Publications by authors named "Stephen K Tyring"

343 Publications

Antibiotic resistance in dermatology: The scope of the problem and strategies to address it.

J Am Acad Dermatol 2021 Sep 20. Epub 2021 Sep 20.

Center for Clinical Studies, Houston, Texas; Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas.

Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. Although resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics play a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as for skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which the development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2021.09.024DOI Listing
September 2021

Concurrent Adjacent Merkel Cell Carcinoma and Chronic Lymphocytic Leukemia without Simultaneous Merkel Cell Polyomavirus Detection: A Case Series.

Dermatopathology (Basel) 2021 Jun 7;8(2):190-201. Epub 2021 Jun 7.

Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, USA.

Background: The association between Merkel cell carcinoma (MCC) and chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL) is well established in the literature. A majority of MCCs are known to be associated with Merkel cell carcinoma polyomavirus (MCPyV), which is postulated to be a possible causative agent linking these two entities. We aim to identify the presence of MCPyV in patients with concurrent adjacent MCC and CLL/SLL.

Methods: Archived pathology materials of three cutaneous or surgical excisions with concurrent MCC and CLL/SLL were reviewed. Additional 12-µm sections from paraffin-embedded tissue of these resections were matched with original hematoxylin and eosin-stained slides and used to extract foci from each tumor separately. DNA was extracted from these tissues, and polymerase chain reaction (PCR), utilizing a primer set within a highly conserved "small T" viral DNA region, was done to detect MCPyV.

Results: Out of 140 cases of cutaneous or surgical excisions with MCC identified in our electronic medical records (EMR), three had coexisting neighboring CLL/SLL in the same resection specimen. In one case out of three, MCPyV was detected in MCC but not in CLL/SLL. The remaining two cases showed no detection of MCPyV in either MCC or CLL/SLL.

Conclusion: MCPyV was not concurrently associated with adjacent MCC and CLL/SLL, indicating that it is not driving simultaneous tumorigenesis, at least in a subset of these cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/dermatopathology8020025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293110PMC
June 2021

Generalized Wrinkling and Laxity of the Skin: Answer.

Am J Dermatopathol 2021 Jul;43(7):532

Department of Dermatology, Baylor Scott & White Medical Center, Temple, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001736DOI Listing
July 2021

A Recurrent, Painful, and Vesicular Rash in a Dermatomal Distribution.

Am J Med 2021 09 20;134(9):1110-1112. Epub 2021 Apr 20.

Center for Clinical Studies, Webster, Tex; Department of Dermatology, University of Texas Health Science Center at Houston, Houston, Tex.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2021.03.012DOI Listing
September 2021

A case report of disseminated verrucosis secondary to ustekinumab in a patient with Crohn's disease.

SAGE Open Med Case Rep 2021 17;9:2050313X211003056. Epub 2021 Mar 17.

Section of Dermatology, School of Medicine, Virginia Tech Carilion, Roanoke, VA, USA.

Ustekinumab is a biologic agent with Food and Drug Administration approval for the treatment of moderate-to-severe plaque psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease. It functions to inhibit the p40 subunit common to both interleukin-12 and interleukin-23. These pro-inflammatory cytokines are implicated in autoinflammatory and autoimmune disorders, but they also play an important role in cell-mediated immunity against viral, bacterial, and fungal pathogens. Therefore, antagonism of interleukin-12 and interleukin-23 by ustekinumab may increase the risk of human papillomavirus infection or reactivation which can lead to the development of verrucae. To the best of our knowledge, there is only one published report of disseminated verrucosis secondary to ustekinumab treatment for psoriasis. Here, we present the first case report of ustekinumab-induced disseminated verrucosis occurring in the setting of treatment for Crohn's disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050313X211003056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7975484PMC
March 2021

Identification of Polyomaviruses in Skin Cancers.

Intervirology 2021 16;64(3):119-125. Epub 2021 Feb 16.

Department of Dermatology, Clinics Hospital of the Medical School of the University of São Paulo, São Paulo, Brazil.

Background: Polyomaviruses (PyVs) were initially described in animals. They have also been detected in humans with some evidence that could play a role in skin carcinogenesis.

Objectives: This study aimed to verify the presence of PyVs in different skin tumour samples and to make clinical correlations with patients' epidemiological data from Clinics Hospital of Medical School of University of São Paulo, Brazil.

