Neal Bhatia

Evidence-based recommendations for the management of acne fulminans and its variants

Background Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence‐based information and no clear guidelines concerning the classification and treatment of AF. Objective To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research. Methods A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5‐hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations. Results Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus. Limitations Limited evidenced‐based data and prospective studies in the literature concerning the treatment of AF is available. Conclusion These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants. Abbreviations used: AF: acne fulminans; AF‐SS: acne fulminans with systemic symptoms; AF‐WOSS: acne fulminans without systemic symptoms; ICP: intracranial pressure; IIAF‐SS: isotretinoin‐induced acne fulminans with systemic symptoms; IIAF‐WOSS: isotretinoin‐induced acne fulminans without systemic symptoms; IL‐1: interleukin 1; PAPA: pyogenic arthritis, pyoderma gangrenosum, and acne; PAPASH: pyogenic arthritis, pyoderma gangrenosum, acne, and hidranitis suppurative; PASH: pyoderma gangrenosum, acne, and hidranitis suppurative; PTCS: pseudotumor cerebri syndrome; SAPHO: synovitis, acne, pustulosis, hyperostosis, and osteitis.

Cutaneous fungal infections are commonly misdiagnosed: A survey-based study

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An open-label exploratory study evaluating the efficacy and safety of ingenol mebutate gel 0.05% for the treatment of verruca vulgaris

REFERENCES 1. Izumi K, Nishie W, Mai Y, et al. Autoantibody profile differentiates between inflammatory and noninflammatory bullous pemphigoid. J Invest Dermatol. 2016;136:2201-2210. 2. Sakai A, Shimomura Y, Ansai O, et al. Linagliptin-associated bullous pemphigoid that was most likely caused by IgG autoantibodies against the midportion of BP180. Br J Dermatol. 2017;176:541-543. 3. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roborts EA. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1991;30:239-245. 4. Pf€ utze M, Niedermeier A, Hertl M, Eming R. Introducing a novel autoimmune bullous skin disorder intensity score (ABSIS) in pemphigus. Eur J Dermatol. 2007;17:4-11. 5. Fairley JA, Burnett CT, Fu CL, Larson DL, Fleming MG, Giudice GJ. A pathogenic role for IgE in autoimmunity: bullous pemphigoid IgE reproduces the early phase of lesion development in human skin grafted to nu/nu mice. J Invest Dermatol. 2007;127:2605-2611.

Highlights of Skin Disease Education Foundation’s 41st Annual Hawaii Dermatology SeminarTM

New therapies, recent pathophysiological findings, and updated guidelines combined to create compelling presentations at the Skin Disease Education Foundations 41st Annual Hawaii Dermatology Seminar™. This educational supplement summarizes the highlights of clinical sessions presented during this CME/CE conference. A growing understanding of the biology of psoriasis has facilitated the development of increasingly efficacious medications. Skin clearance used to be regarded as an impractical goal for psoriasis therapy. Now, some clinical trials of newer medications report more than half of participants attaining Psoriasis Area and Severity Index (PASI) scores of 90. Two leading investigators review the latest findings about the treatment of this condition. Recent evidence demonstrates that psoriasis and psoriatic arthritis share multiple pathological underpinnings. A T helper type 17 (Th17) lymphocyte-based pathogenesis, genes, and microbiome changes have been identified in both conditions. Many therapeutics used in psoriasis care are efficacious in psoriatic arthritis. An expert in psoriatic arthritis updates readers about this condition. Cutaneous fungal infections, including onychomycosis, pose diagnostic and treatment challenges. New topical therapies and an investigational oral agent offer expanded options for management. The American Academy of Dermatology has issued new guidelines for the treatment of acne. Appropriate antibiotic use is a prominent theme. The US Food and Drug Administration has issued a communication about the risk of unintentional injection of soft tissue fillers into facial blood vessels-including blindness. The lead author of a recent review about this topic discusses how to prevent this serious outcome. The volume of new information about pathophysiology, diagnosis, therapy, and safety challenges our ability to keep current while enabling us to improve patient care. We hope that the highlights of this seminar offer you information that can be applied to your busy practices.