Facial hyperhidrosis: Botulinum toxin A injection vs. topical glycopyrrolate
A Dermatologic Surgery study evaluated the clinical efficacy, safety, and tolerability of topical 2% glycopyrrolate versus intradermal Botulinum toxin A injection in the treatment of facial hyperhidrosis. In an open-label clinical trial, 24 patients with facial hyperhidrosis were treated with either 2% glycopyrrolate or intradermal Botulinum toxin A injection.
[Entering a golden age of toxins. Read more in DermWorld.]
In the Botulinum toxin group, all patients showed a complete or partial response at two weeks, which was sustained at three months and lost by six months. In the glycopyrrolate group, 75% of patients had a complete response and only one patient did not respond. For most patients, the effect was lost on the third day after stopping treatment. Both topical glycopyrrolate and intradermal Botulinum toxin A injection are effective in the treatment of facial hyperhidrosis. Glycopyrrolate has a faster onset of action but requires continuous treatment, while Botulinum has a slower onset of action but longer duration of action.
DermWorld Insights and Inquiries: JAKne is on the horizon
If you are like me, you have read much more about JAK inhibitors (JAKi) than have prescribed them. We are all on a learning curve. The rapid introduction of topical ruxolitinib (Opzelura), oral upadacitinib (Rinvoq), and abrocitinib (Cibinqo) for atopic dermatitis (AD), followed by last month’s approval of baracitinib (Olumiant) for alopecia areata (AA) and last week’s approval of ruxolitinib for vitiligo, has been stunning.
In reading studies, I have been intrigued by acne as an adverse event. Given the ever-expanding list of inflammatory disorders touting the benefit of JAKi (vitiligo, psoriasis, lupus, others), I assumed that acne would benefit from JAKi as well. Perhaps in some circumstances, it might. There is relatively little literature devoted to this topic. Keep reading!
Dupilumab for chronic prurigo, chronic idiopathic pruritus
A systemic literature review published in the Journal of European Academy of Dermatology and Venereology, analyzed the results of 25 studies including patients with chronic prurigo or chronic idiopathic pruritus to gauge the effectiveness of dupilumab. When used at standard dosages, dupilumab was associated with improvement in pruritus in 89% and 100% of patients with chronic prurigo and chronic idiopathic pruritus, respectively. Ninety patients out of 109 (83%) noticed improvement in pruritus before four weeks of dupilumab therapy.
[Read the about latest understanding and treatments for chronic itch in DermWorld.]
At the end of treatment, 14% of patients had complete remission of pruritus. The authors note that patients who showed improvement before four weeks of treatment led to significantly greater final itch reduction.
Safety of Q-switched alexandrite laser in darker skin
Authors of a retrospective JAAD study performed an analysis of adults who received at least one treatment with a 755-nm Q-switched alexandrite laser to determine the frequency of adverse events in patients with Fitzpatrick skin types I-VI.
[Pulsed dye laser versus ablative fractional CO₂ laser for hypertrophic scars. Read more in DermWorld Weekly.]
A total of 239 755-nm QSAL treatments were included in the analysis, 19% of which had short-term (two weeks or less) or long-term complications (more than two weeks). The most frequent complications were crusting (45.7%), swelling (10.9%), and hyperpigmentation (10.9%). Reported adverse events were in excess of the expected normal wound healing process. The long-term adverse events included hyperpigmentation (10.9%) and hypopigmentation (2.2%). Complications were disproportionately observed with skin type IV (34.4%; FST IV vs. other FST: odds ratio 2.59). Patients treated with higher pulse counts were also found to have increased risk of side effects.
Dermatologist experts discuss the latest advances in laser technology and offer tips on how to navigate the research and acquisition process in DermWorld.
According to a recent study published in the American Journal of Clinical Dermatology, the gel formulation of chlormethine may be safer and more effective than the ointment for the treatment of mycosis fungoides.
A comparison between patients who only used chlormethine gel and those who switched from the ointment to the gel was made for time to response. Results showed no association between frequency of treatment and skin response, although researchers did observe an association between contact dermatitis and improvement in lesion severity. The post-hoc analysis showed that patients who initiated treatment using the gel had faster and higher responses compared with patients who initially used the ointment for 12 months.
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