Authors of a systematic review and meta-analysis published in the Journal of Dermatological Treatment evaluated chemotherapeutic agents linked to inflammation-induced resolution of actinic keratosis (AK). Patients with AK treated with chemotherapeutic agents experienced a partial or complete inflammation regression rate of 96.4% — with taxanes, pemetrexed, and doxorubicin showing the most effectiveness.
[A review of calcipotriol plus 5-FU for AK. Read more DermWorld Weekly.]
Prior to chemotherapy, 74% of patients had AK. The patients were exposed to 21 different chemotherapeutic agents, and 58% received monotherapy. The overall median time from initiation of treatment to AK inflammation was 10 days. The median time to AK resolution was three weeks, which did not differ significantly between the medication subgroups. Inflamed AK partially regressed in half of patients and complete regression was seen in 46% of patients. The rate of regression was not higher for patients treated with multidrug combinations compared with those on monotherapy, and 93% of those on multidrug therapy were treated with one of five chemotherapeutic agents linked to AK inflammation resolution as monotherapy, including 5-FU, docetaxel, paclitaxel, pemetrexed, and doxorubicin.
What’s new in treating actinic keratosis? Find out in DermWorld.
DermWorld Insights and Inquiries: Palmar Pagetoid dyskeratosis — A sheep in wolf’s clothing
Furrows are fine, ridges are risky. I learned that phrase in a stellar lecture given by Jennifer A. Stein, MD, PhD, FAAD, discussing the use of dermoscopy for acral pigmented lesions. It has served me in good stead as I have reassured many patients that their acral nevi appear benign and have identified cases of acral lentiginous melanoma with greater confidence. A parallel ridge pattern on dermoscopy is highly sensitive and specific for acral lentiginous melanoma on the palms and soles, although it may be observed in other conditions including subcorneal hemorrhages, posttraumatic purpura, congenital nevi, blue nevi, lentigines, acral angiomas, verrucae, chemotherapy-induced hyperpigmentation, fixed drug eruptions, exogenous pigmentation, and ethnic pigmentation. Dermatologists should now also add palmar Pagetoid dyskeratosis (PPD) to this list, as there have been an increasing number of reports of this benign disorder. Keep reading!
A guide to transitioning to JAK inhibitors for AD patients
To reduce atopic dermatitis (AD) flares as patients transition to JAK inhibitors, authors of an article published in Dermatitis propose a tapering schedule with down titration of immunosuppressants or dupilumab. The oral JAK inhibitors approved for AD — abrocitinib and upadacitinib — typically demonstrate efficacy within two to three weeks, with most of the treatment effect seen by one month.
[FDA approves abrocitinib, upadacitinib for AD. Read more inDermWorld Weekly.]
For patients on bimonthly dupilumab injections, a final injection is sufficient while starting a JAK inhibitor. Immunosuppressants, including methotrexate, cyclosporine, and mycophenolate mofetil, should be tapered as the JAK inhibitor is started.
Improving recognition of dermatologic conditions in skin of color
A study published in Clinical and Experimental Dermatology assessed whether educational interventions improved recognition of common dermatologic conditions in patients with skin of color (SOC). Before the interventions, confidence in recognizing these conditions in patients with SOC was low.
Medical students and junior doctors (internal medicine and general practitioner trainees) in the UK scored significantly higher on objective assessment and a Likert scale measuring confidence in recognizing common dermatologic conditions after participating in education interventions. Following the first intervention — an interactive lecture — confidence in recognizing common conditions in SOC increased for both medical students and junior doctors by 2.5 and 1.8, respectively. The mean assessment score also increased in the medical student and junior doctor groups by 3.68 and 3.87, respectively. The most incorrectly answered question in the assessment was related to skin cancer in patients with skin of color.
A recent article published in the New England Journal of Medicine explores the associations and distinctions between physician burnout and depression. Awareness of physician burnout is at an all-time high, which has helped to reduce the stigma associated with burnout, wrote Srijan Sen, MD, PhD. Efforts to destigmatize burnout have often emphasized a strong distinction between burnout and depression — highlighting the idea that burnout is a result of a system-level problem and not an individual weakness. The assumption then becomes that depression is an individual-level problem that should be mitigated by individual-level interventions, he said.
[How to tackle the top 3 administrative burdens in dermatology. Read more inDermWorld.]
Dr. Sen argues that this framing is inconsistent with research and perpetuates the stigma associated with depression, which may deter physicians from fully utilizing the tools that treat depression. He points out that work-related stress is a primary driver of depression among physicians. “Overall, the relative importance of work-related factors and non–work-related factors is similar for depression and for burnout.”
Experts discuss how the conversation surrounding physician mental health has changed. Read more inDermWorld.
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