RESULTS: Overall, the mean percent affected toenail following efinaconazole treatment decreased from 36.4% to 20.6% (a 43% reduction). The percent reduction in mean percent affected toenail (range, 43.6% to 59.8%) with efinaconazole was similar irrespective of baseline severity. Improvement was only seen in the very mildest patients with vehicle and not before week 36. Improvement was influenced by gender (females did better) and disease duration (long standing disease responding less well).
CONCLUSIONS: Our onychomycosis patients treated with efinaconazole might expect a 50% improvement in their disease within a year, and this will be seen as significant by many, especially those who have suffered for many years. Many will do better, but they will need to be reminded of the slow growth of the toenail.
J Drugs Dermatol. 2015;14(7):694-698.
Adam J. Friedman MD FAAD,a Erika C. von Grote PhD,b Matthew H. Meckfessel PhDb| |
J Drugs Dermatol. 2016;15(5):633-639.
Prognostic Factors for Complete Cure Following Treatment of Mild and Moderate Toenail Onychomycosis With Efinaconazole Topical Solution 10%
Nathaniel J. Jellinek MD FAAD FACMSa and Andrew Korotzer PhDb| |
METHODS: A subgroup analysis of patients, aged 18 to 70 years, randomized to receive efinaconazole topical solution 10% or vehicle from 2 identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point, complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture) at week 52 was evaluated based on mycologic cure at week 24, and the degree of clinical improvement in nail involvement at week 12.
RESULTS: Over a quarter (25.1%) of patients treated with efinaconazole topical solution 10% who could demonstrate at least 10% improvement in affected nail involvement by week 12 progressed to complete cures at week 52. Similarly, 21.7% of patients who demonstrated mycologic cure at week 24 achieved complete cures at week 52.
CONCLUSIONS: Early clinical improvement and mycologic clearance may help to predict treatment success with efinaconazole topical solution 10%.
J Drugs Dermatol. 2015;14(8):871-875.
Andrew F. Alexis MD MPH| |
J Drugs Dermatol. 2014;13(suppl 6):s61-s65.
Comparison Between 1% Tretinoin Peeling Versus 70% Glycolic Acid Peeling in the Treatment of Female Patients With Melasma
Gita Faghihi MD,a,b Anahita Shahingohar MD,a Amir Hossein Siadat MDa,b| |
Objective: The main purpose was to compare the efficiency and complications of GA 70% with Tretinoin 1% peeling.
Methods: A randomized, double-blinded clinical trial performed on 63 female patients with bilateral melasma. One facial side was treated by drug A (GA 70%) and the opposite side by agent B (Tretinoin 1%) peeling for four sessions with 2-week intervals. Descending changes in Melasma Area and Severity Index (MASI) scores, patients' discomfort and untoward complications following peeling all were evaluated and compared during the research period.
Results: The efficiency of Tretinoin 1% peelings in declining the MASI score (treatment of melasma) was similar to GA 70%, as well as the rare unwanted complications of them. However, the patients' discomfort following procedures as expressed by their own, was significantly lower with Tretinoin 1% compared to GA 70% peeling. The cases' satisfaction with the intervention was statistically similar to each other. Furthermore, we experienced almost the equal times of beginning the therapeutic responses in both groups.
J Drugs Dermatol. 2011;10(12):1439-1442.
Efficacy, Tolerability, and Pharmacodynamics of Apremilast in Recalcitrant Plaque Psoriasis: A Phase II Open-Label Study
Alice B. Gottlieb MD PhD,a Robert T. Matheson MD,b Alan Menter MD,c Craig L. Leonardi MD,d Robert M. Day PhD,e ChiaChi Hu EdM,e Peter H. Schafer PhD,e and James G. Krueger MD PhDf| |
METHODS: This multicenter, open-label study comprised four phases: pre-treatment (≤35 days), treatment (12 weeks), extension (12 weeks), and observational follow-up (4 weeks). Patients with recalcitrant plaque psoriasis received apremilast 20 mg BID for 12 weeks. Responders (≥75% improvement in Psoriasis Area and Severity Index [PASI-75]) continued treatment and non-responders (< PASI-75) were titrated to apremilast 30 mg BID through week 24. Efficacy assessments included change in static Physician's Global Assessment, PASI, and body surface area, and proportion of patients achieving PASI-50, PASI-75, and PASI-90. Other assessments included adverse events, lesional skin biopsies to assess changes in epidermal thickness, and immunohistochemistry to assess changes in peripheral blood subsets.
