Topical tofacitinib for alopecia areata affecting facial hair
In an article published in theBritish Journal of Dermatology, 26 patients with eyebrow, eyelash, and/or beard alopecia areata were treated with topical tofacitinib compounded as 2% poloxamer gel twice daily for eyebrow and beard involvement or 0.005% aqueous solution eye drops once daily for eyelashes. No topical or systemic steroids were used during the study. Patients were treated with topical tofacitinib for at least three months and a media of eight months.
Complete and partial eyebrow regrowth was noted in eight and four patients, respectively. Of the nine patients with beard involvement, two had complete regrowth and five had partial regrowth. All four patients with eyelash involvement had complete regrowth. Overall, 80% with two facial areas involved had complete regrowth of both areas, whereas the other patients had partial regrowth. Those with partial or limited eyebrow and eyelash alopecia were more likely to have complete regrowth.
Of the four patients who had been on stable systemic treatment for scalp alopecia areata (two with eyebrow, two with beard), who had no facial regrowth on systemic therapy, three (75%) had regrowth with topical tofacitinib.
The potential FDA approval of multiple JAK inhibitors could offer new treatment options for dermatology patients. Read more inDermWorld.
DermWorld Insights and Inquiries: Monitoring infantile hemangiomas — What’s the score?
Infantile hemangiomas (IH) are common vascular tumors that generally run a self-limited course of rapid growth in the first 2-3 months of life, slow growth for another 4-6 months, and then total or near-total involution over the next 4-5 years. Despite this harmless progression, some hemangiomas need aggressive therapy and evaluation. While a recent, comprehensive clinical practice guideline was recently published in Pediatrics, primary care providers are understandably confused as to which infants to refer and which to simply monitor. A standardized referral instrument would be a valuable tool for primary care providers and an enhancement of patient care, providing timely referral for potentially significant IHs and avoiding unnecessary referrals.Keep reading!
Is there an effective treatment for skin picking disorder?
In a letter to the editor inJAAD, the authors found that there is evidence to support the use of N-acetylcysteine (NAC) for skin picking disorder. In this single-center, retrospective cohort study, 28 patients with a diagnosis of skin picking disorder, acne exorciée, or neurodermatitis were treated with NAC.
Overall, 13 patients completed an adequate trial (defined as a minimum dose of 600 mg twice daily for three consecutive months). Of these 13 patients, 61.5% had documented improvement on physical exam. The most common side effect was gastrointestinal upset (7.1%). Just over half of the patients did not complete an adequate trial, with 40% of patients discontinuing treatment due to a lack of response. The authors recommend that responses should not be assessed until follow up at least three months later.
Chilblains before and during the COVID-19 pandemic
In a study published inJAMA Dermatology, the authors evaluated the incidence of chilblains in northern California before and during the COVID-19 pandemic and found an increase in the annual incidence of chilblains from 5.2 per 100,000 person-years before the pandemic to 28.6 per 100,000 person-years during the pandemic in 2020.
[Chilblains and COVID-19: Is there an association? Read more inDermWorld Weekly.]
Only 3.7% of patients with chilblains tested during the pandemic were positive for COVID-19, and only 2% of patients were positive for COVID-19 within six weeks of the chilblain diagnosis. Chilblains cases were weakly correlated with the incidence of COVID-19 across 207 location-months. The authors speculated that the weak association between chilblains and COVID-19 in northern California may be due to increased presentation to health care providers for evaluation of chilblains or more people going barefoot at home while sheltering in place.
JAAD study demonstrates link between chilblains and COVID-19. Read more inDermWorld Weekly.
Efficacy of ruxolitinib cream in vitiligo patients
A study published in JAADprovided subgroup analyses of treatment response from a phase 2 trial of ruxolitinib cream for vitiligo patients. Thirty-three patients used 1.5% ruxolitinib cream twice daily and achieved ≥50% improvement in facial Vitiligo Area Scoring Index (F-VASI50). At week 24, F-VASI50 responders were more likely to be older than 50 and female. Also, those with baseline facial body surface area ≤1.5% with disease duration longer than 20 years and had previously been treated with phototherapy were more likely to be responders.
The highest proportion of total-VASI50 responders had disease in the head and neck region (60%), followed by upper and lower extremities (52.9% and 52.6%, respectively), with the lowest proportion of responders affected on the hands and feet (15% and 29.4%, respectively).
[A dermatologist treats a tricky case of vitiligo, helping his patient regain her confidence. Read more.]
Ruxolitinib cream demonstrated trends for clinical activity in the treatment of vitiligo across demographics and clinical characteristics, including patients with longstanding and extensive disease.
Experts discuss the role of technology in clinical trials and what the future may, or may not, hold inDermWorld.
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