Volume 18 | Issue 3
Glynis Ablon MD FAAC|This review of the current available OTC options is much appreciated in the December 2018 article by Bater and Rieder, however, most of the products mentioned have no current research or data in the past decade except for the supplements.
Philip R. Cohen MD|No abstract details for the moment.
Christopher J. Yao MPH,a,b Mark G. Lebwohl MDb|
Objectives: The time that drugs for moderate-to-severe psoriasis take to see a clinically meaningful improvement (TOA) is one of the most important attributes of treatment success. This study synthesizes TOA data from previously reviewed drugs and adds clinical data for tidrakizumab and certolizumab pegol for comparison
Methods: We reviewed published and presented efficacy data regarding TOA, which was defined as the time at which 25% of the sample population reached Psoriasis Area and Severity Index (PASI) 75 or the time at which the sample population reached a mean PASI 50.
Results: Antipsoriatic drugs obtained clinically meaningful outcomes within 1.8-25.4 w, and brodalumab had the fastest TOA for both outcome measures.
Conclusion: Brodalumab may continue to have the most rapid onset of action of available antipsoriatic therapies.
J Drugs Dermatol. 2019;18(3):229-233.
Joanna Jaros BAa and Peter Lio MDb|Low-dose naltrexone (LDN) has been successfully studied as an immunomodulatory and anti-inflammatory therapy in a wide range of conditions including Crohn’s disease, fibromyalgia, major depressive disorder, cancer, chronic regional pain syndrome, Charcot-Marie-Tooth, and multiple sclerosis.1-5 Recently, off label LDN has been shown to improve dermatologic conditions such as systemic sclerosis, Hailey-Hailey Disease, lichen planopilaris, and guttate psoriasis.6-9 In this article, we examine the existing evidence for use of LDN in skin disease and discuss its potential application in the treatment of atopic dermatitis (AD).
J Drugs Dermatol. 2019;18(3):235-238.
Treating Acne With Topical Antibiotics: Current Obstacles and the Introduction of Topical Minocycline as a New Treatment Option
Lauren Meshkov Bonati MD,a,b Jeffrey S. Dover MD FRCPCa|Oral antibiotics are well established treatments for acne vulgaris but are associated with undesirable side effects. Topical antibiotics offer an improved safety profile but have led to an alarming rise in worldwide P. acnes resistance. Fortunately, a new class of topical minocycline products has been developed for the treatment of acne and rosacea that decreases the risk for antibiotic resistance while maintaining safety and efficacy. Recent clinical studies have demonstrated that a hydrophilic minocycline gel (BPX-01) and a lipophilic minocycline foam (FMX101) both reduced acne lesion counts with negligible systemic absorption. Head-to-head studies have yet to be completed, but the hydrophilic gel studies reported greater treatment efficacy than the lipophilic foam studies.
J Drugs Dermatol. 2019;18(3):240-244.
Dillon Nussbaum BSc and Adam Friedman MD FAAD|The purpose of this review is to discuss the disease process and wide variety of treatment options for psuedofolliculitis barbae (PFB), or razor bumps. PFB is caused by hair follicles penetrating the skin and causing an inflammatory response. PFB can occur to anyone who shaves, and is more likely in those with curly hair. PFB can cause significant hyperpigmentation and scarring, more noticeable in darker skin types. PFB can be treated with a variety of topical, systemic, or light/laser therapies. Minimal progress has been made in treating PFB in recent years, partially due to the success of well-established current treatments discussed in this review. The most effective treatments involve a multifaceted approach including behavioral changes in shaving habits as well as the use of topical therapies.
J Drugs Dermatol. 2019;18(3):246-250.
