According to a review published in Dermatologic Therapy, there is need for effective pharmacologic treatment options for patients with trichotillomania. Currently, there are no FDA-approved medications for treating patients with trichotillomania, although selective serotonin reuptake inhibitors (SSRIs) are often used as first-line pharmacologic therapy. Despite wide usage of these drugs, evidence of their benefit is weak, the researchers noted. Antipsychotics have also been studied as potential treatment options, but they can have many side effects, the authors wrote.
N-acetylcysteine (NAC), a derivative of the amino acid I-cysteine, has direct and indirect antioxidant activity and alters glutamate metabolism. While evidence of its efficacy has varied, in nonplacebo-controlled studies, the evidence has been promising. In two main placebo-controlled studies, “one has shown significant benefit over placebo while the other has not,” the authors said. Dronabinol, a cannabinoid agonist, showed significant benefit in reducing hair-pulling behavior in one small study, they noted.
Studies on the disorder’s comorbidity and genetics have shown the potential for future investigation and novel strategies for patient-specific treatment, the researchers wrote.
Read about how dermatologists have embraced empathy and antipsychotics to help patients with psychocutaneous disease in Dermatology World.
DW Insights and Inquiries: Mogamulizumab for CTCL — Targeted therapy and immunotherapy crossing paths
Preserving the host-immune system for as long as possible has been one of the guiding principles for me in treating patients with mycosis fungoides/Sezary Syndrome (MF/SS), subtypes of CTCL. As a CTCL clinical trial researcher, it has been rewarding to be able to offer novel therapies for CTCL patients who need them. Over the past 20 years, six systemic therapies have been FDA approved (bexarotene, denileukin diftitox, vornostat, romidepsin, brentuximab, and mogamulizumab) to fill the gap between the familiar skin-directed treatments and the traditional cytotoxic chemotherapeutic agents that were previously the only option for advanced disease.
However, targeting cancer T-cells, whether using monoclonal antibodies/drug conjugates or, hopefully in the future, engineered CAR-T cells is a difficult task due to the consequences of harming normal T-cells. Though CTCL still lacks a universal robust tumor marker or consistent driver mutation, we are fortunate to now have agents that are more targeted with fewer immunosuppression-related and infectious adverse events (AEs) overall.
Mogamulizumab (MG) is a humanized defucosylated monoclonal antibody that activates antibody dependent cellular cytotoxicity (ADCC); it was initially developed and approved in Japan for adult T-cell leukemia/lymphoma in 2012 (1). MG targets the C-C chemokine receptor-4 (CCR4) normally expressed by thymic T-cells and CD4+ Th2 and regulatory T-cells, but also highly expressed by malignant skin-homing T-cells in MF and SS (advanced stage > early stage). Keep reading!
2021 Medicare fee schedule rewards cognitive work, but cuts procedures
Last week, CMS released a proposed rule for the 2021 physician fee schedule and Quality Payment Program, which projects an overall cut in payments to dermatology of 2%. An initial review and analysis by the American Academy of Dermatology Association (AADA) shows that these policy proposals reflect a significant shift by placing a higher value on physicians’ cognitive work over procedures. The AADA will strongly advocate for a balanced solution to the redistribution of Medicare reimbursement. Learn more about the sweeping changes relevant to dermatology on the Academy’s website.
Executive Order on improving rural health, telehealth access
Last week, the Trump Administration released an Executive Order directing the Secretary of HHS to develop regulations which would consider an extension of reimbursement policy and flexibilities for telehealth services after the public health emergency. This action is meant to improve access to health care in rural communities across the U.S. and make this service permanent within the health care system.
Dermal absorption of topical drugs
The University of Maryland Center of Excellence in Regulatory Sciences and Innovation recently hosted a workshop, “Topical Drug Development – Evolution of Science and Regulatory Policy II.” It followed up a workshop last year focused on dermal absorption development in topical drug development, an issue currently affecting sunscreen access in the United States. The FDA and industry stakeholders discussed advances in, and examples of, the use of in vitro and in silico methods to test sunscreens and reviewed the maximal usage trial (MUsT) studies conducted on sunscreen products. While researchers found absorption of organic sunscreen ingredients, it does not mean that sunscreen ingredients are unsafe. Rather, FDA is seeking additional safety data for currently marketed organic ingredients and those pending approval that are available abroad.
Henry W. Lim, MD, chair of the Academy’s Ad Hoc Task Force (AHTF) on Sunscreens, presented on sunscreen as part of a comprehensive photoprotection plan and stated that the Academy is encouraged that FDA and industry are working together to facilitate access to sunscreen products for the benefit of patients and the public. Sheila Fallon Friedlander, MD, also a member of the AHTF on sunscreens, presented on absorption and skin factors, highlighting that absorption is different for children given their body mass to surface area ratio. View slides from the presentations and read the Academy’s statement on the safety on sunscreen.
Academy seeks assistant secretary-treasurer nominees
Applications and nominations are now being solicited for the position of assistant secretary-treasurer for the American Academy of Dermatology and AAD Association for the term beginning March 2022.
Members interested in serving the Academy in this position should have significant administrative and financial management experience. The position of assistant secretary-treasurer requires a considerable time commitment. Applicants must be able to serve for six years: three years as assistant secretary-treasurer and three additional years as secretary-treasurer.
To learn more about the position and apply, visit staging.aad.org/AST. Applications are due Jan. 4, 2021. Questions may be directed to Cyndi Del Boccio in the AAD Executive Office at (847) 240-1041 or cdelboccio@aad.org.
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