Recent Developments

 

Dr. Sandra Marchese Johnson, Yoseph Dalia Recognized for Best Case

Fort Smith, Arkansas-based dermatologist Sandra Marchese Johnson MD, FAAD and Yoseph Dalia, BS took home Practical Dermatology® magazine’s Best Case of 2018 award for a Resident Resource Center submission that detailed the first reported case of facial rash following dupilumab therapy for atopic dermatitis.

The report, which was published in the April 2018 issue of Practical Dermatology® magazine, fostered a productive dialogue among others in the dermatology community that aimed to mitigate this potential side effect and enable patients to stay on the highly effective therapy.

In their case study, Dr. Johnson and Mr. Dalia reported on a 26-year-old white woman with a long history of atopic dermatitis (AD) and contact dermatitis who failed to improve with methotrexate and was treated with dupilumab. She was satisfied with the treatment, but six months later developed worsening rash on her face and neck. “Unsuccessful treatments to date include oral prednisone, fluconazole, and doxycycline. Moreover, topical calcipotriene, oxiconazole, ivermectin, clobetasol, tacrolimus, and moisturizers have not improved her facial symptoms,” they wrote.

“We present this case to raise clinical awareness of this potential adverse effect. We are also interested to discover if other physicians have seen this issue and how they have treated it. Our patient is extremely frustrated and would like to continue dupilimab.” (Read the full report at practicaldermatology.com/2018/04)

In response to the publication, dermatologist Booth Durham, MD of Turnersville, NJ, reported a second case of a facial rash following dupilumab therapy. “The facial dermatitis only responded to intermittent short courses of oral prednisone,” Dr. Durham wrote. “Several topicals including steroids, tacrolimus, Eucrisa, antifungals, and Alcortin A were ineffective.”

In this case, Dupixent had to be discontinued and the facial rash gradually improved over the next five months.

The initial case study and subsequent reports also prompted discussion about the possibility that these rashes are actually caused by an underlying allergic contact dermatitis (ACD) that could be discovered with patch testing.

In the October 2018 issue of JAAD Case Reports, researchers highlighted three cases of severe AD treated with dupilimab in which patch testing was critical to unmasking an underlying ACD.

“Patch testing dupilumab candidates before initiation of therapy helps identify potential underlying ACD, thereby decreasing the chances of falsely identifying treatment as failed,” they write. “Patients can be patch tested on dupilimab…Patients with residual facial dermatitis on dupilumab may benefit from further comprehensive patch testing.”


AD Linked to Suicidal Thoughts and Attempts

Patients with eczema may be more likely to have suicidal thoughts and attempts compared to their counterparts without eczema, according to a new study in JAMA Dermatology.

Researchers evaluated the association between eczema and suicidal thoughts and attempts by analyzing the combined results of 15 studies including 310,000 patients with eczema and 4.4 million people without eczema. They found that patients with atopic dermatitis had a 44 percent increased odds of suicidal ideation and a 36 percent increased odds of suicide attempts compared with patients without atopic dermatitis. Studies investigating completed suicides in patients with AD had inconsistent results.

It is well known that atopic dermatitis has a negative affect on quality of life, but its link to suicide risk and ideation was inconclusive until now.

“It is important for dermatology providers to be aware of this increased risk in patients with atopic dermatitis, monitor for suicidality, and make appropriate referrals to mental health professionals,” the study authors conclude.


New Review Assesses Prurigo Nodularis Treatments

Emerging treatments such as neurokinin-1 receptor antagonists show the most promise for prurigo nodularis, according to a review in JAMA Dermatology.

Neurokinin-1 receptor is a target of substance P, a mediator of itch and a probable pathogenic agent of prurigo nodularis.

Adam Friedman, MD, Professor of Dermatology at the George Washington University School of Medicine and Health Sciences, and his team looked at 35 studies with differences in factors such as the number of subjects and the delivery of the treatment. They gave a score to each study, ranking its efficacy and consistency against prurigo nodularis.

Many of the treatment options, including topical agents, phototherapy, and systemic immunomodulatory drugs, show limited promise due to side effects and low efficacy, the study found.

“Currently, there is a lack of targeted pharmacologic therapy for prurigo nodularis and all current treatment approaches utilized show variable success,” Dr. Friedman says in a news release.

“We wanted to provide a summary of evidence-based treatments to highlight promising directions and also underscore areas that require improvement,” he says. “By identifying which current and future therapies are effective for prurigo nodularis, we can gain a better understanding of the biological underpinnings of this disease, and patients will ultimately benefit from better treatment options,” he adds.

“Our summary not only provides guidance for practitioners with regards to the broad array of off-label therapies in our armament, but also to researchers in identifying the gaps in treatment development,” Dr. Friedman says.

The team suggests that higher-powered studies and additional randomized controlled trials are needed to better evaluate treatment options for prurigo nodularis.

CLOSE UP

With Brian Berman, MD, PhD

Close to 18 million people develop keloids, and these unsightly scars can negatively affect quality of life, self-esteem, and self-confidence. Keloids are typically removed surgically, but there tends to be an extremely high recurrence rate. This is why there is so much enthusiasm about the use of Sensus Healthcare’s SRT-100™ superficial radiation therapy following keloidectomy, which dramatically slashed recurrence rate in a new case series in Skin: The Journal of Cutaneous Medicine. Here, Florida dermatologist and lead study author, Brian Berman, MD, PhD, an Emeritus Professor of Dermatology and Cutaneous Surgery at The University of Miami Miller School of Medicine and member of the American Academy of Dermatology’s Board of Directors, discusses the implications of the new study and his team’s follow-up plans.

Why is this topic important to study?