RESULTS: A total of 30 patients were enrolled. At week 12, 67% of patients had a ≥1-point improvement in static Physician’s Global Assessment, meeting treatment effect criterion. Mean percent decreases (improvements) from baseline were –59% for PASI score and –53% for body surface area. Most adverse events were mild. Median reduction in epidermal thickness was 34% at week 12 (P=0.083); five patients showed absence of keratin 16. Significant reductions in CD11c, CD3, and CD56 indicate that apremilast reduced myeloid dendritic cell, T-cell, and NK-cell or NK–T-cell infiltration into the epidermis and dermis. Reduced inflammatory leukocytes, with a pattern of broad, partial inhibition, suggested reduced IL-23/Th17 and Th22 response pathways.
CONCLUSIONS: These results confirm apremilast's biological and clinical activity and support ongoing studies in psoriasis. Clinicaltrials.gov Identifier: NCT00521339.
J Drugs Dermatol. 2013;12(8):888-897.
Phoebe Rich MD| |
METHODS: An analysis of 1655 patients, aged 18-70 years, randomized to receive efinaconazole topical solution, 10% or vehicle from two identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of target toenail, and both negative potassium hydroxide examination and fungal culture) at Week 52. Three groups were compared: those with early disease (<1year), patients with a baseline disease of 1-5 years, and those with long-standing onychomycosis (>5years).
RESULTS: The majority of patients had long-standing disease; were older, male and white. While nail involvement of the target toenail did not differ noticeably amongst the three groups, the number of nails involved did increase progressively with disease duration. Differences were seen in terms of infecting pathogens in early disease that might have important treatment implications. Efinaconazole was more effective in treating early disease, however more than 40% of patients with long-standing disease were considered treatment successes.
LIMITATIONS: A period of 52 weeks may be too brief to evaluate a clinical cure in onychomycosis.
CONCLUSIONS: Treatment of onychomycosis early to avoid disease progression to other toenails is important. Once daily efinaconazole topical solution, 10% is particularly effective in these patients.
J Drugs Dermatol. 2015;14(1):58-62.
Randomized, Double-Blind, Split-Face Study Evaluating Fractional Ablative Erbium:YAG Laser-Mediated Trans-Epidermal Delivery of Cosmetic Actives and a Novel Acoustic Pressure Wave Ultrasound Technology for the Treatment of Skin Aging, Melasma, and Acne Scars
Macrene Alexiades MD PhDa,b| |
AIM: Evaluate the safety and efficacy of a novel acoustic pressure wave ultrasound device following fractional ablative Er:YAG 2940-nm laser (FELR) and topical agents for rhytids, melasma, and acne scars.
STUDY DESIGN: Randomized, blinded, parallel group split-face side-by-side, controlled study evaluating FELR and topical anti-aging and anti-pigment agents to entire face succeeded by ultrasound to randomized side. Fifteen subjects were enrolled to three treatment arms:rhytids, melasma, and acne scars. Two monthly treatments were administered with 1, 3, and 6 month follow-up. Efficacy was assessed by Comprehensive Grading Scale of Rhytids, Laxity, and Photoaging by Investigator and two blinded physician evaluators. Subject assessments, digital photographs, and reflectance spectroscopic analyses were obtained.
RESULTS: Rhytid severity was reduced from a mean of 3.25 to 2.60 on the 4-point grading scale. Spectrophotometric analysis demonstrated increases in lightness (L*) and reductions in redness (a*) and pigment (b*), with greater improvements on the ultrasound side as compared to FELR and topicals alone. Moderate erythema post-treatment resolved in 7 days and no serious adverse events were observed.
CONCLUSION: In this randomized, paired split-face clinical study, FELR-facilitated TED of topical anti-aging actives with ultrasound treatment is safe and effective with improvement in rhytids, melasma, and acne scars. Statistically significant greater improvement in pigment levels was observed on the ultrasound side as compared to FELR-TED and topical agents alone.
J Drugs Dermatol. 2015;14(11):1191-1198.
Joshua A. Zeichner MD| |
J Drugs Dermatol. 2015;14(suppl 10):s32-s34.