Intralesional HPV vaccine may clear recalcitrant warts
Authors of a JAAD research letter compared the efficacy and tolerability of intralesional quadrivalent HPV vaccine versus intralesional bivalent HPV vaccine for the treatment of multiple recalcitrant warts. While both HPV vaccines are promising treatments for recalcitrant warts, according to the study’s authors, the quadrivalent option shows a significant statistical superiority.
[Remedies for warts abound, but high-quality studies are lacking. Read more.]
In the randomized controlled trial, 50 patients with multiple recalcitrant warts were assigned to receive intralesional 0.1 mg doses of either quadrivalent HPV vaccine, bivalent vaccine, or saline control into their largest wart every two weeks until complete clearance or five sessions. Of the 20 patients in the quadrivalent vaccine group, complete clearance was seen in 18 (90%), whereas six of the 20 patients (30%) in the bivalent group achieved this goal. None of the patients in the saline control group experienced complete clearance. The researchers noted that adverse events were mild and tolerable.
DermWorld Insights and Inquiries: Cycling back to doxycycline’s roots as therapy for bullous pemphigoid
The concept of antibiotics (usually doxycycline or minocycline) as anti-inflammatory agents was novel in the 1980s and has become a standard first-line treatment for bullous pemphigoid (BP), aside from corticosteroids (ultrapotent topical or systemic). Treating BP requires a thorough medical knowledge of the patient and their comorbidities — tailoring therapy to include second-line agents (azathioprine, mycophenolate mofetil, dapsone, or methotrexate) or third-line therapies (IVIG, rituximab, omalizumab, dupilumab, and others) must be individualized to the patient’s overall health. This commentary will focus on the use of doxycycline for BP. Can its efficacy be solely due to its anti-inflammatory effect? Keep reading!
FDA approves first molluscum contagiosum treatment
The FDA has approved a cantharidin topical solution (Ycanth) for the treatment of molluscum contagiosum in adults and children aged two years and above. This is the first approved treatment for the disease in the United States.
The treatment showed efficacy in two late-stage studies with about half of patients on the treatment achieving complete clearance of all treatable molluscum lesions over 12 weeks, which was much higher than the placebo group. The company will also be testing the cantharidin topical solution for common warts and external genital warts in ongoing late-stage trials. According to the drug company, the treatment should be commercially available by September 2023.
Does remission for psoriasis patients mean they can discontinue biologics?
A research letter published in JAAD investigated disease markers during the first two years following cessation of biologics due to remission. The authors found that of 3,844 psoriasis patients who discontinued biologics 1% did so owing to disease remission.
[AAD launches innovative project to improve outcomes for patients with generalized pustular psoriasis. Read more.]
Overall, two years following the treatment cessation, 43% remained in remission or were treated with topical therapy only. Of the 18 patients who restarted biologic therapy, most restarted with the same treatment with a good treatment effect noted after reinitiation. The authors note that their results suggest that some patients, especially those who achieve complete skin clearance, can discontinue biologic treatment and still maintain long-term disease control.
According to a recent article published in The New York Times, Pfizer announced a shortage of Bicillin L-A (penicillin G benzathine). Infectious disease experts have warned that the protracted scarcity of the drug could worsen the rising rate of syphilis infections as well as the drug’s recent use as an alternative to amoxicillin for more general infections. Syphilis has been on the rise in the U.S since 2000, with cases increasing nearly 75% from 2017 to 2021, according to the CDC.
[Dermatologists discuss interview techniques for taking a sexual history and screening for sexually transmitted infections. Read more in DermWorld.]
During that same four-year period, congenital syphilis tripled. Bicillin is the only recommended treatment for pregnant women who are infected, as it is very effective at preventing transmission to the fetus if provided early enough. Alternatives to Bicillin for pregnant women are under development but are years away from being available. A spokesperson for Pfizer said it would likely take about a year for the company to increase production by 50% and manufacture enough of the drug to meet demand and shore up reserves.
After a resurgence of syphilis, dermatologists find themselves as syphilologists...once again. Read more in DermWorld.
The AADA seeks information following tornado damage to Pfizer plant; FDA assessing drug supply
The AADA recently contacted Pfizer following a tornado causing significant damage to their Rocky Mount, North Carolina plant that manufactures sterile injections. The AADA shared its concern for Pfizer employees and relief that no serious injuries were reported. The AADA requested information about the impact the damage will have on its lidocaine supply and efforts to mitigate potential disruptions in the supply chain. The AADA also contacted Fresenius Kabi, the other major manufacturer of lidocaine in the United States, for a status update on their lidocaine supply.
While the AADA awaits a response, both manufacturers released public statements. Pfizer’s initial assessment shows that damage was to its warehouse facility and not to medicine production areas. Fresenius Kabi shared that they activated their emergency response team to help prevent and mitigate possible disruptions. The FDA released a statement that it is conducting an extensive assessment of the products that are impacted and their current availability.
This is a developing story, and the AADA will provide updates. In the meantime, members are encouraged to visit Pfizer and Fresenius Kabi product availability sites.
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