Consensus statements for the treatment of vitiligo in younger patients
Authors of an article in JAMA Dermatology developed evidence- and consensus-based expert recommendations on the diagnosis and treatment of vitiligo in pediatric, adolescent, and young adult patients. Forty-two recommendations were made on the diagnosis of vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream — used off-label for patients younger than 12 years and limited to nonsegmental vitiligo — were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients, with specific guidance on age-based data, minimum therapeutic trial of six months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources.
The authors conclude that evidence supports the use of topical calcineurin inhibitors, topical corticosteroids, and topical Janus kinase inhibitors as effective therapeutics for vitiligo in pediatric, adolescent, and young adult patients, with specific decisions on choice of agent based on factors such as site location, body surface area, and age.
Recent advances in vitiligo treatment and research open doors for physicians and patients. Read more in DermWorld.
DermWorld Insights and Inquiries: Eyebrow-raising complications of microblading
One of the most significant challenges of being a medical dermatologist is that patients assume you are well-versed in all aspects of dermatology, including cosmetic procedures. It is a reasonable expectation that dermatologists have at least a rudimentary knowledge of cosmetic procedures and their risks, even if not performing them. Recently, I have been asked for my opinion about the microblading technique for tattooing hairstrokes that simulate natural hair, used chiefly for eyebrows. Knowing nothing about this technique served as the impetus for this commentary with the sole purpose of not offering a blank stare to future patients who inquire about it. Keep reading!
Role of low-dose oral minoxidil for treatment of alopecia areata
Authors of a JAAD study addressed the current clinical evidence in low-dose oral minoxidil’s (LDOM) role in the treatment of alopecia areata (AA). Eleven studies met eligibility criteria. Of the published articles, LDOM has been studied as monotherapy or adjunctive treatment on 363 AA patients. Treatment duration ranged between four and 20 months. The daily dose ranged from 0.03 mg/day to 15 mg/day. LDOM was administered with a JAK inhibitor in five studies and with oral dexamethasone in one study. One study concluded that a combination of LDOM with a JAK inhibitor may be more effective than JAK inhibitor monotherapy.
The authors conclude that “LDOM may offer favorable effects in AA, including immunomodulation, anagen induction, accelerated linear hair growth, and reversal of incidental androgenetic alopecia.” Treatment of AA with LDOM should be tailored on an individual basis, as prospective randomized studies are needed to assess the efficacy and optimal dosing, either alone or combined with approved agents.
FTC votes to ban noncompete agreements for most workers
In a 3-2 vote, last week the Federal Trade Commission (FTC) banned noncompete agreements for most U.S. workers, noting that the agreements suppress wages and stifle entrepreneurship. In the final rule, the Commission determined that “it is an unfair method of competition, and therefore a violation of Section 5 of the FTC Act, for employers to enter into noncompetes with workers and to enforce certain noncompetes.” This new rule makes it illegal for employers to include the agreements in employment contracts and requires companies with active noncompete agreements to inform workers that they are void. These changes, however, may not take effect for years as the rule is expected to be tied up in litigation.
[Read more about the physician view of employment agreements inDermWorld.
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The noncompete ban does not apply to nonprofit companies, as the FTC determined it only has jurisdiction over for-profit companies. The ban likely won’t apply to most of the country’s hospitals and some of the country’s biggest health insurers.
Updated Academy resources, including a DermWorld article that dives into the details of this final rule, are coming soon.
Is acitretin effective for skin cancer prevention?
A study published in JAAD assessed the effectiveness of acitretin for skin cancer prevention in immunosuppressed and immunocompetent patients. The study included 34 adults (20 immunocompetent and 14 immunosuppressed) with two or more cutaneous squamous cell carcinomas (cSCCs) who underwent at least three months of acitretin therapy.
There was a 68% decrease in the rate of invasive cSCC during acitretin therapy compared with the year prior to acitretin therapy. Recipients of solid organ transplantation and immunocompetent patients experienced a comparable reduction in the rate of invasive cSCC; however, those with other forms of immunosuppression had no significant change in the rate of invasive cSCC. There was no change in the rate of basal cell carcinoma or SCC in situ. The authors found that acitretin therapy may lead to a reduction in the rate of invasive cSCC among immunocompetent patients and recipients of solid organ transplantation.
DermWorld highlights some of the common (and not-so-common) skin complications associated with ICIs, and shares expert tips for management. Read more.
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