Methods: This is a cross-sectional study. A random selection was performed of 120 patients with histopathological exams of different cutaneous neoplasms equally divided into 6 groups and 20 patients with normal skin. The available skin specimens were analysed with 2 different techniques of PCR (conventional and real time) for detection of PyV DNA. Concomitantly, retrospective analysis of the respective medical records for the collection of epidemiological data was done. Analyses suitable for categorical data were used to compare the proportion of patients in each group.

Results: PyV DNA was found in 25.69% of the samples: 15% in basal cell carcinoma group, 15% in squamous cell carcinoma, 28.57% in melanoma, 15% in dermatofibrosarcoma protuberans, 13.33% in Kaposi sarcoma, 65% in Merkel cell carcinoma (MCC), and none in normal skin. Merkel cell PyV detection was statistically significant in MCC patients (p value <0.01), but no correlations were found between PyVs and others skin tumours.

Conclusion: This study demonstrated the presence of PyVs in different skin tumours; however, no association of any PyVs found in any skin tumour with epidemiological data could be shown. Further studies are still needed to elucidate the mechanisms of PyVs in skin carcinogenesis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000513544DOI Listing
February 2021

Kaposi Sarcoma of the Medial Foot in an MSM, HIV-Negative Man: A Fifth Clinical Variant.

J Clin Aesthet Dermatol 2020 Oct 1;13(10):42-44. Epub 2020 Oct 1.

Dr. Swali is a Resident Physician, PGY-2, with the Department of Dermatology at the University of Nebraska Medical Center in Omaha, Nebraska.

Kaposi sarcoma (KS) is a low-grade vascular neoplasm with four well-documented clinical types: classic, African (endemic), acquired immunodeficiency syndrome (AIDS)-associated (epidemic), and iatrogenic, as well as a fifth recently described variant, men having sex with men (MSM) without human immunodeficiency virus (HIV) infection. Often distinguishable on clinical exam, KS lesions are typically found on the skin and mucosa of immunocompromised individuals, though numerous published reports have demonstrated the ability of KS to present in immunocompetent individuals. Here, we present the case of a 66-year-old, HIV-negative MSM with violaceous, non-blanching macules and patches of the medial foot referred to dermatology by his primary care physician. Histopathologic analysis revealed Kaposi sarcoma. Although this patient engaged in same-sex sexual behaviors, his HIV-negative status and otherwise lack of immunocompromise would deter many clinicians from suspecting a diagnosis of KS. Despite therapy, disease prognosis is often dependent upon stage at diagnosis. Therefore, it is important that every clinician understand the cutaneous findings associated with KS and be aware of the higher rates of KS even in HIV-seronegative MSM to facilitate prompt diagnosis and immediate treatment of this high-risk population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840092PMC
October 2020

Long-Term Safety and Efficacy of Risankizumab in Patients with Moderate-to-Severe Chronic Plaque Psoriasis: Results from a Phase 2 Open-Label Extension Trial.

Dermatol Ther (Heidelb) 2021 Apr 29;11(2):487-497. Epub 2021 Jan 29.

University of Texas Health Science Center and Center for Clinical Studies, Houston, TX, USA.

Introduction: Although many biologic therapies are effective for clearing skin of patients with psoriasis, some lose effectiveness over time. This phase 2 open-label extension (OLE) trial was designed to investigate the long-term safety and efficacy of risankizumab.

Methods: In the phase 2, double-blind, active comparator, predecessor trial (NCT02054481), patients with moderate-to-severe chronic plaque psoriasis were treated for 24 weeks with subcutaneous (SC) risankizumab or ustekinumab, followed by a 24-week follow-up without treatment administration. Patients could enroll in the OLE (NCT02203851) when they experienced loss of treatment response (< 50% improvement in the Psoriasis Area Severity Index [PASI 50]) during follow-up) or at the end of follow-up if treatment response was ongoing. In the OLE, patients were treated every 12 weeks for at least 48 weeks with SC risankizumab 90 or 180 mg, beginning at week 12 (OLE visit 2), if the patient had not achieved PASI 90. Efficacy endpoints included the proportions of patients who achieved PASI 50/75/90/100 and static Physician's Global Assessment (sPGA) of clear or almost clear skin at week 48 (sPGA 0/1; OLE visit 5).

