Authors of a JAAD research letter investigated recurrence rates of actinic keratoses (AK) after at least 12 months. Nine randomized controlled trials reported participant-specific recurrence rates. Cryotherapy and photodynamic therapy with 5-aminolevulinate showed the lowest recurrence rates of 39%. They were followed by placebo (44%), photodynamic therapy with methyl-aminolevulinate (45%), and imiquimod 5% (45%). The highest participant-specific recurrence rates were observed for diclofenac (85%), followed by ablative laser treatment (54%), and 5-fluorouracil 5% (52%).
[Dermatologists talk about AK treatments in the context of cost to the patient, insurers, and the health care system. Read more in DermWorld.]
Data on lesion-specific recurrence rates were available from four RCTs. They were lowest for placebo (15%) followed by photodynamic therapy with 5-aminolevulinate (20%), and photodynamic therapy with methyl-aminolevulinate (34%). The authors note that long-term AK recurrence rates were surprisingly high, even after the initial clearance of lesions.
DermWorld Insights and Inquiries: Isotretinoin and diabetes — Of familiarity and surprise
On a gloriously sparkling, warm spring afternoon in 2009 I sat with my family in the right field bleachers of the new Yankee Stadium as the Bronx Bombers took on the Phillies. I relished the expansive majesty designed to recreate the glory of the original house that Ruth built. My late father-in-law owned the former G&R Bakery, just footsteps away. Baseball luminaries such as Yogi Berra, Mickey Mantle, and Whitey Ford would frequent the shop for bread and pastries. Naturally, my wife’s family were rabid Yankee fans.
My wife leaned over and whispered, “How does this compare to the original Yankee Stadium?”
“What are you talking about? Haven’t you been to a Yankees game before?” I asked incredulously.
“No” she responded sheepishly.
“How on earth is that possible? The bakery was across the street, your family lived here when you were little, and you love the Yankees!”
“It never happened, okay?”
(Answering the original question, I thought the architects did a splendid job recreating the ambiance of the erstwhile stadium while providing the expected modern amenities.)
Since 1982, I have been married to my wife and isotretinoin. Before its availability, only limited options were available for treating severely inflammatory acne, such as dapsone. I am astounded that after approximately 15,000 days there is something new to learn about each. Keep reading!
What physicians should know about monkeypox
A recent article published in JAMAexplores what clinicians need to know about monkeypox in 2022. As of June 9, more than 1,350 laboratory-confirmed cases of monkeypox have been reported from 31 nonendemic countries, and the CDC had reported 45 cases across 15 states and the District of Columbia.
Monkeypox has a wide incubation period ranging from five days to three weeks. Patients typically present with fever, chills, fatigue, headache, muscle aches, sore throat, lymphadenopathy, and skin lesions. The skin lesions evolve from macules and papules to vesicles and pustules that ulcerate and crust before healing over several weeks. The skin lesions usually occur in crops. The initial lesions are usually at the site of inoculation, which may explain why in the current outbreak, lesions have been located on or near the genitalia or anus. Most often, monkeypox infection is self-limited, usually lasting two to four weeks.
The differential diagnosis of monkeypox includes other poxviruses and herpesviruses, including chickenpox. The clinical diagnosis of monkeypox must be confirmed using laboratory methods, which are currently only available at state public health departments, where screening polymerase chain reaction is performed, and positive cases are sent to the CDC for specific clade confirmation. Read more about pathology, diagnosis, prevention, and treatment of monkeypox.
Anti-PD-1 therapy for melanoma patients after achieving a complete response
In a study published in theBritish Journal of Dermatology, the authors performed a retrospective analysis of patients with advanced melanoma who achieved a complete response with anti-PD-1 monotherapy. They found no significant difference in disease-free survival rates between patients who continued the therapy and those who discontinued the therapy after at least six months. However, patients with a complete response who received less than six months of anti-PD-1 monotherapy had a significantly higher risk of relapse than patients receiving at least six months of therapy. The authors found that there may be clinical benefit associated with the duration of anti-PD-1 monotherapy beyond six months in patients with advanced melanoma with a complete response.
Immune checkpoint inhibitors offer hope for non-melanoma skin cancer patients. Read more inDermWorld.
Asymptomatic dermatologic surgery patients who test positive for COVID-19
Authors of a JAAD research letter performed a retrospective chart review assessing patients scheduled for dermatologic surgery involving the head and/or neck from June 1, 2020, to March 1, 2022. Three days before planned procedures, reverse transcription-polymerase chain reaction testing was performed. Of 1,118 patients, 1.7% tested positive for COVID-19. Fourteen were confirmed as asymptomatic (1.3%). The authors note that data from these types of studies could inform periprocedural protocols that balance the safety of staff and patients.
What do dermatologists need to know about COVID-era practice regulations — and how have they adapted? Read more inDermWorld.
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