The Role of Topical Retinoids in Prevention and Treatment of Atrophic Acne Scarring: Understanding the Importance of Early Effective Treatment
Jerry Tan MD,a Emil Tanghetti MD,b Hilary Baldwin MD,c Linda Stein Gold MD,d Edward Lain MDe|
Atrophic acne scarring is a frequent occurrence among acne patients. These facial marks are often very emotionally distressing for the patient and can result in adverse impact to quality of life. While most clinicians consider scarring as a sequela of moderate to severe acne, recent studies have found that scars are also associated with mild acne. Risk factors include time to effective treatment, severity of acne, family history, and excoriations. New data shows that early and effective acne treatment can reduce the development of new scars, confirming the widespread perception of this approach in prevention. It is also becoming clear that the inflammatory process drives both the development of acne lesions and atrophic scars. This implies that inhibiting activation of inflammatory pathways early is key to preventing scars. Data also suggests a useful role for adapalene for the treatment of well-established acne scars with scar remodeling accompanied by the production of new collagen and elastic tissue. Acne guidelines and recommendations continue to highlight the central role of retinoids, with fixed-dose combination retinoids being particularly important due to targeting of multiple inflammatory pathophysiologic factors and for patient convenience. Higher concentrations of retinoids such as adapalene 0.3%/benzoyl peroxide 2.5% (A0.3/BPO2.5) have shown increased efficacy, particularly among patients with moderately severe and severe acne – a population at high risk for scarring. Further, controlled study of A0.3/BPO2.5 in patients with moderate acne (mean, 40 acne lesions per half face) and mild-moderate scarring demonstrated A0.3/BPO2.5 was significantly superior to vehicle in reducing scar counts from baseline over 24 weeks. While scar counts lessened on the A0.3/BPO2.5 side, counts increased on the vehicle side during the study. This occurred in the setting of active acne, where the efficacy of A/BPO is well known, emphasizing the dual actions of A0.3/BPO2.5 in both treatment and prevention.
J Drugs Dermatol. 2019;18(3):255-260.
Matthew R. Donaldson MDa,b and L. Arthur Weber MDa|Perineural invasion (PNI) is associated with high risk keratinocyte carcinomas. Identification of PNI during Mohs surgery is important for staging and post-adjuvant treatment decisions but can be challenging. To confirm or exclude PNI suspected on hematoxylin and eosin sections, we performed immunohistochemical double staining on Mohs frozen sections. Neural marker SOX10 and pan-cytokeratin marker AE1/AE3 were combined in a simultaneous assay using species-specific (mouse and rabbit) antibodies and horseradish peroxidase and alkaline phosphatase detection systems. Of 23 Mohs cases with suspected PNI, 18 were confirmed to have definitive nerve involvement by tumor using double staining. Double staining frozen tissue is feasible and can be beneficial for real time confirmation of PNI during Mohs.
J Drugs Dermatol. 2019;18(3):262-264.
Debraj Shome MD FRCS, FACS, MBAa Stuti Khare MD,b Rinky Kapoor MDc|
Copy: The injectable adipocytolytic drug deoxycholic acid (DCA) is the first pharmacological intervention approved for the reduction of submental fat (SMF) and offers an alternative to invasive measures to improve the submental profile and the cervico-mental angle. DCA injection (ATX-101, Kybella [United States], Belkyra [Canada]; Kythera Biopharmaceuticals, Inc., Westlake Village, CA, acquired by Allergan, Inc.), are proprietary formulations of synthetically derived DCA that is FDA approved for improvement in the appearance of moderate to severe convexity or fullness associated with SMF.
Aim: As none of the aforementioned are available in India, we undertook this study to study the efficacy of generic DCA for SMF reduction in Indian patients.
Methods: 50 patients with confirmed Indian ethnicity and unwanted SMF were injected 3 mg/cm2 of generic DCA into their SMF, with a 12-week follow-up period. In each session, 5 ml of 30 mg /ml DCA was injected. The sessions were spaced approximately 2 months apart. All these patients with reductions in SMF were reported using Clinician Reported SMF Rating Scale (CR-SMFRS) and Patient Reported SMF Rating Scale (PR-SMFRS) using the Validated Rating Scale for improvement in the appearance of their chin, the neck, and the cervico-mental profile. Also, for objective assessment of improvement in SMF, caliper measurements were used.