Results: Of the 110 enrolled patients, 99 (90.0%) completed the OLE. No patients discontinued the study because of adverse events. At week 48, 74.1% of patients achieved PASI 90, whereas 98.1, 91.7, 53.7, and 67.6% achieved PASI 50/75/100 and sPGA 0/1, respectively. All efficacy results were consistent or slightly increased at OLE week 48 compared with week 12. No new safety findings were observed.

Conclusion: Risankizumab treatment was well tolerated with sustained clinical efficacy for at least 48 weeks.

Trial Registration: ClinicalTrials.gov identifier; NCT02203851.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13555-021-00490-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018913PMC
April 2021

Effects of β-HPV on DNA damage response pathways to drive carcinogenesis: a review.

Virus Genes 2021 Feb 3;57(1):23-30. Epub 2021 Jan 3.

Department of Dermatology, McGovern Medical School at UT Health Science Center, Houston, TX, 77030, USA.

The DDR is a complex signaling network responsible for the preservation of genomic integrity. Beta human papillomaviruses (β-HPVs) are able to destabilize the host genome by attenuating the DDR machinery at the molecular scale following expression of the oncogenes E6 and E7. In the event of β-HPV infection, the E6- and E7-mediated inhibition of the DDR enhances the oncogenicity of UV-induced mutations to enable carcinogenesis in an otherwise immunocompetent host, marking an important mechanistic divergence from the alpha genus of HPVs. In this review, we summarize recent updates to build upon the 'hit-and-run' hypothesis of β-HPV pathomechanism and highlight strain-dependent variations. Simultaneously, we illuminate points within the β-HPV-DDR interface that may unravel new insights for HPV viral genetics, genus-specific mechanistic models, and developments in targeted molecular therapy of β-HPV-related cancers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11262-020-01813-wDOI Listing
February 2021

Immunosuppressant-induced cutaneous drug reactions in solid organ transplant recipients.

Transpl Immunol 2021 02 29;64:101355. Epub 2020 Nov 29.

Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, 05403-900 São Paulo, SP, Brazil. Electronic address:

Solid organ transplant recipients (SOTRs) are susceptible to various cutaneous side effects as a consequence of long-term immunosuppressive therapy. Skin cancers and infections are well-studied complications that can cause death and/or allograft rejection. Other cutaneous drug reactions, such as inflammatory manifestations, have a high prevalence but are rarely studied. We analyzed these manifestations' prevalence and their association with immunosuppressants in transplant recipients from a Brazilian tertiary center. Among 532 SOTRs followed at our dermatology clinic, 60 (11.3%) developed some cutaneous adverse reactions to the immunosuppressants, with a median age at transplantation of 50.5 years and a median life span posttransplantation of seven years. Acneiform eruption was the most common drug reaction found (21 patients, 30.4%), followed by diffuse non-scarring alopecia (16 patients, 23.1%), lymphedema (10 patients, 14.5%), gingival hyperplasia (7 patients, 10.1%), hypertrichosis (6 patients, 8.7%) and sebaceous hyperplasia (9 patients, 13.1%). Adequate immunosuppression is an essential prerequisite for successful organ transplantation. In the immediate post-transplant period, significant immunosuppression is needed, but after that, the complications of excessive immunosuppression outweigh the risk of organ rejection. SORTs may present with a broad spectrum of inflammatory and cosmetic findings due to immunosuppressants that can impair life quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.trim.2020.101355DOI Listing
February 2021

Hand foot and mouth disease: Enteroviral load and disease severity.

Authors:
Stephen K Tyring

EBioMedicine 2020 Dec 10;62:103115. Epub 2020 Nov 10.

Center for Clinical Studies USA; University of Texas Health Science Center, Houston, TX 77030 USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ebiom.2020.103115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658477PMC
December 2020

Hyperkeratosis of the left cheek.

Proc (Bayl Univ Med Cent) 2020 Jul 7;33(4):592-593. Epub 2020 Jul 7.

Center for Clinical Studies, Houston, Texas.

