Treating warts with needle-free fluorouracil injection
In JAMA Dermatology, authors discuss two case reports of patients successfully treated with needle-free injection of fluorouracil (FU). According to the authors, needle-free injection uses high-speed liquid flow to deliver drugs into skin tissue without causing much pain, which allows for a more even and controllable distribution of the drug.
The first patient had multiple warts on a finger and was treated with an intralesional injection of FU with a needle-free injector. After two treatments, the warts on the patent’s finger were completely healed without scarring or hyperpigmentation and no recurrence at a six-month follow-up. The second patient, with one wart, received two treatments of 0.08 mL each. The wart cleared and did not recur for six months. Both patients experienced clearance of their wart(s) with minimal pain. A larger randomized clinical trial is underway to determine the efficacy and safety of this therapy.
Remedies for warts abound, but high-quality studies are lacking. Read more inDermWorld.
DermWorld Insights and Inquiries: Tag, you’re it!
Chances are you will see a patient with skin tags today. Patients will likely ask you two questions: Why do I get them? What do you mean my insurance won’t cover their removal (for asymptomatic lesions)? This commentary will focus on run-of-the-mill, workaday, ho-hum skin tags (aka acrochordons, fibroepithelial polyps [FEPs]). FEPs appear in up to 60% of the adult general population, equally affecting men and women. Skin tags are more common in patients with diabetes, obesity, metabolic syndrome, and a family history of FEPs. They have been observed increasingly in children and adolescents, correlating with the epidemic of obesity in the young. Acrochordons mostly affect flexural areas (neck, axillae, inguinal region) and eyelids.Keep reading!
Clinical outcomes of chronic urticaria after two years
A study published in Acta Dermato-Venereologica included two-year follow-up of 158 patients with chronic urticaria (CU) that failed treatment with four times the recommended antihistamine dosage. At the two-year mark, patients experienced significant improvement in frequency of recurrent wheals or angioedema. The majority of patients were treated with omalizumab, and 43% needed omalizumab over the entire study period. Of note, 8% required higher dosing than the approved 300 mg every four weeks (they required from 450 to 600 mg). At baseline, 21% of patients were treated with systemic corticosteroids, which fell to 14% at year two.
[Tackling itch. Understanding and treating chronic itch. Read more in DermWorld.]
There was significantly less health care utilization, including ER visits, with 0% of patients visiting ERs for CU at two years compared with 27.5% of patients at baseline. There was also an improvement in symptoms, quality of life, health care utilization, and work absenteeism at the two-year follow-up.
Clues to help identify patients with ocular rosacea
Authors of a study published in the International Journal of Dermatology administered a survey to more than 700 patients with rosacea to provide an updated assessment of patients who may have ocular rosacea.
[Refocusing on rosacea. Experts reexamine the disease's classification in DermWorld.]
According to the results of the analysis, 51% reported ocular symptoms, including eye redness (45%), itching (47%), sty or chalazion (77%), and dryness (27%). Of note, 45.3% of patients who consulted with an ophthalmologist were diagnosed with ocular rosacea. Those with self-reported ocular symptoms had significantly more cutaneous rosacea findings and poorer quality of life. Patients with dry to mixed skin also reported more frequent ocular symptoms compared to those with normal or oily skin. Eye involvement in rosacea patients was common, often presenting with unspecific symptoms.
Study compares AI and dermatologist judgments of melanoma thickness
According to a study published in the Journal of the European Academy of Dermatology and Venereology, both readers and artificial intelligence predict melanoma thickness with fair to moderate accuracy using dermoscopy images. Researchers evaluated how accurately an international group of readers could discriminate between melanoma in situ (MIS) and invasive melanoma and estimate the Breslow thickness of invasive melanomas based on dermoscopy images. The analysis included 22,314 readings by 438 readers.
The researchers found that the overall accuracy for distinguishing melanoma thickness was 56%; the overall accuracy rates for correctly classifying MIS and invasive melanoma were 63% and 71%, respectively. For melanomas ≤1.0 mm (including MIS), readers accurately predicted the thickness in nearly 86% of images compared with 71% of melanomas >1.0 mm. For differentiating MIS from invasive melanoma, the readers outperformed a de novo convolutional neural network but not a pretrained convolutional neural network.
Where do things currently stand with machine learning — and what does the future hold? Find out in DermWorld.
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