Results: One session was required in 2 patients, 12 patients needed 2 sessions, 32 patients needed 3 sessions, and 4 patients needed 4 sessions. Altogether, 90% patients showed at least a decrease of 1 point in (CR-SMFRS). Reduction in SMF as confirmed by caliper measurements was statistically significant.
Conclusion: The findings show generic deoxycholic acid to be equally effective in the treatment for SMF in Indian patients.
J Drugs Dermatol. 2019;18(3):266-272.
Combination of Fractional Resurfacing and Dermabrasion Techniques to Improve Aesthetic Outcomes of Facial Grafts
Brandon Worley MD MSc,a Joel L. Cohen MD FAAD FACMSb,c|No abstract details for the moment.
Assessing the Synergistic Effect of a Fixed Combination Halobetasol Propionate 0.01% and Tazarotene 0.045% Lotion in Moderate-to-Severe Plaque Psoriasis
Leon H. Kircik MD,a Kim A. Papp MD PhD,b Linda Stein Gold MD,c Susan Harris MS,d Tina Lin Pharm D,e Radhakrishnan Pillai PhDf|
BACKGROUND: Fixed combinations are commonplace in dermatology, providing significant efficacy and tolerability benefits. In some cases, two active ingredients complement each other providing a cumulative or additive effect. In rarer cases, a synergistic effect may be seen where the sum of the two active ingredients combined action is greater than the sum of the efficacy of the constituent parts.
OBJECTIVE: To determine whether a novel halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) fixed combination lotion provides a synergistic effect in the treatment of moderate-to-severe plaque psoriasis.
METHODS: Post hoc analysis of 212 patients with moderate-to-severe plaque psoriasis randomized (2:2:2:1) to HP/TAZ lotion, HP, TAZ or vehicle once-daily for 8 weeks, with a 4-week posttreatment follow-up. Treatment success was evaluated based on two outcomes: percent of patients achieving at least a 2-grade improvement in Investigator Global Assessment (IGA) and IGA score equating to ‘clear’ or ‘almost clear’; and percent change from baseline in the IGAxbody surface area (BSA) score, an alternative to assessing response to therapy that is more sensitive to area change than the Psoriasis Area Severity Index (PASI). In addition, a clinically meaningful outcome was reported in patients who achieved a 75% reduction in IGAxBSA. Synergy was established when the benefit of combination HP/TAZ lotion was greater than benefit of HP plus TAZ, with a ratio (HP/TAZ divided by HP+TAZ) >1.0.
RESULTS: HP/TAZ lotion was synergistic at week 8, and four weeks posttreatment. At week 8, treatment success with HP/TAZ lotion relative to vehicle was 42.8% compared with 32.5% for HP plus TAZ (ratio 1.3); and percent change from baseline in IGAxBSA score relative to vehicle was 51.6% compared with 40.6% for HP plus TAZ (ratio 1.3). At week 12, treatment success with HP/TAZ lotion relative to vehicle was 31.3% compared with 20.0% for HP plus TAZ (ratio 1.6). Percent change from baseline in IGAxBSA score relative to vehicle was 47.3% compared with 34.2% for HP plus TAZ (ratio 1.4). HP/TAZ lotion also provided synergistic benefits in terms of achieving a clinically meaningful outcome, with a ratio of 1.3 and 2.0 at weeks 8 and 12.
CONCLUSIONS: Halobetasol propionate 0.01% and tazarotene 0.045% (HP/TAZ) fixed combination lotion provides a synergistic benefit in the treatment of moderate-to-severe plaque psoriasis. In addition, by combining two agents into one once-daily formulation, this novel formulation reduces the number of product applications and may help patient adherence.
J Drugs Dermatol. 2019;18(3):279-284.