A 66-year-old man with a recent history of herpes zoster in the second division of the trigeminal nerve presented with hyperkeratotic plaques along his left cheek and temple. A shave biopsy was found to be consistent with postherpetic hyperkeratosis. This case represents a unique presentation of Wolf's postherpetic isotopic response: a new skin disorder emerging at the site of a previously healed herpetic, predominantly zoster, infection. We aim to increase awareness of an unusual complication of herpes zoster and the importance of appropriate vaccination to help protect patients from these potential postinfection effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08998280.2020.1775481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7549997PMC
July 2020

Perinatal chikungunya induced scalded skin syndrome.

IDCases 2020 25;22:e00969. Epub 2020 Sep 25.

Center for Clinical Studies, Webster, TX, United States.

Chikungunya is a rapidly emerging infectious disease worldwide caused by a virus that belongs to the Togaviridae family. It can have varied presentations, but vesiculobullous lesions are commonly described. A widespread dissemination of such lesions, however, is extremely rare. Person-to-person transmission has not been documented, but rare reports have described maternal-fetal vertical transmission. We herein describe a unique case of congenital chikungunya resulting in a staphylococcal scalded skin syndrome-like presentation and discuss the clinical presentation, underlying pathophysiology, and how to differentiate this condition from true Stevens Johnson Syndrome-Toxic epidermal Necrolysis (SJS-TEN).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.idcr.2020.e00969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558828PMC
September 2020

The role of human papillomavirus in the pathogenesis of sinonasal inverted papilloma: a narrative review.

Rev Med Virol 2021 05 13;31(3):e2178. Epub 2020 Oct 13.

Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA.

Sinonasal inverted papillomas (IPs) are rare tumours arising from the nasal epithelial mucosa. Most lesions are benign, but a subset of IPs progress to dysplasia and squamous cell carcinoma. Although the epidemiology and clinical features of IPs are well known, the pathogenesis is still unclear. Given the established role of human papillomaviruses (HPVs) in the formation of other mucosal tumours including cervical and oropharyngeal cancer, some have suggested the virus may play a role in IP development. However, the association between HPV and IPs has not yet been proven, and the variable detection of HPV DNA in IPs has cast uncertainty on whether the virus plays a major role in pathogenesis. In this review, we summarize early clinical reports and synthesize recent studies that may elucidate the association between HPV and IPs. We also discuss the role HPV may have in the progression of benign IP to dysplasia and malignancy, as well as potential pathological mechanisms. We hope that synthesizing the initial and recent studies on this topic will not only lead to a better understanding of research in the role of HPV in IP development, but also help guide and contextualize future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/rmv.2178DOI Listing
May 2021

Hydrogen Peroxide Topical Solution, 45% for Common Warts: Phase 2 Efficacy and Safety Trial Results.

J Drugs Dermatol 2020 10;19(10):969-976

Background: No FDA-approved prescription therapies are available for common warts.

Objective: We evaluated a proprietary hydrogen peroxide topical solution, 45% (w/w) (HP45) for treatment of common warts.

Methods: In the phase 2 randomized, double-blind, vehicle-controlled WART-203 trial (NCT03278028), eligible patients aged ≥8 years had 1–6 warts (1 target wart) on the trunk or extremities with a Physician’s Wart Assessment™ (PWA) grade ≥2 (range, 0 [clear] to 3 [wart 3–8 mm in diameter or length]). Patients self-administered HP45 or vehicle twice weekly for 8 weeks and were evaluated through 12 weeks posttreatment (week 20). Efficacy assessments included mean change in target wart PWA grade from baseline at week 8 (primary endpoint) and proportions of patients with target wart clearance. Safety assessments included treatment-emergent adverse events (TEAEs) and local skin reactions (LSRs).

Results: A total of 157 patients completed 8 weeks of treatment (HP45, n=79; vehicle, n=78); 151 patients completed the 20-week posttreatment evaluation (HP45, n=75; vehicle, n=76). A significantly greater reduction in mean target wart PWA grade from baseline at week 8 was achieved with HP45 (−0.87) vs vehicle (−0.17; P<0.0001) and maintained at week 20 (−1.00 vs −0.39; P=0.0004). The proportion of patients with target wart clearance at week 8 was significantly greater with HP45 (25.3%) vs vehicle (2.6%; P<0.0001) and remained significantly greater at week 20 (37.3% vs 11.8%; P=0.0002). Forty-seven patients reported 76 TEAEs; most were mild or moderate in severity. Most LSRs were mild and resolved by week 20. In pediatric patients (HP45, n=13; vehicle, n=6), greater reductions in mean target wart PWA grade from baseline were observed with HP45 vs vehicle at weeks 8 (−1.0 vs 0) and 20 (−1.2 vs −0.5).

