Is red light PDT with ALA effective for the treatment of BCC?
Authors of a JAAD study determined the efficacy and safety of red light photodynamic therapy (PDT) with 10% aminolevulinic acid (ALA) for the treatment of superficial basal cell carcinoma (BCC). The randomized, double-blind vehicle-controlled phase 3 study treated participants with ≥1 naïve superficial BCC with one or two PDT cycles (two PDTs each cycle) followed by clinical and histological assessment 12 weeks after start of the last PDT cycle.
[Red and green LED light therapy in individuals with androgenetic alopecia. Read more.]
The investigators found that those receiving 10% ALA gel had a 76% histological clearance rate and an 83% clinical clearance rate compared with 19% and 21%, respectively, in those receiving vehicle. After the last PDT cycle, 82% of participants treated with ALA gel and 21% of those treated with vehicle achieved complete clinical clearance. Complete clinical and histological clearance was observed in 64% of the ALA gel group versus 4.8% in the vehicle group. There were no previously unknown adverse events reported.
The researchers concluded that red light PDT with 10% ALA gel achieved statistically significantly higher clearance rates than vehicle. They found that it is a highly suitable alternative — or potential adjunctive therapy — to surgical excision for the treatment of superficial BCC, especially for multiple or large lesions, in low-risk areas, or where patients oppose surgery.
DermWorld Insights and Inquiries: The 21st Century Cures Act — What a difference a day makes
The 21st Century Cures Act (CA) was signed into law on Dec. 13, 2016. In April 2021, the Information Blocking Rule (IBR) of the CA went into effect, giving patients immediate access to notes, radiology reports, laboratory results, and surgical pathology reports. How has the CA affected your practice? I was very anxious about the ramifications of the IBR when it became enforced. Would we be deluged by portal messages left by worried patients questioning the meaning of their reports? Four years into the CA offers some perspective. Keep reading!
Longitudinal melanonychia: Benign or malignant?
Authors of a study published in JAAD reviewed clinical features and diagnostic techniques to distinguish between benign and malignant longitudinal melanonychia (LM). Nail unit melanoma (NUM) should be considered in patients presenting with widening, asymmetric, monodactylous LM, whether new or existing, with irregularly spaced lines of varying widths and colors, with dark hue, and associated onychodystrophy or nail plate splitting, the authors noted. NUM stemming from the nail bed may present as pigmented or nonpigmented nodules, ulceration with bleeding, unexplained monodactylous paronychia, or partial/complete nail plate destruction.
Histopathologic examination of nail clippings is a valuable initial diagnostic tool for LM, while nail matrix excisional biopsy remains the gold standard for NUM diagnosis, the authors wrote. For concerning LM, a nail matrix tangential excisional biopsy is preferred, with longitudinal (mid-line/lateral) excision recommended for highly suspicious invasive NUM cases, they concluded.
The FDA has approved ruxolitinib cream 1.5% for the short-term and non-continuous chronic treatment of non-immunocompromised children 2-11 years old with mild-to-moderate atopic dermatitis (AD) whose disease is not well controlled with topical prescription therapies.
[The impending role of OX40 inhibition in AD. Read more.]
Patients with an Investigator’s Global Assessment (IGA) score of 2 to 3 and with AD on 3% to 20% of their body surface area were randomized 2:2:1 to receive ruxolitinib cream 0.75% twice daily; ruxolitinib cream 1.5% twice daily; or vehicle. The TRuE-AD3 study met its primary endpoint with significantly more patients treated with ruxolitinib cream achieving Investigator’s Global Assessment of 0 (clear) or 1 (almost clear) than patients treated with vehicle. In addition, a secondary endpoint was achieved — patients demonstrating at least a 75% improvement in the Eczema Area and Severity Index (EASI75) at week 8. Patients who successfully completed an efficacy assessment at week 8 were offered participation in the 44-week long-term safety treatment extension period with their same treatment group.
In 2021, ruxolitinib cream was approved by the FDA for mild-to-moderate AD in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies. In 2022, it was approved by the FDA for the treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older.
Advances in vitiligo treatment and research open doors for physicians and patients. Read more.
Off-label use of biologics, JAK inhibitors for scarring alopecias
An article published in the Archives of Dermatological Research examined literature reporting off-label use of biologics and JAK inhibitors for the treatment of scarring alopecias. TNF-α inhibitors such as infliximab, adalimumab, and certolizumab were often used off-label for folliculitis decalvans (FD) and dissecting cellulitis (DC). Multiple case reports and one larger-scale study demonstrated disease stabilization or remission for patients with recalcitrant FD with adalimumab therapy. Similar results were noted in the treatment of DC. According to a few case reports, IL-17 inhibitor secukinumab demonstrated improvement in both FD and DC.
[Dermatologist hair experts share insights on what may play a role in FFA and CCCA. Read more.]
Multiple case reports showed improvement for lichen planopilaris (LPP), DC, and FD with secukinumab, ixekizumab, and brodalumab with fast results.
[What are treatment recommendations for managing CCCA? Read more.]
The authors concluded that TNF-α, IL-17, and JAK inhibitors may demonstrate the most potential in managing scarring alopecias, most notably in DC and FD, with some evidence for LPP, frontal fibrosing alopecia, and central centrifugal cicatricial alopecia. Adalimumab resulted in clinical improvement for all patients beginning in the first month of treatment, with sustained response.
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
