Megan Kinney

A retrospective analysis of pediatric patients with lichen sclerosus treated with a standard protocol of class I topical corticosteroid and topical calcineurin inhibitor

Abstract Background: Lichen sclerosus (LS) is a chronic, inflammatory condition of the skin, affecting primarily the anogenital region potentially leading to changes in vaginal architecture and vulvar squamous cell carcinoma. Current recommended treatment for LS is high-potency corticosteroids. Calcineurin inhibitors may also have a role. Objective: The objective of this study is to introduce a treatment regimen involving clobetasol to induce remission, then tacrolimus to maintain remission in pediatric females with LS. Methods: As a retrospective case series, we report 14 pediatric females between 2 and 10 years of age with LS treated with clobetasol 0.05% topical ointment and systematically bridged to tacrolimus 0.1% topical ointment. For each patient, gender, age at disease onset, and clinical symptoms and features were noted. Time in weeks to 75% clearance and to complete clearance were recorded. Results: Thirteen patients showed complete clearance. One patient showed significant clearance of the disease. The time to complete clearance averaged 43.1 weeks, with a range of 4–156 weeks. Conclusions: The use clobetasol to induce remission and tacrolimus to maintain remission can be used to treat LS in pediatric females. This regimen may minimize side effects associated with long-term, high-potency corticosteroid use and reduce the risk of changes to genital architecture secondary to LS.

Nonmelanoma skin cancer treatment training varies across different medical specialists

Abstract Background: Physicians from various specialties treat patients with nonmelanoma skin cancer (NMSC). The isolation of specialties from each other may result in different approaches to skin cancer training. Purpose: Our purpose was to determine the type and amount of NMSC surgical training that is received during dermatology, general surgery, internal medicine, otolaryngology, and plastic surgery residencies. Methods: E-mail contact information for residency program directors of all accredited programs in each specialty was compiled through the American Medical Associations online residency database. A total of 920 residency program directors were emailed surveys concerning the training of residents in the treatment of NMSC. Results: Forty-two of 920 surveys were returned. All surveyed specialty groups, except internal medicine, had training in NMSC treatment including simple excision, split thickness skin grafts, and tissue rearrangement. A majority of the dermatology and plastic surgery programs instruct their residents in Mohs micrographic surgery and full thickness skin grafts. Electrodessication and curettage was most often instructed in dermatology, general surgery, and plastic surgery programs. Conclusion: Greater consistency in NMSC treatment training may be beneficial. Because different approaches may be best suited to particular clinical situations, NMSC treatment training should include adequate exposure to all NMSC treatment techniques.

Small-vessel vasculitis.

The term vasculitis is defined as inflammation of the blood vessel wall. Small‐vessel vasculitides affect post‐capillary venules, mostly in the skin. Defining the different types of small‐vessel vasculitides is important as they may be associated with systemic manifestations, may require additional patient evaluation and may require more than only supportive care. Evaluation of a patient with suspected small‐vessel vasculitis requires skin biopsy, evaluation of the extent of the disease, and an attempt to define an etiology. Management is based on providing supportive care, treating any underlying condition, avoiding any triggers, and treating based on severity of skin lesions and systemic involvement.

IL-12/23 Inhibitors and Their Potential Benefits and Risks for Psoriasis Patients

Background Interleukin (IL)-12 and IL-23 are implicated in the pathogenesis of psoriasis and new IL-12/23 inhibitors are currently being studied for psoriasis treatment. Objective To review the literature and provide an update on the current use of anti-IL-12/IL-23 therapies for psoriasis, with special emphasis on risks and benefits. Methods A PubMed search was performed to identify articles in English with key words “Ustekinumab and psoriasis,” “IL-12 and IL-23 and psoriasis,” “ABT-874 and psoriasis,” “IL-12/23 monoclonal antibody,” “IL-12/23 antibody” and “CNTO-1275.” Supplemental methods included Google Scholar, article reference lists and scholarly posters. Results Anti-IL-12/23 therapies may be more effective for psoriasis treatment than concurrent biologics. However, there is a potential risk of compromising cancer surveillance mechanisms through blocking IL-12. Limitations More research is needed into the long-term effects of anti-IL-12/23 agents. Conclusions Convenient dosing of ustekinumab and greater efficacy make the anti- IL-12/23 agents a promising therapeutic option.