Conclusion: These findings support the efficacy and safety of HP45 for the treatment of common warts in patients ≥8 years of age. J Drugs Dermatol. 2020;19(10):969-976. doi:10.36849/JDD.2020.5054.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.36849/JDD.2020.5054DOI Listing
October 2020

Generalized Wrinkling and Laxity of the Skin: Challenge.

Am J Dermatopathol 2021 Jul;43(7):e82

Department of Dermatology, Baylor Scott & White Medical Center, Temple, TX.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001735DOI Listing
July 2021

PSO-LONG: Design of a Novel, 12-Month Clinical Trial of Topical, Proactive Maintenance with Twice-Weekly Cal/BD Foam in Psoriasis.

Adv Ther 2020 11 23;37(11):4730-4753. Epub 2020 Sep 23.

Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Background: Psoriasis vulgaris is commonly treated with topical corticosteroids and vitamin D analogues. Although potent and super-potent topical corticosteroids are very effective at clearing psoriasis, with short-term reactive treatment durations, symptoms usually recur after treatment discontinuation, necessitating long-term disease management strategies. A foam formulation of calcipotriol and betamethasone dipropionate (Cal/BD foam), consisting of calcipotriol 50 μg/g and betamethasone dipropionate 0.5 mg/g, is approved for the daily treatment of psoriasis for up to 4 weeks. Here, we describe a clinical trial protocol for evaluating the long-term safety and efficacy of twice-weekly Cal/BD foam as a proactive topical maintenance therapy for plaque psoriasis for up to 52 weeks.

Objective: The aim of this trial was to evaluate the safety and efficacy of Cal/BD foam when applied twice weekly for up to 52 weeks as proactive maintenance therapy, with the goal of preventing or delaying disease relapse as long as possible while minimizing adverse effects.

Methods: Once-daily Cal/BD foam treatment responders from an initial 4-week open-label period were randomized to receive Cal/BD foam or foam vehicle applied to previously cleared plaques twice weekly for up to 52 weeks. In case of relapse, affected subjects in either group received rescue therapy with once-daily Cal/BD foam for 4 weeks on active areas. Thus, the trial (NCT02899962) compared the long-term use of Cal/BD foam in a proactive approach with a conventional, reactive approach.

Planned Outcomes: Efficacy endpoints included the time to first relapse, the number of relapse-free days, and the number of relapses during the maintenance phase. Safety assessments included adverse events, incidence of rebound, local safety and tolerability scores, and effects on calcium metabolism and hypothalamic-pituitary-adrenal axis function.

Trial Registration: ClinicalTrials.gov identifier, NCT02899962.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-020-01497-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547957PMC
November 2020

Penile nodules.

Int J Dermatol 2020 Sep 21. Epub 2020 Sep 21.

Department of Dermatology, University of Texas Houston Health Science Center, Houston, TX, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15175DOI Listing
September 2020

The Effects of Once-Daily Tretinoin 0.05% Lotion on Quality of Life in Patients with Moderate-to-Severe Acne Vulgaris.

Am J Clin Dermatol 2020 Dec;21(6):891-899

Ortho Dermatologics, Bridgewater, NJ, USA.

Background: In two phase III clinical trials of patients with moderate-to-severe acne (NCT02932306, NCT02965456), tretinoin 0.05% lotion reduced inflammatory and noninflammatory lesions relative to vehicle lotion, with low potential for cutaneous irritation.

Objective: Data from these studies were analyzed post hoc to investigate the effects of tretinoin 0.05% lotion on patient-reported quality of life, as assessed using the Acne-Specific Quality of Life Questionnaire (Acne-QoL).

Methods: Mean changes from baseline to week 12 in Acne-QoL scores were analyzed in the pooled intent-to-treat population and a subgroup with treatment success (≥ 2-grade improvement on the Evaluator's Global Severity Scale and rating of "clear" or "almost clear"). Pearson correlations were conducted in the pooled intent-to-treat population to assess the relationship between the Acne-QoL acne symptoms domain and each of the other three domains.