Dr. Berman: The potential for recurrence of keloids at the sites of previously excised keloids is a well-recognized consequence following keloidectomy, and based on the published literature, it has been reported to occur approximately in 71 percent of cases.

Describe the research and your findings.

Dr. Berman: In a multi-center, case series we observed the recurrence rate of keloids post keloidectomy with peri-operative treatment with a biological effective dose 30 of superficial radiation.

Fully, 297 keloids were surgically excised, and starting on post-operative day one, the suture closure line, with a 5mm margin, received a total biologically effective dose 30 (BED 30) superficial radiation delivered by an SRT-100, usually on three consecutive post-operative days of 6 Gy/day. The follow-up period ranged from one month to three years, with the majority having been followed for more than one year for recurrence. There were nine clinical keloid recurrences in the 297 keloidectomy sites for a recurrence rate of three percent.

Radiation dermatitis was not reported. The most common adverse local skin reaction was transient (3-6 months) hyperpigmentation, occurring in Fitzpatrick Skin Type V-VI individuals.

What are the next steps?

Dr. Berman: We plan a prospective study with a follow-up of at least one year to determine recurrence rates of keloids for superficial radiation therapy post-surgical keloidectomy.

For further reading

Berman, B, et al. “Low Rate of Keloid Recurrences Following Treatment of Keloidectomy Sites with a Biologically Effective Dose 30 of Superficial Radiation.” (2018). https://jofskin.org/index.php/skin/article/view/370

National Rosacea Society Grants Available

The National Rosacea Society (NRS) has new grants available in 2019 to support research into potential causes and other key aspects of rosacea that may lead to improvements in its management, prevention, or potential cure. The deadline for submitting proposals for research grants in 2019 is June 17.

Funded by donations from rosacea sufferers, the NRS research grants program has awarded more than $1.5 million to support 70 studies, including scientific investigations that have connected the dots in the inflammatory process of the disorder. Other studies have investigated the genetics of rosacea, the skin’s microbiome, changes to tear film development in ocular rosacea, and many other areas.

Researchers interested in applying for grants may obtain forms and instructions through the research grants section of the NRS website at rosacea.org; by contacting the National Rosacea Society, 196 James Street, Barrington, Illinois 60010; or emailing info@rosacea.org.

A high priority in awarding grants will be given to studies relating to such areas as the pathogenesis, progression, mechanism of action, cell biology and potential genetic factors of rosacea. Research in epidemiology, predisposition, quality of life and relationships with environmental and lifestyle factors may also be funded.


RealSelf Forms Strategic Medical Advisory Council

RealSelf, Inc. has formed a Strategic Medical Advisory Council made up of the Business Advisory Board, the Medical Review Advisory Board, and the Industry Advisory Board, all of which are comprised of board-certified doctors and surgeons. The formation of the council follows the appointment of the first RealSelf Chief Medical Officer last summer.

“As a fast-moving technology company in the rapidly-changing aesthetics industry, it is imperative we keep our ear to the ground to stay ahead of trends to best serve the needs of consumers and doctors. Doctor feedback has always been a valuable part of our evolution and I am incredibly excited to formalize the Council as part of our operations to ensure we are best serving the needs of our consumers and medical practitioners for decades to come,” says Tom Seery, co-founder and CEO of RealSelf, in a news release. “These doctors are forward-looking leaders in their fields and will help RealSelf better understand historical industry challenges, evaluate what we plan to bring to market, and envision the aesthetics landscape of the future. We’re honored to welcome them to the RealSelf team.”

The Business Advisory Board is to work with RealSelf senior leadership.

“As RealSelf Chief Medical Officer for the past six months, I’ve been collecting feedback and insights from doctors and surgeons from around the world on how we can make RealSelf more useful for medical professionals and consumers, and we’re already implementing ideas and changes as a result of this valuable input,” says Lara Devgan, MD RealSelf Chief Medical Officer and New York City-based plastic surgeon, who is also an inaugural member of the Advisory Council. “RealSelf has created a valuable platform for transparency that’s helping tens of millions of consumers every year research aesthetic treatment options, get answers to their questions and connect to trusted providers. Formalizing this Advisory Council with such an esteemed group of medical experts is an important next step to further increase transparency and demystify the category, and ensure RealSelf is at the forefront of the innovation happening in this industry.”

Inaugural members were selected to represent diversity of medical practice specialties and geography as well as their personal commitment to transparency in aesthetics and their engagement in digital and social platforms. Advisory council terms range from six to 12 months and new members will be invited periodically.


EWG VERIFIED Goes Mainstream with Herbal Essences

The EWG VERIFIED program is launching nationwide in stores with Procter & Gamble’s two new Herbal Essences shampoos.

The two Herbal Essences shampoos were reformulated to meet the Environmental Working Group’s (EWG) rigorous criteria for transparency and health and now have the EWG VERIFIED mark.

The Herbal Essences shampoos hit store shelves in this month.

To date, more than 1,350 products carry the EWG VERIFIED mark.

“Because of Procter & Gamble’s sheer size and market share, these new EWG VERIFIED shampoos could be the domino that triggers similar actions from other companies that have not yet embraced this level of transparency,” says EWG President Ken Cook in a news release. “As more information comes out about the harmful impact of some of these chemical ingredients, companies are starting to really listen to consumers who are asking for products made with healthier ingredients. P&G is clearly listening to its customers and working to move the market in the right direction.”

“EWG VERIFIED goes beyond basic ingredient labels to hold companies on the cutting edge of making the healthiest products to an even higher standard,” says Jocelyn Lyle, EWG’s vice president of development. “Our mark will make shopping even easier for overwhelmed consumers who want to quickly find a bottle of shampoo and other personal care products that meet our rigorous standards and that are better for their health.”

 

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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.