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Am J Clin Dermatol 2022 May 24. Epub 2022 May 24.

Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.

Pyoderma gangrenosum is a rare inflammatory skin disease classified within the group of neutrophilic dermatoses and clinically characterized by painful, rapidly evolving cutaneous ulcers with undermined, irregular, erythematous-violaceous edges. Pyoderma gangrenosum pathogenesis is complex and involves a profound dysregulation of components of both innate and adaptive immunity in genetically predisposed individuals, with the follicular unit increasingly recognized as the putative initial target. T helper 17/T helper 1-skewed inflammation and exaggerated inflammasome activation lead to a dysregulated neutrophil-dominant milieu with high levels of tumor necrosis factor-α, interleukin (IL)-1β, IL-1α, IL-8, IL-12, IL-15, IL-17, IL-23, and IL-36. Read More

Am J Clin Dermatol 2022 May 23. Epub 2022 May 23.

Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.

Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Read More

Am J Clin Dermatol 2022 May 18. Epub 2022 May 18.

Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 11th Floor, New York, NY, 10016, USA.

Sarcoidosis is a multisystem disorder of unknown etiology characterized by accumulation of granulomas in affected tissue. Cutaneous manifestations are among the most common extrapulmonary manifestations in sarcoidosis and can lead to disfiguring disease requiring chronic therapy. In many patients, skin disease may be the first recognized manifestation of sarcoidosis, necessitating a thorough evaluation for systemic involvement. Read More

Am J Clin Dermatol 2022 May 17. Epub 2022 May 17.

Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 15F, No. 7, Chung-Shan South Road, Taipei, Taiwan.

Background: Rituximab is a potential initial adjuvant therapy for bullous pemphigoid, yet clinical experience is scarce.

Objective: We aimed to examine the clinical outcomes and safety of initial combination therapy with systemic corticosteroids and adjuvant rituximab for the treatment of bullous pemphigoid.

Methods: A retrospective cohort study was performed on 84 patients with bullous pemphigoid, who received systemic corticosteroids with or without initial adjuvant rituximab therapy (defined as rituximab use within 12 weeks after initiation of systemic corticosteroids). Read More

Am J Clin Dermatol 2022 May 16. Epub 2022 May 16.

Department of Dermatology, Rutgers New Jersey Medical School, Newark, NJ, USA.

Food allergies are relatively prevalent, but mammalian meat allergy remains uncommon and represents an important, potentially acute healthcare risk. This risk is partly because both clinicians and the public lack awareness of this serious allergy, which is unique in three important ways: it incurs a delayed reaction, it is induced by a carbohydrate rather than a protein, and it is linked to tick bites. Although various symptoms are possible, its unique presentation means that mammalian meat allergy is often presented to the dermatologist. Read More

Am J Clin Dermatol 2022 May 14;23(3):365-383. Epub 2022 May 14.

Regeneron Pharmaceuticals, Inc., 77 Old Saw Mill River Road, Tarrytown, NY, 10591, USA.

Background: For adolescent patients (aged ≥ 12 to < 18 years) with uncontrolled moderate-to-severe atopic dermatitis (AD), 16 weeks of treatment with dupilumab resulted in substantial clinical benefit compared with placebo, with an acceptable safety profile. However, long-term data on the approved dose regimens of dupilumab in adolescents with AD are lacking.

Objectives: This open-label extension study (LIBERTY AD PED-OLE, NCT02612454) reports the long-term safety, efficacy, and pharmacokinetics of dupilumab in adolescents with moderate-to-severe AD who had participated in dupilumab parent trials. Read More

Am J Clin Dermatol 2022 May 10. Epub 2022 May 10.

Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikvah, Israel.

Background: Chlormethine gel was approved for treatment of mycosis fungoides, the most common cutaneous T-cell lymphoma, on the basis of results from study 201 and study 202. A post-hoc analysis of study 201 found interesting trends regarding improved efficacy of chlormethine gel vs ointment and noted a potential association between dermatitis and clinical response.

Objective: To expand these results by performing a post-hoc analysis of study 202. Read More

Am J Clin Dermatol 2022 May 9. Epub 2022 May 9.

Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Brain metastases from melanoma are no longer uniformly associated with dismal outcomes. Impressive tumor tissue-based (craniotomy) translational research has consistently shown that distinct patient subgroups may have a favorable prognosis. This review provides a historical overview of the standard-of-care treatments until the early 2010s. Read More

Am J Clin Dermatol 2022 May 3;23(3):393-408. Epub 2022 May 3.

Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA.

Background: Moderate-to-severe atopic dermatitis (AD) often requires long-term management with systemic therapies.

Objective: Our objective was to report the safety and efficacy of dupilumab treatment up to 4 years in adults with moderate-to-severe AD and efficacy in a subgroup of patients who transitioned from dupilumab once-weekly (qw) to administration every other week (q2w).

Methods: This interim analysis of the open-label extension study (NCT01949311) evaluated dupilumab 300 mg qw or q2w in adults previously enrolled in dupilumab trials for moderate-to-severe AD. Read More

Am J Clin Dermatol 2022 May 3;23(3):409-420. Epub 2022 May 3.

Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.

Baricitinib (Olumiant) is an oral small molecule inhibitor of Janus kinase (JAK)1 and JAK2, which have been implicated in the pathogenesis of atopic dermatitis (AD). In phase III studies in adults with moderate to severe AD who were inadequately controlled with topical corticosteroids (TCS) or systemic treatments (e.g. Read More

Am J Clin Dermatol 2022 Apr 30. Epub 2022 Apr 30.

Department of Dermatology-Allergology, Toulouse University and CHU de Toulouse-Larrey, 24 Chemin de Pouvourville TSA 30030, 31059, Toulouse, France.

Background: The decision of when to discontinue systemic treatment after achieving remission in psoriasis is an important question. In this systematic review, we sought to evaluate time to relapse after the discontinuation of systemic treatment in psoriasis patients.

Methods: Systematic searches of PubMed, Cochrane Library, and Embase databases were performed for randomized controlled studies reporting time to relapse after discontinuation of systemic drugs in psoriasis patients. Read More

Am J Clin Dermatol 2022 Apr 29. Epub 2022 Apr 29.

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, South Tower, 7th floor, Philadelphia, PA, 19104, USA.

Background: Methotrexate cutaneous ulceration is a rare methotrexate complication, and has only been described in case reports and case series.

Objective: To document patient characteristics, morphologic features, and mortality risk factors for methotrexate cutaneous ulceration.

Methods: A systematic literature review of PubMed and Embase (last date 1 November 2021) was performed with data collected from case reports and case series. Read More

Am J Clin Dermatol 2022 May;23(3):353

Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.

Am J Clin Dermatol 2022 Apr 20. Epub 2022 Apr 20.

Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. Read More

Am J Clin Dermatol 2022 Apr 15. Epub 2022 Apr 15.

Department of Dermatology, Mayo Clinic, Rochester, MN, USA.

Anti-interleukin (IL)-17 agents have shown excellent therapeutic efficacy in patients with psoriasis and are expected to be expanded to other chronic inflammatory diseases. However, patients receiving anti-IL-17 agents are at an increased risk of developing Candida infection, with some agents reported to increase the incidence in a dose-dependent manner. Interleukin-17 is secreted by the Th17 subset of CD4+ lymphocytes, CD8+ T cells, and innate cells, including natural killer T cells, lymphoid tissue inducer cells, innate lymphoid cells, and γδ-T cells, and plays an important role in antifungal defense. Read More

Am J Clin Dermatol 2022 May 10;23(3):421-424. Epub 2022 Apr 10.

Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.

Am J Clin Dermatol 2022 May 4;23(3):355-364. Epub 2022 Apr 4.

Progressive Clinical Research, San Antonio, TX, USA.

Background: Ruxolitinib cream is a topical formulation of ruxolitinib, an inhibitor of Janus kinase 1 and Janus kinase 2.

Objective: We aimed to determine the safety, tolerability, and bioavailability of 1.5% ruxolitinib cream under maximum-use conditions in patients with atopic dermatitis. Read More

Am J Clin Dermatol 2022 May 31;23(3):331-338. Epub 2022 Mar 31.

Department of Oncology, The University of Oxford, Oxford, OX 37LE, UK.

Increasing knowledge about the biology of melanoma and of immunology has led to the development and regulatory approval of the immune checkpoint inhibitors ipilimumab, nivolumab, and pembrolizumab, which are indicated for the treatment of melanoma irrespective of the B-Raf proto-oncogene mutation status of the tumour. Only a subset of patients will respond, but those who do can expect long-lasting, previously unheard-of responses. Long-term survival results for the registration trials, including CheckMate 067, Keynote-006, and Keynote-001, have recently been published. Read More

Am J Clin Dermatol 2022 May 29;23(3):319-329. Epub 2022 Mar 29.

Hull York Medical School, York University, Heslington, York, UK.

Patient and public involvement (PPI) in research is defined as research being carried out 'with' or 'by' members of the public, patients, and carers, on both an individual and a group level, rather than simply 'about', or 'for' them. Within dermatology, PPI is increasingly recognised as a vital component of research as it helps to ensure that research remains relevant to the populations we intend to serve. Dermatology scholarship, with its rich psychosocial implications due to the stigma, physical disability, and mental health burdens these conditions may incur, is in a unique position to benefit from PPI to unlock previously inaccessible patient lived experiences or therapeutic consequences. Read More

Am J Clin Dermatol 2022 May 16;23(3):385-392. Epub 2022 Mar 16.

Clalit Health Services, Tel-Aviv, Israel.

Background: The effectiveness of messenger RNA coronavirus disease 2019 (COVID-19) vaccines in patients with atopic dermatitis (AD) is yet to be delineated. It remains largely unknown how AD-related immunosuppressive medications affect the development of vaccine-induced immunity.

