Authors of a JAAD research letter assessed the tolerability, duration of treatment, and six-month clearance rate of combination 5-FU and imiquimod. Patients enrolled in the study had at least seven clinically visible and/or palpable actinic keratoses (AKs) located within a defined field. Patients applied a thin layer of 5-FU 5% and imiquimod 5% creams across the field at bedtime. After 1 week, the researchers assessed for a brisk reaction, defined as at least 80% of reactive areas in the field displaying erosion/crusting on an erythematous base. Treatment ended if a brisk reaction occurred; otherwise, they continued therapy until it did. Seventeen patients (32 fields) completed the study.
[What’s new in treating actinic keratosis? Read more.]
The mean number of initial visible and/or palpable AKs per field was 15.1. Less than 5% of the overall AKs were hypertrophic. The average duration of therapy was 11 days. The average follow-up was 7 months. A brisk reaction was achieved in 30 of 32 fields (93.8%). The mean clearance rate was 90.3%. The authors concluded that combination therapy with topical 5-FU and imiquimod creams is well tolerated, may shorten the duration of therapy, and is at least as effective, and possibly more effective, when compared to monotherapy with either treatment.
DermWorld Insights and Inquiries: San Diego AAD musings
What an outstanding meeting! The weather was perfect (compared to a prior San Diego AAD meeting hampered by biblical deluges), and the atmosphere civil, convivial, and (hallelujah) mask-free. We are truly blessed to be dermatologists. This point was punctuated by our new AAD President, Seemal Desai, who delivered a heartfelt, passionate address focusing on service and unity in our vital specialty. We are in able, dedicated, visionary hands. We are on the cusp of tremendous technological changes that will alter our practices. I am optimistic about the future of dermatology because of the commitment and energy of our colleagues who strive for excellence. I look forward to the AAD Innovation Academy this August in Seattle where I have the honor of delivering the Everett C Fox, MD Memorial Lecture, where I will focus on permanencies amidst innovation. I hope to see you there! Keep reading!
Talking points: Benzene found in acne care products
The Academy has developed key messages for dermatologists regarding the Valisure report that found the chemical benzene in acne products containing benzoyl peroxide.Read the key messages.
Safety of dermatologic medications in pregnancy
A CME article published in JAAD reviewed the safety of dermatologic therapies during pregnancy. In general, it is safe to continue biologics during the first trimester. If biologics are continued during the second and third trimesters, live attenuated vaccines should be avoided in infants for the first six to 12 months of life. Certolizumab is the safest biologic to continue throughout pregnancy due to minimal placental transfer.
Intermittent topical mild-moderate potency corticosteroids, calcineurin inhibitors, and salicylic acid are permitted during pregnancy. Tapinarof, PDE-4, JAK, and TYK2 inhibitors should be avoided due to limited safety data while methotrexate and acitretin are contraindicated during pregnancy. Narrowband and broadband UVB phototherapy are permissible during pregnancy; however, PUVA phototherapy should be avoided.
The other medications reviewed include immunosuppressants, antipruritics, anesthetics, antibiotics, antifungals, antivirals, and antiparasitics as well as cosmetic, alopecia, psoriasis, eczema, acne, and rosacea treatments.
Itraconazole vs. itraconazole and luliconazole for dermatophytosis
A study published in Mycoses evaluated the efficacy of oral itraconazole alone or in combination with topical luliconazole. Patients with disseminated dermatophytosis who were treated with oral itraconazole alone or in combination with topical luliconazole 1% had similar clinical and mycologic responses.
[What do you need to know about emerging, antifungal medication-resistant dermatophyte infections? Read more.]
Investigators conducted a randomized, open-label, double-arm, parallel study at a tertiary care hospital in India. Eligible patients were adults with clinically diagnosed dermatophytosis of nonglabrous skin involving more than 5% body surface area. All patients received a six-week systemic regimen of oral itraconazole 100 mg twice daily plus luliconazole 5 mg twice daily. Patients were randomly assigned to receive the systemic regimen plus either topical bland emollient or twice daily topical luliconazole 1% cream for six weeks.
The primary endpoint was complete clinical and mycologic cure at the end of the active treatment period at week six. The researchers concluded that the addition of topical luliconazole with oral itraconazole has no advantage in terms of cure rate at the end of the six-week active treatment period.
Dermatologist nail experts discuss the diagnosis and management of onychomycosis as well as increasing resistance to anti-fungal therapies. Read more.
CMS announces reopening of the 2023 MIPS EUC application in response to Change Healthcare cyberattack: Now open until April 15.
In response to the Change Healthcare cyberattack in late February, CMS extended the data submission deadline and is now reopening the 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception application to provide relief to MIPS-eligible clinicians impacted by this cybersecurity incident. CMS will only be accepting EUC applications for eligible clinicians who have been impacted by the cyberattack; any applications submitted for reasons outside of the Change Healthcare cyberattack will be denied. Additionally, any data submitted to CMS will override your application for those performance categories.
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