February 8, 2023
IN THIS ISSUE / Feb. 8, 2023
DermWorld Insights and Inquiries: A surgeon’s primary intention is to reduce secondary infection
CDC investigating possibility of treatment-resistant dermatophytosis
High-dose clobetasol propionate in patients with cutaneous lichen planus
A review of newer agents for alopecia areata
A systematic review published in the Journal of the European Academy of Dermatology and Venereology analyzed novel treatments for alopecia areata (AA). The review included 12 randomized controlled trials with patients with 25-100% affected scalp areas. Biologics (including dupilumab and secukinumab), JAK inhibitors, and PDE-4 (apremilast) inhibitors were reviewed.
[As biologic therapies expand indications to children and adolescents, what do dermatologists need to know about balancing the risks and benefits? Read more in DermWorld.]
Overall, biologics and PDE-4 inhibitors appeared mostly ineffective. There are, however, several new JAK inhibitors that showed short-term, dose-dependent efficacy for up to 36 weeks. Baricitinib was recently approved by the FDA for the treatment of severe AA while ritlecitinib and deuruxolitinib have received an FDA breakthrough therapy designation. Up to 34% and 30.6% of patients achieved treatment success after 36 weeks of baricitinib treatment and 24 weeks of ritlecitinib treatment, respectively.
[What has research revealed about the pathogenesis of hair disorders and emerging treatments? Read more in DermWorld.]
Topical JAK inhibitors, however, appeared relatively ineffective so far, with ruxolitinib and delgocitinib cream showing no significant difference in efficacy compared to the vehicle. The authors note that while JAK inhibitors appear to be the most promising new class of medications to treat AA, future studies are needed to examine the long-term efficacy and safety of these agents.
Dermatologists discuss the latest clinical guidance for managing hirsutism. Read more in DermWorld.
Antihistamines as adjunct therapy for alopecia areata – DermWorld Weekly (January 2023)
FDA approves first systemic treatment for alopecia areata – DermWorld Weekly (June 2022)
DermWorld Insights and Inquiries: A surgeon’s primary intention is to reduce secondary infection
available studies were small, assessed a limited number of wound locations, and did not directly compare the infection rate for sutured versus second intention wounds. To address these knowledge gaps, we conducted the largest published retrospective cohort study to examine the rate of postsurgical infections after skin cancer removal by Mohs micrographic surgery or wide local excision. Keep reading!
CDC investigating possibility of treatment-resistant dermatophytosis
Responding to multiple JAAD Case Reports articles indicating a growing problem, the CDC is investigating whether a pattern of treatment-resistant dermatophytosis is emerging.
The CDC asks dermatologists who see patients with tinea infections to complete its survey so it can assess the extent of this problem.
Gu et al reported what they believed to be the first U.S. case of treatment-resistant dermatophytosis in a 2020 JAAD Case Reports article. A response in 2022 suggested a second case had been identified. The literature indicates that treatment resistance has been seen in India and possibly elsewhere.
High-dose clobetasol propionate in patients with cutaneous lichen planus
A study published in The Journal of Dermatology assessed the efficacy of high-dose topical clobetasol propionate 0.05% in adults with diffuse cutaneous lichen planus affecting more than 10% of the body surface area. The median daily dose of clobetasol propionate was 20g/day with a median duration of three weeks. At week 16, 72% of patients achieved a complete response (BSA <5%), with nearly two-thirds of those patients experiencing remission within six weeks of treatment. Adverse effects were infrequent and included hypopigmentation and folliculitis.
[Got a tricky diagnosis? Try the AAD Clinical Community.]
The authors conclude that topical corticosteroids appear to be as effective as traditional systemic treatments (e.g., methotrexate and acitretin) for cutaneous lichen planus, with an improved side effect profile and without the need for laboratory monitoring.
Allergens in pediatric sunscreens
The authors of a study published in Dermatitis analyzed the top 50 pediatric sunscreens to evaluate sunscreen cost, marketing claims, ingredients, and allergens. They found that the products contained an average of 1.1 ingredients from the core contact allergen list. Sunscreens marketed as suitable for “sensitive skin” were more expensive ($8.90 vs. $3.50 per ounce) and less likely to contain allergens. Pediatric sunscreens with mineral-only UV blockers contained significantly fewer allergens than those containing chemical UV blockers (5.6%, n = 1 vs. 94.4%, n = 17).
What’s new in pediatric dermatology? Find out in DermWorld.
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