0.5% 5-Fluorouracil/10% Salicylic Acid for the Treatment of Distal Actinic Keratoses Under Daily Practice Conditions
Á. Iglesias-Puzas MD, A. Batalla PhD, H.J. Suh-Oh MD, Á. Flórez PhD|
BACKGROUND: Actinic keratosis (AKs) are sun-induced skin lesions that are at risk to progress to invasive squamous cell carcinoma (SCC). Treatments have shown to be effective on face or balding scalp area but limited data support their efficacy on distal extremities.
OBJECTIVE: To describe the efficacy of 0.5% 5-fluorouracil/10% salicylic acid (5FU/AS) in the treatment of distally-located AKs in daily clinical practice. Additional objectives were to review tolerance and adherence to this treatment.
METHODS: Retrospective review of 23 patients with distal grade II to III AKs who were treated with 5FU/AS under daily practice conditions. Primary endpoint included local skin response according to percentage on AKs reduction at week 20 (8 weeks after ending the treatment).
RESULTS: 75% (30/40) treatment 75% to 100% at week 20. Complete response (100% clearance) was recorded in more than half of the cases (53%, 21/40). Good, partial, and low responses were respectively observed in 22% (9/40), 20% (8/40), and 5% (2/40) of patients.
Most adverse events were graded as low, and adherence to treatment was considered correct in 25 patients (63%). In addition, a correct adherence to treatment was significantly related to a better response (P equals 0.001).
CONCLUSION: Findings indicate that topical 5FU/AS is an effective treatment for multiple distal AKs, with a proper safety profile.
J Drugs Dermatol. 2019;18(3):285-288.
Clinical Evidence of Dermal and Epidermal Restructuring from a Biologically Active Growth Factor Serum for Skin Rejuvenation
Frank Barone MD FACS,a Sameer Bashey MD FAAD,b and Frederick W. Woodin Jr. BSc|
Background: Topical skin care products use various technologies to promote skin repair. Growth factors of human, animal, and plant-derived origins have clinically demonstrated the ability to repair skin by promoting collagen, elastin, and glycosaminoglycan (GAG) production to reconstruct and reinforce skin’s extracellular matrix (ECM). Human skin cells respond to instructions from highly specialized proteins or hormones referred to as growth factors. These growth factors initiate cellular communication that instigates cellular replication, production, or proliferation. The production of elastin and collagen dermal connective fibers slows, and, with age, the regenerative rates of GAGs become delayed. These biological issues can be exacerbated by extrinsic factors such as sun exposure, pollutants, and various other factors. Growth factor-based products have become important topical treatment modalities for addressing signs of skin aging such as fine lines, deep wrinkles, dryness, laxity, and textural irregularities.
Objective: The aim of a 12-week clinical trial of a growth factor composition was to assess its effectiveness at restoring skin health through dermal and epidermal restructuring of aged skin.
Results: Data from expert grading, and from corneometer and cutometer evaluations, as well as 2D and 3D image analysis, reflected significant improvements in facial skin appearance, firmness, elasticity, and hydration. Elements that improved most dramatically in investigators’ assessments included radiance, firmness, tactile elasticity, textural smoothness, overall appearance, and crow’s feet. Ultrasound imaging showed continual increases in dermal and epidermal restructuring throughout the study duration. Subject assessments reflected positive product tolerability and positive perception across a broad range of efficacy attributes through 12 weeks of usage.
Conclusion: The results verified the ability of a multi-modal plant and enzymatically derived growth factor-based product to achieve skin rejuvenation improvements by stimulating dermal ECM and fibrous tissue regeneration to reduce fine lines and coarse wrinkles, and improve skin firmness and elasticity, while restoring skin to a properly hydrated state.
J Drugs Dermatol. 2019;18(3):290-295.
