Melody Maarouf

Targeted treatments for hidradenitis suppurativa: a review of the current literature and ongoing clinical trials

Abstract Purpose: Targeted, immune-modulating drugs are at the forefront of therapy for HS, and a comprehensive clinical trial registry is needed to facilitate data pooling and clinical efficacy comparison. Materials and methods: A systematic review of the ClinicalTrials.gov database was searched for planned, in-progress, completed, or terminated trials investigating the effect of targeted biologic therapies for hidradenitis suppurativa (HS). When results of RCTs were not available, case reports or series were included. Results: Inflammatory mediators that are targeted by biologic agents include tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), IL-17, IL-12, IL-23, phosphodiesterase 4 (PDE4), lymphocyte function-associated antigen 1 (LFA-1), and complement component 5a (C5a). Clinical efficacy was measured by reduction in Sartorius score, Hidradenitis Suppurativa Clinical Response (HiSCR), Dermatology Life Quality Index (DLQI), or pain Visual Analog Scale (VAS). TNF inhibitors (adalimumab, etanercept, and infliximab), IL-1 receptor antagonist (Anakinra), IL-17A inhibitor (secukinumab), IL-12/23 inhibitor (ustekinumab), and PDE4 inhibitor (apremilast) show promise due to statistically significant improvements in disease severity. Conclusions: Currently, adalimumab is the only FDA-approved biologic available for the treatment of HS. However, results from trials of other biologic agents targeting downstream mediators are promising. Large-scale, randomized, placebo-controlled trials in patients with skin of color, as well as weight-based dosing trials, are needed.

Disordered Presentation of Paraneoplastic Pancreatitis, Polyarthritis and Panniculitis (PPP) Syndrome in a Patient with End-Stage Pancreatic Cancer

We report a rare case of PPP due to stage IV beta-islet pancreatic cancer presenting with polyarthritis, whose diagnosis was delayed due to an incomplete presentation of PPP syndrome. Following an extensive one-month infectious disease workup, tender erythematous papules began to develop, which prompted the consideration and subsequent biopsy for pancreatic panniculitis. Thus, the diagnosis was delayed due to a lagging cutaneous presentation—a component of the triad that is commonly the initial presentation in most patients.

Multi-Center Randomized Clinical Study of The Effects of Natural Oils on Xerosis and Skin Barrier Properties

Objective : To compare the effect of natural oils and white petrolatum on skin barrier function in patients with xerosis. Design, Setting, and Participants : Randomized, open label, comparison pilot study (NCT03093597). Interventions : Participants were randomized to apply 1 of 4 moisturizers to assigned treatment areas twice daily for 2 weeks. Clinical dry skin score, stratum corneum hydration, and transepidermal water loss (TEWL) were assessed at baseline, 1 week, and 2 weeks. Results : Thirty-two participants completed the study. Neither TEWL nor hydration were statistically different among the moisturizers at each visit. All four moisturizers led to significant initial increase in TEWL at week 1 (p < 0.05) with an associated increase in hydration for coconut oil, jojoba oil, and white petrolatum. All four moisturizers led to significant increase in hydration by week 2 (p < 0.01). The preferred moisturizers were almond oil and coconut oil, which were most “liked” by 38% and 31% of the participants, respectively. The least preferred moisturizer was white petrolatum. Conclusions : Almond oil, jojoba oil, and coconut oil significantly increased hydration after 2 weeks, and are as effective as white petrolatum as daily moisturizers for xerosis. The participants preferred natural oils to white petrolatum, implying that these moisturizer options may improve patient compliance.

Trimethoprim-sulfamethoxazole-induced drug reaction with eosinophilia and systemic symptoms in a child with congenital renal disease

We present a special case of an 8‐year‐old girl diagnosed with severe drug reaction with eosinophilia and systemic symptoms due to trimethoprim‐sulfamethoxazole for urinary tract infection prophylaxis for congenital vesicoureteral reflux. The patient is believed to have developed drug reaction with eosinophilia and systemic symptoms because of her underlying renal disease.

Head-and-neck dermatitis: Diagnostic difficulties and management pearls

Head‐and‐neck dermatitis is a variant of atopic dermatitis (AD) often seen in children and is challenging to diagnose, as it frequently overlaps with other eczematous dermatoses. Successful head‐and‐neck dermatitis (HND) treatment requires identification of common triggers and clinical mimickers, such as airborne dermatitis, periorificial dermatitis, and steroid‐induced rosacea. Head‐and‐neck involvement negatively impacts quality of life and is often harder to treat than other body parts, as long‐term topical corticosteroid use carries higher risks for skin atrophy on the face. Heating and flushing associated with HND further exacerbate the itch‐and‐scratch‐cycle and disrupt sleep. We aim to address diagnostic gaps, identify clinical mimickers, and share clinical pearls in managing HND, including cooling pillows, thermal water sprays, rice starch paper facial masks, and tips to minimize food and saliva‐induced facial irritation.