Results: In the pooled intent-to-treat population (n = 1640), greater mean improvements were found with tretinoin 0.05% lotion vs vehicle in all four domains: self-perception (mean change: 7.4 vs 6.7); role-emotional (6.8 vs 6.0); role-social (4.8 vs 4.6); acne symptoms (6.5 vs 5.6); all p < 0.05. Relative to the intent-to-treat population, participants who experienced treatment success with tretinoin 0.05% lotion had higher (better) mean Acne-QoL scores at week 12. Correlations between acne symptoms and the other three domains were found at baseline and week 12 (p < 0.05).

Conclusions: Participants with moderate-to-severe acne reported better quality of life after 12 weeks of treatment with tretinoin 0.05% lotion. Clinical improvements in acne symptoms may have contributed to these outcomes.

Trial Registration: ClinicalTrials.gov: NCT02932306, NCT02965456.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40257-020-00559-3DOI Listing
December 2020

Recent developments in trichodysplasia spinulosa disease.

Transpl Infect Dis 2020 Dec 16;22(6):e13434. Epub 2020 Aug 16.

Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA.

Trichodysplasia Spinulosa (TS) is a rare proliferative skin disease that occurs primarily in immunocompromised patients, specifically organ transplant recipients. TS is characterized by uncontrolled inner root sheath cell proliferation and folliculocentric papular eruption that can progress to disfiguring leonine facies when left untreated. TS presents with distinct histological features including the presence of large eosinophilic, trichohyaline granules within hyperproliferating inner root sheath cells of the hair bulb. The discovery of the Trichodysplasia Spinulosa Polyomavirus (TSPyV) and recent studies highlighting the role of TSPyV tumor antigens in cell proliferation pathways have provided new insight into the mechanisms of TS development. In this review, we discuss the expansion of our understanding of TS, specifically over the past 5 years. We summarize novel cases of TS and recent developments in the mechanisms underlying TSPyV-mediated disease progression. We also evaluate advancements in diagnostic methods and treatment options. As the incidence of TS continues to rise, it is becoming critical for clinicians to understand the clinical features of TS and emerging research regarding pathogenesis and therapeutics for early treatment of this potentially disfiguring disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/tid.13434DOI Listing
December 2020

Novel Polymeric Tazarotene 0.045% Lotion for Moderate-to-Severe Acne: Pooled Phase 3 Analysis by Race/Ethnicity.

J Drugs Dermatol 2020 Jul;19(7):727-734

Background: Acne vulgaris and inflammation-associated sequelae are highly prevalent in black and Hispanic populations. In a phase 2 study, a novel polymeric emulsion formulation of tazarotene 0.045% lotion had relatively fewer adverse events than tazarotene 0.1% cream, but with comparable efficacy. The objective was to evaluate tazarotene 0.045% lotion by race and ethnicity in the pivotal trials. Methods: In two phase 3, double-blind, 12-week studies (NCT03168334; NCT03168321), participants with moderate-to-severe acne were randomized 1:1 to tazarotene 0.045% lotion or vehicle lotion (N=1,614). This pooled, post hoc analysis included subsets of participants that self-identified as white (n=1191) or black (n=262) and Hispanic (n=352) or non-Hispanic (n=1262). Coprimary endpoints were inflammatory/noninflammatory lesion counts and treatment success (defined as at least a 2-grade reduction from baseline in Evaluator's Global Severity Score and a score of 'clear' or 'almost clear'). Treatment-emergent adverse events (TEAEs) and cutaneous safety and tolerability were evaluated. Results: At week 12, tazarotene 0.045% lotion led to significantly greater percent reductions in inflammatory and noninflammatory lesions compared with vehicle in white, Hispanic, and non-Hispanic participants (P<0.05, all). Black participants had significantly greater reductions in noninflammatory lesions following treatment with tazarotene 0.045% versus vehicle (P<0.05). Treatment success rates in all subpopulations were higher with tazarotene 0.045% lotion (29.4-34.1%) versus vehicle (16.4-23.1%). TEAE rates were similar across tazarotene-treated groups and most were mild-to-moderate in severity. The incidence of hyperpigmentation decreased in black tazarotene-treated participants from baseline to week 12. Conclusions: Tazarotene 0.045% lotion demonstrated efficacy and was well tolerated across racial and ethnic subpopulations in this pooled analysis. J Drugs Dermatol. 2020;19(7) doi:10.36849/JDD.2020.5125.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.36849/JDD.2020.5125DOI Listing
July 2020

Zoster patients on earth and astronauts in space share similar immunologic profiles.