Objective: We aimed to evaluate the prevalence of the BNT162b2 messenger RNA vaccine among patients with AD and to assess its effectiveness in protecting against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19-associated hospitalization, and mortality. Read More

Am J Clin Dermatol 2022 May;23(3):425

Department of Dermatology, Columbia University, New York, NY, USA.

Am J Clin Dermatol 2022 May 8;23(3):287-300. Epub 2022 Mar 8.

Department of Dermatology Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.

There has been no extensive synthesis of studies evaluating the cost of chronic hand eczema (CHE). This review evaluated the societal costs, healthcare resource utilisation, missed work time and job loss due to CHE. MEDLINE and 16 other databases and websites were searched in October 2020 for studies meeting prespecified inclusion criteria. Read More

Am J Clin Dermatol 2022 May 5;23(3):277-286. Epub 2022 Mar 5.

Dermatology Section, Boston Children's Hospital, 300 Longwood Avenue, Fegan 6, Boston, MA, 02115, USA.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19) pandemic, affecting people worldwide. SARS-CoV-2 infection is a multisystem disease with potential for detrimental effects on various systemic organs. It affects people of all ages with varying degrees of disease severity. Read More

Am J Clin Dermatol 2022 May 5;23(3):267-275. Epub 2022 Mar 5.

Lee Kong Chian School of Medicine, Singapore, 11 Mandalay Road, Singapore, 308232, Singapore.

Background: Previous studies have shown that serum 25-hydroxyvitamin D (25(OH)D) may be associated with atopic dermatitis (AD), and that vitamin D (VD) supplementation may decrease AD severity.

Objective: The aim of this study was to investigate the association between serum 25(OH)D level and AD, and the effect of VD supplementation on AD severity, while providing stratified analyses based on latitude and region.

Methods: A systematic review was performed on all published studies in MEDLINE, Embase, and Cochrane Library databases that analyzed effects of serum 25(OH)D and VD supplementation on AD. Read More

Am J Clin Dermatol 2022 Mar 21;23(2):231-246. Epub 2022 Feb 21.

Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany.

Pruritus in pregnancy is a common and burdensome symptom that may be a first sign of a pregnancy-specific pruritic disease (atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, and intrahepatic cholestasis in pregnancy) or a dermatosis coinciding with pregnancy by chance. Despite its high prevalence, pruritus is often underrated by physicians, and data regarding the safety profiles of drugs for pruritus are very limited. In this review, we illustrate the epidemiology, possible pathophysiology, clinical characteristics, and diagnostic workup of various pregnancy-related diseases and discuss antipruritic treatments. Read More

Am J Clin Dermatol 2022 May 19;23(3):339-352. Epub 2022 Feb 19.

Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Institute of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.

Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Read More

Am J Clin Dermatol 2022 May 14;23(3):301-318. Epub 2022 Feb 14.

Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA.

Sweet syndrome (SS), or acute febrile neutrophilic dermatosis, is an inflammatory, non-infectious skin reaction characterized clinically by tender, erythematous papules/plaques/pustules/nodules commonly appearing on the upper limbs, trunk, and head and neck; histologically, SS is characterized by dense neutrophilic infiltrate in the dermis. SS is accompanied by fever; an elevation of inflammatory markers (e.g. Read More

Am J Clin Dermatol 2022 Mar 4;23(2):257-266. Epub 2022 Feb 4.

Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Objective: Our objective was to describe the incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in a large unselected cohort, to validate the culprit drugs involved and the frequency of SJS/TEN for each drug, and to analyze the clinical risk factors for SJS/TEN.

Methods: Using the computerized database of Clalit Health Services, we identified all adult patients with a new SJS/TEN diagnosis between 1 January, 2008 and 30 June, 2019 and validated each case. Cumulative incidence of SJS/TEN for each culprit drug was calculated by dividing the number of valid cases by the total number of new users of the drug in the study period. Read More

Am J Clin Dermatol 2022 Mar 2;23(2):177-193. Epub 2022 Feb 2.

Department of Dermatology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen (370), The Netherlands.

Changes in nail color can provide important clues of underlying systemic and skin disease. In particular, white discoloration (leukonychia) has a high prevalence with a wide array of potential relevant causes, from simple manicure habits to life-threatening liver or kidney failure. Therefore, a reliable assessment of the patient with leukonychia is essential. Read More

Am J Clin Dermatol 2022 Jan 21;23(Suppl 1):39-50. Epub 2022 Jan 21.

Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, M6 8HD, UK.

Generalized pustular psoriasis (GPP) is a rare neutrophilic skin condition characterized by episodes of widespread eruption of sterile macroscopic pustules that can be associated with systemic inflammation. The rarity of GPP and its heterogeneous cutaneous and extracutaneous symptoms pose considerable challenges to the development and adoption of comprehensive accurate disease measures for the routine clinical assessment of disease severity and the evaluation of new treatments in clinical trials. Psoriasis disease measures remain among the most commonly used methods for evaluating patients with GPP, despite their limitations owing to a lack of assessment of pustules (a hallmark of GPP), systemic inflammation, and disease symptoms. Read More