Truths and myths in sunscreen labeling

The American Academy of Dermatology (AAD) has prioritized skin cancer prevention efforts in 2018, as photoprotection measures adopted by the general public remain suboptimal. A large proportion of patients lack understanding of primary prevention methods for skin cancer, and mistruths in advertising may contribute significantly to this deficit. Sunscreen labels are often stacked with multiple claims of seemingly high significance, making it difficult for patients to differentiate their validity when selecting a sunscreen. The United States Food and Drug Administration (FDA) published its monograph in 2011 to address these controversies in sunscreen labeling, but the reliability of several other claims remain unclear. In this article, we discuss several claims commonly made on sunscreen labels, and address the truths and mistruths surrounding them.

Myths, Truths, and Clinical Relevance of Comedogenicity Product Labeling

he concept of acne cosmetica was first introduced in 1972 to describe low-grade persistent acneiform eruptions in women who use cosmetics daily.1 Although histologically similar to acne vulgaris, which forms from abnormal differentiation and proliferation of keratinocytes in the follicular duct, acne cosmetica comedones are smaller and closed and show less sebaceous gland involution.1 Although sebum composition, follicular hyperkeratosis, androgens, and cytokines are implicated in the pathogenesis of acne vulgaris, acne cosmetica results from the prolonged use of cosmetic compounds that block follicular ducts. In 1972, 28% of adolescents and 4% of women (≥31 years of age) were affected.1 We believe that the prevalence of acne cosmetica is increasing with cosmeceutical industry growth. Thus, comedogenicity is an important consumer consideration.

Cutaneous erysipeloid metastasis of cholangiocarcinoma and evaluation by in vivo reflectance confocal microscopy

PET: positron emission tomography RCM: reflectance confocal microscopy INTRODUCTION Cutaneous metastases are relatively uncommon, occurring in only 0.7% to 9% of all internal malignancies. Cholangiocarcinoma is a rare bile duct neoplasm that accounts for less than 2% of maligancies. Although it is well known that cholangiocarcinomametastasizes to the lungs, liver, peritoneum, and retroperitoneal lymph nodes, a retrospective review of the literature from 1978 to 2014 indicates only 30 cases of cutaneous cholangiocarcinoma, with 17 cases presenting without concurrent metastasis in other sites. Among these patients, the cutaneous metastatic disease occurred evenly at adjacent and distant sites, presenting as 0.3-cm to 4-cm erythematous papules or nodules with or without ulceration. The median overall survival after diagnosis of cutaneous cholangiocarcinoma metastasis is 4 months. Paradoxically, single-site metastases carry a significantly worse prognosis than multiple-site metastases and may be attributed to difficulty in identifying a singular lesion. In vivo reflectance confocal microscopy (RCM) is a novel, noninvasive diagnostic alternative to skin biopsy with comparable insurance reimbursement that captures real-time, high-resolution, cellular-level images from the skin surface down to the reticular dermis (up to 300 mdepth). Thismodality forgoes traumatic biopsy and has been used for diagnosis and monitoring of skin cancers and inflammatory dermatoses.

Topical micronutrients in atopic dermatitis-An evidence-based review

The role of dietary factors is an important and controversial topic in the pathogenesis of atopic dermatitis (AD). Despite the preponderance of consumer products utilizing oral micronutrients supplementation for relief AD symptoms, less attention has been paid on the utility of topical micronutrients, specifically for individuals with AD. We review evidence on topical formulations of vitamins (A, B, C, D, and E) and trace minerals (magnesium, manganese, zinc, and iodine) for treatment of AD. While topical B, C, and E formulations appear to provide some benefit to AD individuals, topical vitamin A has no utility, and topical vitamin D may exacerbate symptoms. Magnesium, zinc, and iodine all appear to improve AD through anti‐inflammatory and anti‐microbial effects, though future studies must evaluate their use as monotherapy. The exposition of the effects that topical micronutrients have on AD offers an adjuvant treatment modality for this common inflammatory dermatosis.

The role of nutrition in inflammatory pilosebaceous disorders: Implication of the skin-gut axis

Nutrition plays a critical role in the manifestation and management of inflammatory pilosebaceous disorders. There is rich potential for insight into the impact of dietary effects on the pathophysiology of inflammatory pilosebaceous disorders including acne vulgaris, hidradenitis suppurativa, rosacea, and the closely related seborrhoeic dermatitis. Acne vulgaris and hidradenitis suppurativa are thought to have similar diet‐modulating pathogenic pathways. Western diet influences Acne vulgaris and hidradenitis suppurativa by increasing insulin and modulating FOX01/mTOR, resulting in over‐expression of cytokeratins, hyperproliferation of keratinocytes, and hypercornification of the follicular wall. Key receptors in rosacea are alternatively activated by UV radiation, hot beverages, spicy foods, vanilla, cinnamon, caffeine, alcohol, cold temperatures, and niacin‐ and formalin‐containing foods, to increase oedema and flushing, resulting in erythema, telangiectasia, and warmth, characteristic features of the condition. Seborrhoeic dermatitis, while not a follicular disorder, is closely related, and can be modulated by dietary influences, such as biotin and probiotics. This overview summarizes the role that nutrition plays on these disorders, and identifies dietary modifications as potential adjunctive therapies.