Life Sci Space Res (Amst) 2020 May 14;25:119-128. Epub 2019 Oct 14.

NASA Johnson Space Center, 2101 E NASA Pkwy, Houston, TX 77058, United States. Electronic address:

Background: On long-duration spaceflight, most astronauts experience persistent immune dysregulation and the reactivation of latent herpesviruses, including varicella zoster virus (VZV). To understand the clinical risk of these perturbations to astronauts, we paralleled the immunology and virology work-up of astronauts to otherwise healthy terrestrial persons with acute herpes zoster.

Methods: Blood samples from 42 zoster patients - confirmed positive by PCR for VZV DNA in saliva (range from 100 to >285 million copies/mL) were analyzed for peripheral leukocyte distribution, T cell function, and plasma cytokine profiles via multi-parametric flow cytometry and multiplex bead-based immune-array assays. Patient findings were compared to normal value ranges specific for each assay that were defined in-house previously from healthy adult test subjects.

Results: Compared to the healthy adult ranges, the zoster patients possess (1) a higher proportion of constitutively activated T-cells, (2) a T-cell population skewed towards a more experienced maturation state, (3) depressed general T-cell function, and (4) a higher concentration of 20 of 22 measured plasma cytokines.

Discussion: The pattern of immune dysregulation in zoster patients is similar to that of astronauts during spaceflight who shed VZV DNA in their saliva. Because future deep space exploration missions will be of an unprecedented duration, prolonged immune depression and chronic viral reactivation threaten to manifest overt disease in exploration class astronauts.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lssr.2019.10.001DOI Listing
May 2020

Acute zoster plasma contains elevated amyloid, correlating with Aβ42 and amylin levels, and is amyloidogenic.

J Neurovirol 2020 06 8;26(3):422-428. Epub 2020 May 8.

Department of Neurology, University of Colorado School of Medicine, 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO, 80045, USA.

Herpes zoster is associated with an increased dementia and neovascular macular degeneration risk and a decline in glycemic control in diabetes mellitus. Because amyloid is present and pathogenic in these diseases, we quantified amyloid, Aβ40, Aβ42, and amylin in 14 zoster and 10 control plasmas. Compared with controls, zoster plasma had significantly elevated amyloid that correlated with Aβ42 and amylin levels and increased amyloid aggregation with addition of exogenous Aβ42 or amylin. These results suggest that zoster plasma contains factor(s) that promotes aggregation of amyloidogenic peptides, potentially contributing to the toxic amyloid burden and explaining accelerated disease progression following zoster.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13365-020-00830-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528582PMC
June 2020

Development of a β-HPV vaccine: Updates on an emerging frontier of skin cancer prevention.

J Clin Virol 2020 05 4;126:104348. Epub 2020 Apr 4.

Department of Dermatology, The University of Texas McGovern Medical School, Houston, TX, USA. Electronic address:

Human papillomaviruses (HPVs) are small, non-enveloped, doublestranded DNA viruses. Over 200 subtypes of HPV have been identified, organized into five major genera. β-HPVs are a group of approximately 50 HPV subtypes that preferentially infect cutaneous sites. While α-HPVs are primarily responsible for genital lesions and mucosal cancers, growing evidence has established an association between β-HPVs and the development of cutaneous squamous cell carcinomas. Given this association, the development of a vaccine against β-HPVs has become an important topic of research; however, currently licensed vaccines only provide coverage for genital HPVs, leaving β-HPV infections and their associated skin cancers unaddressed. In this review, we summarize the current advances in β-HPV vaccine development, including progress made in preclinical testing and limited clinical data. We also discuss novel findings in the viral pathomechanisms involved in β-HPV cutaneous tumorigenesis that may play a large role in future vaccine development. We hope that synthesizing the available data and advances surrounding β- HPV vaccine development will not only lead to increased dedication to vaccine development, but also heightened awareness of a future vaccine among clinicians and the public.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcv.2020.104348DOI Listing
May 2020

A Randomized Placebo-Controlled Trial of Secukinumab on Aortic Vascular Inflammation in Moderate-to-Severe Plaque Psoriasis (VIP-S).

