Isotretinoin: Risk of irritable bowel syndrome, ulcerative colitis, and Crohn’s disease
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Authors of a global, population-based retrospective cohort study published in JAAD evaluated the outcomes of acne patients undergoing treatment with isotretinoin versus those undergoing treatment with oral antibiotics.
The study authors found a marginal increase in the risk of a diagnosis of ulcerative colitis (UC) during the first six months of isotretinoin treatment (five additional UC cases/10,000 patients starting isotretinoin). This increased risk disappeared after six months, when there was no longer a difference between the two groups. There was no increase in the risk of diagnosis of Crohn’s disease. Additionally, the results showed a statistically significant decrease in irritable bowel syndrome in participants treated with isotretinoin compared with those treated with oral antibiotics.
DermWorld Insights and Inquiries: Seeing red with dupilumab
Since its release in 2017, dupilumab (a fully humanized monoclonal antibody that blocks IL-4 and IL-13) has transformed the therapeutic landscape for managing atopic dermatitis (AD) and other eczematous disorders, bullous pemphigoid, Kimura disease, etc., when used off-label. Increasingly, practitioners have observed erythematous eruptions, usually on the head and neck, attributed to the use of dupilumab. Since the initial report of facial dermatitis attributed to dupilumab, this adverse reaction has been reported by several names (dupilumab facial redness, persistent facial dermatitis, paradoxical head and neck erythema, others) — I will use the term dupilumab-associated erythema (DAE) in this commentary because it encompasses all presentations. DAE has been reported to occur in up to 10% of patients on dupilumab. Dermatologists must determine if the condition is due to a flare of underlying atopic dermatitis, the unmasking of a contact dermatitis, if Malassezia furfur is contributing to the erythema, rule out the possibility of alcohol-induced flushing, and consider if Demodex is contributory. Keep reading!
IL-17 inhibitors in psoriasis patients in the real world
Authors of an observational cohort study published in the Journal of the European Academy of Dermatology and Venereology investigated the efficacy of interleukin-17 inhibitors (IL-17i) for the treatment of psoriasis in a real-world setting. A total of 111 patients were included in the study, accounting for 134 IL-17i courses using secukinumab, ixekizumab, and brodalumab. Just over half of patients had never received a biologic before receiving the IL17i. During maintenance, 97% and 77% achieved near-complete and complete skin clearance, respectively.
[Selecting the right biologic treatment for psoriasis patients. Read more in DermWorld Weekly.]
The reasons for treatment modification included suboptimal response (63%), and safety issues (9.3%). Reported modifications were switching (25.4%), dose escalation (11.9%) and dose de-escalation (6.7%), treatment association (6%), and stopping the IL-17i (3%). Overall drug survival was 69 months, without difference between the IL-17 biologics. Ixekizumab tended to have the highest survival and least frequent treatment modifications. The authors conclude that IL-17i are effective drugs for treating psoriasis, with ixekizumab as a leading biologic.
What’s new in the management of cutaneous HPV infection?
In an article published in The Journal of Dermatology, the authors reviewed new HPV detection methods, subtypes of epidermodysplasia verruciformis (EV), how to differentiate EV from generalized verrucosis, the carcinogenesis pathway of HPV, and the various skin tumors associated with HPV. The high-risk mucosal HPV types were identified in most nail squamous cell carcinoma (SCC) or Bowen’s disease cases.
[Read about the new CDC treatment guidelines for STIs inDermWorld.]
In addition to viral carcinogenesis, it has been pointed out that β-HPV is also involved in the pathogenesis of many SCCs. Although mucosal high-risk HPV has not been implicated in many skin cancers, its characteristic infection sites, such as the fingers and vulva, have been identified, and it should be considered a sexually transmitted disease among HPV-related internal cancers, the authors suggest. Among β-HPVs, HPV types 5 and 8 in EV patients have been identified as carcinogenic (Group 2B) by the International Agency for Research on Cancer. β-HPV infection has been identified in non-melanoma skin cancer in EV.
[Dermatologists discuss interview techniques for taking a sexual history and screening for STIs inDermWorld.]
Bowen’s disease of the nail apparatus is known to be caused by mucosal high-risk HPV infection. The author reported that mucosal high-risk HPV type 56 is detected in Bowen’s disease of the nail, especially in the type that presents with longitudinal melanonychia. In Bowen’s disease, HPV16 accounted for about half of the cases, and 20 other mucosal high-risk types were also detected. Research on the pathogenesis of Bowen’s disease of the nail can be advanced based on the results of studies concerning mucosal high-risk HPV-related visceral cancers, such as cervical and oropharyngeal cancers, according to the authors of the review.
MIPS data submission open, exception deadline approaching
CMS has opened the data submission period for Merit-based Incentive Payment System (MIPS)-eligible clinicians who participated in the 2022 performance year of the Quality Payment Program (QPP). Data can be submitted and updated until 8 p.m. ET on March 31, 2023.
Please note that the Academy’s DataDerm™ submission deadline for 2022 reporting is Wednesday, March 29, 2023.
As a reminder, CMS has extended the MIPS 2022 EUC Exception application deadline for individuals, groups, virtual groups, and APM Entities citing COVID-19 as the triggering event only through 8 p.m. ET on Friday, March 3, 2023.
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