Abraham M. Korman

Impact and management of depression in psoriasis patients

Psoriasis causes emotional and social burdens [1,2]. Psoriasis patients are 1.5 times more likely to experience depression compared to thosewithout psoriasis (odds ratio 1.57; 95% confidence interval 1.40–1.76) [3]. The proportion of psoriasis patients who have depressive symptoms ranges from 9% to 55%, likely due to differences in screening methods and study populations (Table 1). Estimated adherence to therapies is 40–50% [4,5]. Psychiatric comorbidity is a strong predictor of poor adherence [6,7]. Depression in psoriasis patients may reduce adherence to treatment, resulting in worse psoriasis and more depression [7]. Managing depression may improve adherence and outcomes. To treat depression, it must be detected. Dermatologists’ clinical judgment has a sensitivity and specificity of 60% and 21% for detecting depression [8]. Clinical judgment of depression in psoriasis patients, unaided by formal measures, is poor. This study reviews factors relating to depression in psoriasis patients, estimates the proportion of psoriasis patients with depression and the effect depression has on adherence in psoriasis patients, and discusses management of depression in psoriasis patients. The study also proposes an algorithm for detecting and managing depression in psoriasis patients using two easy-to-use, validated questionnaires.

Oral tofacitinib for the treatment of adults with moderate to severe chronic plaque psoriasis

ABSTRACT New treatments for psoriasis have been developed based on increasing knowledge of the underlying pathogenesis of the disease. The development of very safe and highly effective biologics has revolutionized the treatment of moderate-to-severe psoriasis. Biologics are not perfect, however, as they are delivered parenterally, immunogenic, and costly. Small molecule agents, with molecular weights of less than 1 kDa, are being developed and hold the advantage of being administered orally. Tofacitinib is an oral Janus kinase inhibitor that has been developed to disrupt the aberrant JAK-STAT pathway that contributes to the pathogenesis of psoriasis. Phase II and Phase III clinical trial results for tofacitinib are encouraging, demonstrating substantial efficacy and satisfactory safety in the treatment of patients with moderate-to-severe chronic plaque psoriasis. An effective oral treatment without the organ toxicities of methotrexate and cyclosporine, tofacitinib is a promising alternative to biologics in the treatment of moderate-to-severe psoriasis.

Viral exanthems: An update on laboratory testing of the adult patient

&NA; Although classic viral exanthems of childhood are well described, they are rarely differentiated in adults. Laboratory techniques for viral identification have advanced without substantial literature to suggest how a dermatologist ought to conduct a cost‐effective and diagnostic viral panel. Certain clinical features such as petechiae, vesicles, and dusky macular or morbilliform exanthems point strongly toward a viral exanthem. Differentiation of drug and viral causes of morbilliform eruptions has proven difficult. It is possible that with further diagnostic refinement that unnecessary and fruitless workups of an exanthem and unneeded discontinuation of drugs can be avoided. We review viral exanthems based on clinical features and discuss the available and optimal laboratory techniques to assist the dermatologist in a targeted workup.

Radiation recall dermatitis associated with nivolumab for metastatic malignant melanoma.

References 1 Wassef M, Blei F, Adams D, et al. Vascular anomalies classification: recommendations from the International Society for the study of vascular anomalies. Pediatrics 2015; 136: e203– e214. 2 Patel GA, Schwartz RA. Cutaneous lymphangioma circumscriptum: frog spawn on the skin. Int J Dermatol 2009; 48: 1290–1295. 3 Yanazume S, Douzono H, Kubo H, et al. Cryotherapy for massive vulvar lymphatic leakage complicated with lymphangiomas following gynecological cancer treatment. Jpn J Clin Oncol 2014; 44: 1116–1119. 4 Kortes N, Radeleff B, Sommer CM, et al. Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 2014; 25: 127–132. 5 Lee EW, Shin JH, Ko HK, et al. Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol 2014; 15: 724–732. 6 Hammill AM, Wentzel M, Gupta A, et al. Sirolimus for the treatment of complicated vascular anomalies in children. Pediatr Blood Cancer 2011; 57: 1018–1024. 7 Lackner H, Karastaneva A, Schwinger W, et al. Sirolimus for the treatment of children with various complicated vascular anomalies. Eur J Pediatr 2015; 174: 1579–1584. 8 Adams DM, Trenor CC 3rd, Hammill AM, et al. Efficacy and safety of sirolimus in the treatment of complicated vascular anomalies. Pediatrics 2016; 137: e20153257. 9 Perry B, Banyard J, McLaughlin ER, et al. AKT1 overexpression in endothelial cells leads to the development of cutaneous vascular malformations in vivo. Arch Dermatol 2007; 143: 504– 506. 10 Kobayashi S, Kishimoto T, Kamata S, et al. Rapamycin, a specific inhibitor of the mammalian target of rapamycin, suppresses lymphangiogenesis and lymphatic metastasis. Cancer Sci 2007; 98: 726–733. 11 Nadal M, Giraudeau B, Tavernier E, et al. Efficacy and safety of mammalian target of rapamycin inhibitors in vascular anomalies: a systematic review. Acta Derm Venereol 2016; 96: 448–452.

Frequent skin examinations in patients with actinic keratoses: Ethical, financial, and moral implications

Dr Kandu has a busy dermatology practice in a rural town. As the only dermatologist in the area, Dr Kandu has a 3to 4-month wait list for new patients. Ms Rhodes, a 65-year-old woman, presents at her initial visitwith a concern for scaly spots onher forearmand adesire for a full-body skin examination. She has no personal or family history of skin cancer and had relatively mild sun exposure as a youth. On examination, Ms Rhodes has a few lentigines on her face and 2 thin actinic keratoses (AKs) on her left forearm. Dr Kandu administers cryotherapy to the lesions and counsels her on sun protection. He indicates that she can follow up in 1 year for another skin examination. Ms Rhodes interjects, stating that she saw her previous dermatologist every 3months tomake sure she did not have skin cancer. Given the patient’s history and examination,Dr Kandu does not think there is an indication to see her so frequently, especially when this would take away an appointment slot from another patient in need of dermatologic care. He explains to her that such frequent monitoring is not warranted for minimal actinic damage, but Ms Rhodes insists that it makes her feel better to be scheduled for skin examinations every 3 months.

A Comparison of Academic Journal Impact in Dermatology vs. Similarly Sized Medical Specialties

Purpose of reviewA dearth of research exists on how dermatology compares to similarly sized medical specialties in terms of number of papers published and scholarly impact of top journals. We investigate the impact factor, 5-year impact factor, number of journals with impact factor greater than 2, total documents published, and H5-index of the top 5 journals in dermatology.Recent findingsThe impact of journals in dermatology has not been well described in the literature. We review the methods by which the impact of publications can be assessed and present an approach to interpreting the scope and impact of journal publications. We further identify how dermatology compares to similarly sized specialties in terms of such metrics.SummaryOur results reveal that the Journal of Investigative Dermatology, the highest-ranking dermatology journal for both impact factor (7.2) and SCImago Journal Rank (2.6), ranked second to last among top journals of comparable size. Lancet Neurology and Gastroenterology, by comparison, had impact factors of 21.9 and 16.7, respectively. These findings may result from the relatively low number of academic and fellowship-trained dermatologists, as well as the outpatient nature of dermatology. A positive correlation was observed between total number of academic physicians in a field and impact factor, 5-year impact factor, Source Normalized Impact per Paper (SNIP), percentage of journals with an impact factor greater than 2, and H5-index. Further studies could investigate ways to address barriers to research in dermatology to allow for increased scientific impact.