J Invest Dermatol 2020 09 21;140(9):1784-1793.e2. Epub 2020 Feb 21.

National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.

Psoriasis, a chronic immune-mediated disease, is associated with an increased risk of cardiovascular events and mortality. Secukinumab selectively neutralizes IL-17A and has reported high efficacy with a favorable safety profile in various psoriatic disease manifestations. Subsequent to the 12-week randomized, placebo-controlled, double-blind treatment period, patients with moderate-to-severe psoriasis received secukinumab for 40 weeks. Vascular inflammation using F-2-fluorodeoxyglucose-positron emission tomography/computed tomography imaging and blood-based cardiometabolic was assessed at week 0, 12, and 52. The difference in change in aortic inflammation from baseline to week 12 for secukinumab (n = 46) versus placebo (n = 45) was -0.053 (95% confidence interval = -0.169 to 0.064; P= 0.37). Small increases in total cholesterol, low-density lipoprotein, and low-density lipoprotein particles, but no changes in markers of inflammation, adiposity, insulin resistance, or predictors of diabetes, were observed with secukinumab treatment compared with placebo. At week 52, reductions in TNF-α (P= 0.0063) and ferritin (P= 0.0354), and an increase in fetuin-A (P= 0.0024), were observed with secukinumab treatment compared with baseline. No significant changes in aortic inflammation or markers of advanced lipoprotein characterization, adiposity, or insulin resistance were observed with secukinumab treatment compared with baseline. Secukinumab exhibited a neutral impact on aortic vascular inflammation and biomarkers of cardiometabolic disease after 52 weeks of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jid.2020.01.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434644PMC
September 2020

Presence of human papillomavirus DNA in voriconazole-associated cutaneous squamous cell carcinoma.

Int J Dermatol 2020 May 14;59(5):595-598. Epub 2020 Feb 14.

Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Background: Voriconazole and genus beta human papillomavirus (HPV) are independently associated with the development of photo-exposed cutaneous squamous cell carcinoma (SCC) but have not been evaluated concurrently. The objective of this study is to determine the prevalence and type of detectable HPV DNA in voriconazole-associated SCC.

Methods: SCCs from immunosuppressed patients, in those with and without voriconazole exposure, were evaluated by PCR analysis for HPV DNA and compared to SCC from non-immunosuppressed patients. An additional expanded PCR analysis of all SCC that developed in the voriconazole group was also performed.

Results: HPV DNA was detected by PCR in all groups regardless of the immunosuppression status (80.5%) with beta HPV most prevalent (64.3-78.6%). However, immunosuppressed patients were significantly more likely to be infected by beta HPV types 5, 8, 14, 20, and 21 (P-value 0.014), and represented the majority of beta HPV types found in the voriconazole group.

Conclusions: In this retrospective study, beta HPV 5, 8, 14, 20, and 21 were commonly detected in voriconazole-associated SCC. The results indicate a possible role of beta HPV in the pathogenesis of cutaneous SCC in photo-exposed areas. Further studies are needed to establish the role of HPV and voriconazole in the pathogenesis of the lesion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.14820DOI Listing
May 2020

Management of Ichthyosis: A Brief Review

Skin Therapy Lett 2020 Jan;25(1):5-7

Department of Dermatology, McGovern Medical School at The University of Texas Health Sciences Center at Houston, Houston, TX, USA

The ichthyoses, also termed the disorders of keratinization, are a heterogenous group of skin diseases in which a distinctive horny layer arises secondary to excessive transepidermal water loss. Although occasionally acquired, the majority of ichthyoses are inherited and can be pinpointed to characteristic genetic mutations. Management depends on disease severity and includes topical agents and lifestyle modifications with or without oral retinoids. Genetic counseling is also an important consideration. This review aims to highlight advances in our understanding of disease pathogenesis as well as the holistic approach necessary to adequately manage ichthyosis patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2020

A Diffuse Papular Rash in an Adult.

Am J Med 2020 09 28;133(9):e463-e464. Epub 2020 Jan 28.

Center for Clinical Studies, Houston, Texas; Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjmed.2019.12.036DOI Listing
September 2020
-->