Real-world methotrexate use in pediatric patients with plaque psoriasis
In a prospective study published in Acta Dermato-Venereologica, researchers evaluated the effectiveness of methotrexate, including adverse events and the impact of folic acid on GI events on 105 pediatric patients with plaque psoriasis. Most patients had persistent adverse events such as GI upset, fatigue, increased transaminase levels, and flu-like symptoms. Nearly 40% experienced a persistent GI adverse event, and nearly one in four patients discontinued methotrexate due to intolerance. Despite the high rate of adverse events, only one event was serious (a case of pneumonia).
[Experts break down emerging treatment options for psoriasis and what they can offer patients and physicians inDermWorld.]
Efficacy of the treatment improved until week 24, with a PASI 75 rate of 29%. At week 24 and 48, an absolute PASI ≤ 2.0 was achieved by approximately one-third of all patients. Patients taking folic acid six times per week experienced fewer GI side effects than those taking folic acid once weekly (31.8% vs. 41.7%), although these results are not statistically significant. Because methotrexate is associated with numerous adverse events, physicians should consider switching to biologics early if a persistent adverse event develops.
DermWorld Insights and Inquiries: The ever-changing world of nevus sebaceus
The aphorism in medical education that half of what you learn in medical school will prove to be wrong could use the nevus sebaceus (sebaceous) of Jadassohn as its poster child. First described by Jadassohn in 1895, nevus sebaceus (NS) is a common lesion, affecting 0.3% of newborns. It is a benign congenital hamartoma related to abnormalities of the epidermis, sebaceous glands, sweat glands, and hair follicles. Lesions characteristically present at birth as a well-demarcated hairless, yellowish patch or plaque. NS become more prominent during puberty, reflecting sebaceous growth, often becoming verrucous. NS appear mostly on the scalp and the face. Secondary neoplasms — mostly benign and occasionally malignant — can develop within NS, usually in adulthood. Keep reading!
New anti-wrinkle injection receives FDA approval
Last week, the FDA approved daxibotulinumtoxinA-Lanm (Daxxify) for the temporary improvement of moderate to severe glabellar lines in adults for about six months. The approved label includes 36-week efficacy data from the phase 3 SAKURA clinical trials, which included more than 2,700 patients and approximately 4,200 treatments. The neuromodulator is stabilized with Peptide Exchange Technology™ and is free of both human serum albumin and animal-based components.
DaxibotulinumtoxinA-Lanm is generally safe and well tolerated with no serious treatment-related adverse events reported in the clinical trials and has a safety profile consistent with other currently available neuromodulators in the aesthetics market. The most common treatment-related adverse events observed in trials were headache (6%) followed by eyelid ptosis (2%) and facial paresis, including facial asymmetry (1%).
Last week, the FDA approved deucravacitinib (SOTYKTU), an oral, selective allosteric tyrosine kinase 2 (TYK2) inhibitor with a unique mechanism of action for the treatment of adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Deucravacitinib is the first and only TYK2 inhibitor approved worldwide. The drug is not recommended for use in combination with other potent immunosuppressants.
The phase 3 POETYK PSO clinical trials demonstrated efficacy of the once-daily drug over placebo and twice-daily apremilast in improving skin clearance. Efficacy of deucravacitinib compared to placebo and apremilast was demonstrated at both 16 and 24 weeks, with responses that persisted through 52 weeks.
The most common adverse reaction in the trials were upper respiratory infections (19.2%), blood creatine phosphokinase increase (2.7%), herpes simplex (2.0%), mouth ulcers (1.9%), folliculitis (1.7%), and acne (1.4%).
In a systematic review published in The Journal of Dermatology, 21 articles analyzed hair loss after COVID-19 infection. The most commonly reported hair loss was telogen effluvium (TE), which was observed about two months after infection. Five articles reported alopecia areata after COVID-19 infection, including new onset and rapid progression of preexisting alopecia areata. A total of 11 articles focusing on TE treatment found that oral and topical minoxidil had the highest efficacy in treating this condition.
What have we learned about cutaneous manifestations of COVID-19 and the vaccines? Find out inDermWorld.
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