This month’s news from across the specialty
What’s hot
August 1, 2022
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
You have likely noticed an increase in online reviews of yourself and your practice over the last two years. McKinsey & Company reviewed findings by their Global Institute showing that the number of online consumer reviews for all products and industries has approximately doubled since the beginning of the COVID-19 pandemic (i.e., the quantity of global reviews in 2020 alone was roughly equivalent to the 10 years of reviews prior to COVID-19). In addition, the team noted that customer reviews influence consumers more than brand or any marketing strategy. So, it is important for all of us to manage and learn from consumer reviews of ourselves and our practices.
The authors recommend three primary ways that businesses (or dermatologists) can manage consumer ratings and reviews to their advantage. For most products, increasing the star rating to above 4 (out of 5 stars) leads to significant increases in sales. Therefore, businesses should consider proactively soliciting positive reviews. Second, one can utilize consumer reviews to find feedback into areas where they can improve their products or services. Lastly, reading competitors’ reviews can provide insights into areas where a business may be leading versus lagging behind. While we cannot control online reviews, we can utilize them to supplement our practice improvement processes.
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We are fortunate to have treatment options to consider for individuals with multiple actinic keratoses. When counseling patients, however, their relative efficacy has been unclear, particularly for preventing squamous cell carcinoma. In a secondary analysis of a randomized trial that evaluated the effectiveness of 5% fluorouracil, 5% imiquimod, methylaminolevulinate photodynamic therapy, and 0.015% ingenol mebutate for treating patients with multiple actinic keratoses, the authors observed that the risk of developing invasive squamous cell carcinoma after therapy varied across regimens. The four-year risk of developing invasive SCC was 2.2% after fluorouracil, 3.0% after ingenol mebutate, 3.6% after PDT, and 5.8% after imiquimod. Of note, none of these differences were statistically significant due to the study being underpowered. Nonetheless, this study adds to a growing body of literature suggesting that 5% fluorouracil is the most effective treatment option as it has been shown to be best at eliminating actinic keratoses and it is also associated with the lowest absolute risk of developing post-treatment squamous cell carcinoma. Other factors besides efficacy, like long-term adherence, drug cost, skin toxicity, patient preferences, and a patient’s absolute risk of SCC, should be considered when deciding on an individual management strategy. Ultimately, treatment decisions should be centered on the patient, not the actinic keratosis; one size does not fit all!
Most dermatologic laser-associated eye injury cases occur with laser hair removal and laser resurfacing (Dermatol Surg. 2022;48: 545-50). In a review of 119 cases of eye injury associated with dermatologic laser procedures, 60 cases resulted from direct injury of ocular structures. In 44 of these cases where patients sustained injury, there was improper use or no use of eye protection. Overall, 31 patients had persistent symptoms including one patient with permanent vision loss in one eye and 11 patients with decreased visual acuity. Most commonly the injuries occurred with the alexandrite 755nm and diode 800nm/810nm lasers and most occurred during laser hair removal procedures. The remaining 59 cases were ectropion after laser resurfacing. As the wavelength of the laser determined the ocular injury with 98% concordance, understanding eye anatomy and physics facilitates preventing complications. Appropriate eye protection is crucial for cosmetic laser procedures.
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Systemic Janus kinase (JAK) inhibitors are a novel treatment approach for plaque psoriasis and are still undergoing clinical trials here in the U.S. This network meta-analysis of eligible randomized clinical trials (RCTs) compared the efficacy and safety of JAK inhibitors in moderate-to-severe plaque psoriasis. The endpoints for efficacy were 75% improvement in Psoriasis Area and Severity Index (PASI 75) and the Physician’s Global Assessment (PGA) response. Treatment-related adverse events were also assessed. Eight RTCs with tofacitinib, deucravacitinib, and four others were included (3,612 cases).
All the JAK inhibitors assessed showed superior PASI 75 response at weeks 8 and 12, and had non-inferior safety compared with placebo, except for deucravacitinib 6 mg BID and 12 mg QD. Tofacitinib 15 mg BID, and 10 mg BID were the most efficacious, while the best safety profile was ranked as follows: tofacitinib 2 mg BID > deucravacitinib 3 mg QD > tofacitinib 5 mg BID. A comprehensive evaluation of efficacy and safety showed that tofacitinib at doses of 2 mg, 5 mg, 10 mg, and 15 mg was superior to other JAK inhibitors in the study.
JAK inhibitors are promising treatment options for moderate to severe plaque psoriasis, however, minor differences in dosage significantly impact their efficacy and safety profiles. Tofacitinib 10 mg BID was not approved for the treatment of plaque psoriasis due to treatment-related AEs. After consideration of safety and black box warnings, JAK inhibitors could be useful in plaque psoriasis patients who do not respond to biologics or who have multiple inflammatory diseases.
