The Florida legislature is considering bills that would prevent Florida municipalities, like Key West, from banning the sale and distribution of sunscreens that contain ingredients that are being evaluated for potentially harmful effects on the environment, specifically oxybenzone and octinoxate. The bills would block local regulations of all over-the-counter drugs and cosmetics, including sunscreens and makeup. The state House is currently considering its legislation, and the Senate recently passed an identical bill to the House legislation. It is unclear if Gov. Ron DeSantis will sign the legislation into law, if passed.
DW Insights and Inquiries: Prurigo pigmentosa as the “keto rash”: I’m a believer
Patients are attuned to their diets — healthy, unhealthy, or trendy. Unquestionably, certain foods exacerbate specific dermatoses — just ask any dermatitis herpetiformis patient how they fare with a slice of Sicilian pizza. There is ample literature to support the association of ketosis (and a ketogenic diet) to prurigo pigmentosa.
The “keto rash” is prurigo pigmentosa (PP), an uncommon dermatosis consisting of a network of erythematous, pruritic papules evolving into reticulated hyperpigmentation with a specific predilection for the trunk. It is seen mostly in young adults, more often in women. Originally described in Japan, there have been an increasing number of reports worldwide. PP progresses through several stages of development, commencing as erythematous macules which evolve to urticarial papules and papulovesicles. Subsequently, the lesions become crusted or scaly. A few weeks later, they spontaneously resolve, leaving behind reticulated pigmentation. The histologic features vary with each stage of lesional morphology (initially a neutrophilic infiltrate, with spongiosis, vacuolar alteration, and late dermal melanophages). Therapy is with tetracycline antibiotics (minocycline, doxycycline) or dapsone. Topical steroids may help pruritus but have little effect on the rash itself. Recurrences of PP may occur. Keep reading!
Correction issued to pediatric psoriasis treatment guidelines
The Journal of the American Academy of Dermatology (JAAD) has issued a correction to recently published joint American Academy of Dermatology – National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients (J Am Acad Dermatol. 2020;82:161-201). In the article that published online Nov. 5, 2019, and in the January 2020 print issue, there was a dosage error in Table XXXVII, recommendation number 18.3. The correct maximum dose of methotrexate recommended in younger children is 25 mg/wk as stated in the body of the article and Table XXXVI. The error has been corrected in the online version of the article.
FDA grants priority review of dupilumab for children
The FDA has granted dupilumab priority review status for children ages 6-11 with moderate-to-severe atopic dermatisis. The FDA is expected to make a decision on whether to approve the expanded indication by the end of May 2020. If approved, dupilumab would be the first biologic indicated for children with AD. Stay tuned to DWW for updates.
Does the burden of atopic dermatitis vary by age, race, or ethnicity? Learn more in Dermatology World.
Pemphigus vulgaris therapy granted FDA orphan drug status
The FDA has granted DSG3-CAART, a T-cell therapy for the treatment of pemphigus vulgaris, Orphan Drug Designation. According to the manufacturer, “DSG3-CAART is designed to target the cause of mucosal PV (mPV), B cells that express pathogenic autoantibodies directed against the DSG3 protein, while preserving normal B cell immune function.”
The FDA’s Orphan Drug Designation is granted to therapies that treat or prevent rare diseases or conditions that affect less than 200,000 people in the United States. This designation offers the manufacturer incentives, such as partial tax credits for clinical trial costs, and potential marketing exclusivity.
Read more about how chimeric antigen receptor T cells can potentially cause a surgical strike against pemphigus in Dermatology World.
In late 2018, the FDA expanded the indication for the human papillomavirus 9-valent vaccine to include women and men aged 27 through 45 years. Gardasil 9 may prevent certain cancers and diseases caused by the nine HPV types covered by the vaccine. As such, the Academy’s Advisory Board recently adopted a resolution (AAD07 A19) — which was referred to the Academy’s Council on Science and Research — recommending that residents, fellows, and physicians get vaccinated for HPV. The Advisory Board is a committee of the Academy that considers policy recommendations submitted by members. The Council determined there was insufficient data to make an evidence-based recommendation about vaccination.
Dermatologists may have a higher risk of direct contact with infected patients’ skin, compared to other specialists, and could have a higher risk of exposure. Additionally, the analysis found that procedures using ablative laser, fulguration, electrodesiccation, and vaporization can generate particles in the air from infected skin that could result in an increased risk of HPV infection. The Academy encourages more studies to determine these exposure risks in dermatologic settings and, thus, cannot make a formal recommendation at this time. For more information about the Academy’s Advisory Board, contact Ashley John at ajohn@aad.org.
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