Tarek S. Shaath MD, Amit Om MD, Christopher M. Wolfe DO, George F. Cohen MD|Case Report: Triple Combination Therapy for Recalcitrant Perineal Pyoderma Gangrenosum
Erosive Pustular Dermatosis of the Leg Successfully Treated With an Oral Retinoid and a Bi-layered Skin Substitute
Jose A. Jaller MD,a,b Luis J. Borda MD,a Robert S. Kirsner MD PhDa|Erosive pustular dermatosis is a rare inflammatory skin disorder characterized by crusted erosions, sterile pustules, skin atrophy, and scarring alopecia. Cases of involvement of lower extremities, with or without scalp lesions, have been scarcely reported in the literature, and have been denominated Erosive Pustular Dermatosis of the Legs. The disorder usually affects elderly patients associated with chronic venous insufficiency and venous dermatitis. Topical corticosteroids and topical calcineurin inhibitors have been reported to be effective. On the other hand, several treatments have also failed to achieve appropriate results; hence we present a case of erosive pustular dermatosis of the leg, who was unresponsive to compression and antibacterial ointments, but successfully treated systemically with an oral retinoid and locally with the application of a bioengineered bi-layered skin substitute. This condition may be overlooked, which represents its low prevalence in literature.
J Drugs Dermatol. 2019;18(3):301-302.
Efficacy of a Once-Daily Fixed Combination Halobetasol (0.01%) and Tazarotene (0.045%) Lotion in the Treatment of Localized Moderate-to-Severe Plaque Psoriasis
Andrew Blauvelt MD MBA,a Lawrence J. Green MD,b Mark G. Lebwohl MD,c Paul S. Yamauchi MD PhD,d Tina Lin PharmD,e Gina Martin MOT,f Radhakrishnan Pillai PhDf|No abstract details for the moment.
Tarek S. Shaath MD, Amit Om MD, Christopher M. Wolfe DO, George F. Cohen MD|Program Spotlight: Florida State University College of Medicine Division of Dermatology at Dermatology Associates of Tallahassee
Tarek S. Shaath MD, Amit Om MD, Christopher M. Wolfe DO, George F. Cohen MD|No abstract details for the moment.
No abstract details for the moment.
Rendon, Marta I.|Dermatological Concerns in the Latino Population
Yemisi Dina BS,a Jacqueline McKesey MD MS,b Amit G. Pandya MDb|common cause of depigmentation worldwide is vitiligo. This disorder affects 1-2% of the world’s population and is seen in all races. Vitiligo is an autoimmune disorder in which the predominant cause is an attack by CD8+ cytotoxic T cells on melanocytes in the epidermis. This condition can have a significant negative impact on the quality of life of affected individuals. Treatment options currently include psychological counseling, topical therapy, systemic therapy, phototherapy, surgical therapy, and depigmentation. In patients with stable, refractory disease, successful repigmentation has been achieved using mini-punch grafting, blister grafting, and non-cultured epidermal suspension (NCES) grafting. Emerging therapies include the Janus kinase (JAK) inhibitors ruxolitinib and tofacitinib. Further studies exploring the pathogenesis of vitiligo are warranted in order to optimize treatment for affected patients. J Drugs Dermatol. 2019;18(3 Suppl):s115-116.
