Authors of a JAAD research letter reviewed post-market reports of both alopecia development and improvements in patients taking dupilumab. Of the published reports, there are currently five cases of hair loss and four cases of hair regrowth with dupilumab. All of those who developed alopecia areata (AA) with dupilumab were young men with a history of atopic dermatitis (AD) and no other medical comorbidities. Two of the patients had a later onset and shorter duration of AD (three and seven years, respectively), while one patient reported AD since childhood. Three patients had scalp biopsy that showed AA, AA/spongiotic dermatitis, or drug-induced alopecia.
In comparison, most patients who regrew hair with dupilumab were female and had a history of severe AD from infancy or childhood in addition to other atopic comorbidities such as asthma and food allergies. All patients had recalcitrant, treatment-resistant alopecia totalis or alopecia universalis and experienced almost complete hair regrowth after taking dupilumab for an average of 8.8 months. According to the authors, dupilumab can seemingly both cause and cure AA in patients with concomitant AD, which they hypothesize may be explained by Th2 skewing.
Authors investigated the efficacy and safety of abrocitinib in AD patients after switching from dupilumab. Read more in DermWorld Weekly.
DermWorld Insights and Inquiries: Taking it on the shin — Part one
I am intentionally skeptical of medical literature that purports “new” entities. Are they novel and distinct or just minor variations of long-recognized dermatoses? This two-part commentary will focus on two disorders that involve the pretibial region — pretibial pruritic papular dermatitis (PPPD) and obesity-associated lymphedematous mucinosis (OALM). I have come to believe in both. You have likely encountered these conditions but may not have realized it. Scenario 1: A 60-year-old healthy woman complains of constant pruritus of her shins. Your examination demonstrates somewhat cobblestone pink-red papules within a plaque. Your initial impressions are lichen amyloidosis, lichen simplex chronicus, prurigo nodularis, lichen planus, or contact dermatitis (irritant or allergic). Keep reading!
A simplified dermoscopic algorithm for melanoma diagnosis
Authors of a retrospective study in the International Journal of Dermatology aimed to develop a new dermoscopy algorithm for the diagnosis of melanoma. Four blinded dermatologists examined 1,120 digital microscopy images of atypical melanocytic lesions with histologic confirmation. An algorithm based on polychromia, asymmetry in colors or structures, and some melanoma-specific structures was designed (PASS). Most melanomas had three or more colors (84.5%), asymmetry in colors or structures (90.3%), and at least one melanoma-specific structure (98.7%). The authors suggest that PASS be considered as an alternative to current melanoma dermoscopy algorithms as it may be simpler to use and more efficient in daily practice.
The FDA recently approved retifanlimab-dlwr for the treatment of adult patients with metastatic or recurrent locally advanced Merkel cell carcinoma (MCC). This indication is approved under accelerated approval based on tumor response rate and duration of response. The approved recommended dosage is 500 mg as an IV infusion over 30 minutes every four weeks.
Efficacy of retifanlimab was evaluated in an open-label, multiregional, single-arm study in 65 patients with metastatic or recurrent locally advanced MCC who had not received prior systemic therapy for their advanced disease. The most common adverse reactions include fatigue, musculoskeletal pain, pruritus, diarrhea, rash, pyrexia, and nausea.
Is metformin effective for dermatologic conditions?
Authors of a systematic review published in Clinical and Experimental Dermatology studied the latest evidence on the use of metformin for the treatment of dermatologic diseases. They found that while there is some evidence to support metformin as an adjunctive treatment for polycystic ovarian syndrome and acne, the evidence is mixed and more studies are needed for other dermatologic diseases, including hidradenitis suppurativa, acanthosis nigricans, and psoriasis, among others. While metformin is an off-label option for various conditions, the authors find a lack of evidence to support its use in most dermatologic conditions.
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