Treating keloids, hypertrophic scars with dupilumab
A case report published in the Journal of Drugs in Dermatology discusses the case of a 44-year-old woman who developed hypertrophic scars and keloids following a severe herpes zoster infection. Because of extensive scarring, the use of intralesional corticosteroid injections was not feasible. The patient started on systemic dupilumab therapy, which flattened and improved the texture of many scars. The largest keloid showed significant improvement with intralesional dupilumab injections every two weeks with even more dramatic improvement noted in two months. The authors concluded that dermatologists may want to consider treating keloids that cover a large area with systemic dupilumab. The most recalcitrant areas may further benefit from intralesional dupilumab.
Read about the latest advances in laser technology and learn how to navigate the research and acquisition process in this month’sDermWorld.
DermWorld Insights and Inquiries: Alaskapox — The beat goes on
I feel like Phil Connors (Bill Murray) from Groundhog Day caught in a time loop since 2020 — Biden-Trump, San Francisco 49ers-Kansas City Chiefs, mass shootings, COVID-19 variants du jour, and mPox spiking. Since it is a presidential election year, I will paraphrase Ronald Reagan — here we go again — introducing Alaskapox (AP). Please note that there is minimal peer-reviewed literature about AP and most references provided are from the Alaska Department of Health and the lay press. This situation will change in short order. According to Gigante et al., “Since the eradication of smallpox, there have been increases in poxvirus infections and the emergence of several novel poxviruses that can infect humans and domestic animals. In 2015, a novel poxvirus was isolated from a resident of Alaska. Keep reading!
Cosmetic dermatologic procedures performed by physicians vs. non-physicians
Survey results published in Dermatologic Surgery explore differences in the practice of cosmetic procedures between physicians and non-physicians. This survey involved 1,328 participants who reported having undergone cosmetic procedures. Of these procedures, 62% were performed by a physician, 31% by a non-physician, and 7% by an unknown provider. Laser hair removal, other laser and light treatments, chemical peels, and microdermabrasions were performed by non-physicians approximately one-third of the time. Despite a higher frequency (73.3% vs. 51.8%) of more moderate complications seen in procedures done by non-physician providers, over 70% of respondents indicated that they believe that non-physician providers are qualified enough to continue performing cosmetic procedures.
FDA approves first cellular therapy for advanced melanoma
The FDA has approved the cellular therapy lifileucel for the treatment of patients with previously treated unresectable or metastatic melanoma. Lifileucel, a cellular therapy with tumor-infiltrating lymphocytes, was approved through the accelerated approval pathway, and is the first FDA-approved tumor-derived T-cell immunotherapy, the FDA noted.
Approval was based on a global, multicohort phase II trial, which included adult patients with unresectable or metastatic melanoma who had previously been treated with at least one systemic therapy, including a PD-1-blocking antibody, and if positive for the BRAF V600 mutation, a BRAF inhibitor with or without a MEK inhibitor. Among the 73 patients treated with lifileucel at the recommended dose, 23 achieved an objective response, including three complete responses and 20 partial responses. Among patients who were responsive to the treatment, 56.5%, 47.8%, and 43.5% continued to maintain responses without tumor progression or death at six, nine, and 12 months, respectively.
The most common adverse reactions include chills, fever, fatigue, tachycardia, diarrhea, febrile neutropenia, edema, rash, hypotension, hair loss, infection, hypoxia, and shortness of breath. Lifileucel has a boxed warning for prolonged severe low blood count, severe infection, cardiac disorder, the development of worsening respiratory or renal function, and fatal treatment-related complications.
Experts discuss how personalized vaccines may reshape the future of cancer treatment. Read more.
A study published in JAMA Network Open sought to find out whether taking vacation days and working while on vacation was associated with physician burnout. Among 3,024 respondents, nearly 60% took 15 or fewer days of vacation in the last year, with 20% taking five or fewer days. The majority of respondents (70.4%) performed patient care–related tasks on vacation, with 33% working 30 minutes or more on a typical vacation day. Less than one-half of physicians (49%) reported having full EHR inbox coverage while on vacation.
Taking more than three weeks of vacation per year and having full EHR inbox coverage while on vacation were associated with lower rates of burnout, whereas spending 30 minutes or longer per vacation day on patient-related work was associated with higher rates of burnout. Full electronic health record inbox coverage was associated with lower rates of working while on vacation and with lower burnout.
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