Maritza I. Perez MD|The Hispanic population has been the principal driver of U.S. demographic growth in the last two decades. In 2016, Hispanics accounted for 18% of the nation’s population and were the second-largest racial or ethnic group behind whites making the people of Hispanic origin the nation's largest ethnic or racial minority. Non-melanoma skin cancer (NMSC) is the most common malignancy in the U.S. with over 3.5 million diagnosed in over 2 million people, incidence rising at about 2.6% per year. In Hispanics, Loh et al showed a retrospective 5-year one-institution study that revealed an incidence of 3% for NMSC, in a population that is younger and mainly females as compared to Caucasian and Asians. In the past two decades, melanomas incidence among Hispanics has risen by 20%. Hispanics are younger at diagnosis, present with thicker tumors (>1mm, 35% to 25%), regional involvement (12 to 8%), and distant metastasis (7 to 4%), having the worst survival rate as compared to whites. In general, even though increasing, the incidence of NMSC and MM is lower in Hispanics than Caucasians, however, the mortality is higher. The later stage at diagnosis and worse prognosis in Hispanics have been attributed to several factors: 1.) Less awareness of risks or symptoms leading to a lack of linguistically or culturally targeted screening efforts.20 2.) Decline in sun-safe behaviors because of increasing acculturation.21, 22 3.) Less access to health insurance-- more than 15% Hispanics in last census lack medical coverage causing delays in seeking treatment.23 Many of these factors may be associated with lower socioeconomic status (SES). For cancer control efforts to succeed, we must better understand the major causes of advanced presentation of melanoma in Hispanics (Hispanics and Latinos) who represent the most rapidly expanding demographic segment in the U.S. Increased awareness of skin cancer and ways to prevent it on the part of providers and patients has the potential to decrease incidence, increase early diagnosis, and improve outcomes among Hispanics. Primary care physicians and dermatologists can dispel the myth that melanoma only affects NHWs and educate Hispanic patients in a culturally appropriate manner on melanoma risk factors, how to recognize sunburn, how to identify abnormal lesions, and the need to check non-sun-exposed areas for ALMs that are comparatively more common among Hispanics than among NHWs. J Drugs Dermatol. 2019;18(3 Suppl):s117-120.
Qian Zheng MD PhD,a Janet Wangari-Talbot PhD,a Charbel Bouez PhD,a and Michele Verschoore MDb|Photoaging is a complex and chronic process that induces structural and functional changes in sun-exposed skin, including coarse wrinkles, laxity, dyschromia, telangiectasias, and potential precancerous lesions. Pigmented skin presents different structure and physiology that contribute to distinctive photoaging process. The skin of color population is reported to “age better” than their Caucasian counterparts in general, with fewer wrinkles and better skin texture. However, pigmentary disorders and sun-exposure related dyschromia are highly prevalent in skin of color. Hispanics are the fastest growing population in the U.S. and represents a heterogenous group of people with different skin tones and Fitzpatrick phototypes. They demonstrate large diversity and heterogeneity in skin physiology, pigmentary disorders, and photoaging-related skin color shifting. Specific concerns around hyperpigmentation, skin tone evenness, and texture or roughness are very common among Hispanics, demanding targeted medical and cosmeceutical solutions. Customized daily routines including sufficient photo-protection are essential to address such needs. This mini review identifies some of the specific skin concerns of Hispanics in America and emphasizes the needs for long-term sunscreen use and education. J Drugs Dermatol. 2019;18(3 Suppl):s121-123.
Mercedes Florez-White MD|Acne is a common disease among patients with Latin American ancestry. Its presentation is very similar to that in all skin types, but nodulocystic acne is more frequent in patients with oily and darker skin than in white Caucasians. Acne sequelae in patients with Latin American ancestry and with darker skin include postinflammatory hyperpigmentation (PIH) and atrophic and hypertrophic scars or keloids, with PIH being the most common complication affecting the quality of life of patients. Lately, more attention has been paid to rosacea in patients with darker skin. It has been seen that some of the patients, especially women, diagnosed with adult acne and who did not respond to treatment, were actually patients with rosacea. It is important to recognize the clinical characteristics of this disease in patients with darker skin in whom erythema and telangiectasia are difficult to observe. Here, we present the most relevant clinical characteristics of both diseases, as well as their treatment in patients with darker skin with Latin American ancestry. J Drugs Dermatol. 2019;18(3 Suppl):s124-126.
Sheila Jalalat MDa and Eduardo Weiss MDa,b|Hispanics/Latinos are one of the fastest growing segments in the skin of color population in the United States. Utilization of lasers especially in people with skin of color requires a thorough understanding of laser physics and laser tissue interactions. In this article, we will outline the different lasers used in our practice based on each chromophore. Pretreatment recommendations as well as management of complications will also be shortly discussed. Our goal is for the readers to grasp the importance of proper device selection, understand the concept of selective photothermolysis, and the various treatment parameters required for optimal safety and efficacy. J Drugs Dermatol. 2019;18(3 Suppl):s127-131.