Theresa N. Canavan

Anti-IL-17 Medications Used in the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review

Our ability to successfully treat patients with moderate to severe psoriasis has improved significantly over the last several years with the development of more targeted therapies. IL-17A, a member of the IL-17 family of interleukins, is involved in regulating the innate and adaptive immune systems and has been identified as a key cytokine involved in the pathogenesis of psoriasis and psoriatic arthritis. In this review, we summarize our understanding of IL-17 and its role in psoriasis and psoriatic arthritis, as well as key findings from clinical trials using anti-IL-17 medications for the treatment of the aforementioned diseases. Secukinumab, ixekizumab, and brodalumab are three anti-IL-17 medications used for treating psoriasis, of which only secukinumab is FDA approved; ixekizumab and brodalumab remain under clinical development. Results from clinical trials show that these three medications are highly effective in treating psoriasis and appear to be as safe as other biologic treatments that are FDA approved.

Optimizing Non-Antibiotic Treatments for Patients with Acne: A Review

Acne is a very common non-infectious skin condition that is frequently treated in dermatological practices. Because acne is often chronic and may persist for years, safe and effective long-term maintenance therapy is often required. Given the increasing frequency of antibiotic-resistant bacteria and the gravity of the consequences of this trend, it behooves dermatologists to maximize use of non-antimicrobial therapy when treating acne. In this review of the literature we present data regarding the efficacy and appropriate use of non-antimicrobial treatments for acne. A variety of topical and oral treatment options exist that can be used in a step-wise manner according to the patients’ severity and therapeutic response. Non-antimicrobial treatments can be highly efficacious at controlling acne, especially when used as maintenance therapy. While antibiotics have a role in acne treatment, they should not be used as monotherapy, and lengthy courses of antibiotic use are discouraged.

An Idiopathic Leukonychia Totalis and Leukonychia Partialis Case Report and Review of the Literature.

Leukonychia totalis and leukonychia partialis are rare nail findings characterized by complete or partial whitening of the nail plate. Leukonychia totalis and leukonychia partialis are usually inherited or associated with systemic disease. Here, we report the case of a 25-year-old man with idiopathic acquired leukonychia totalis and leukonychia partialis and review the literature on this topic.

Reply to: “Diagnosing Mycoplasma pneumoniae-induced rash and mucositis (MIRM) in the emergency room”

To the Editor: We would like to thank Dr Norton for his interest and valuable comments regarding our recent publication. We also welcome the opportunity to briefly discuss questions regarding the diagnostic approach to patients with MIRM (Mycoplasmainduced rash and mucositis). Dr Norton’s suggestions for evolving the diagnostic criteria are helpful. We agree that assessing broadly for mucositis in patients with suspected MIRM can be useful, and including evaluations for nasal, urethral, and anal erosions in patients may prove to be informative. Nasal and anal erosions have rarely been reported, although this may represent reporting bias in the literature; further studies are needed to better define the true incidence of MIRM-associated mucositis at these sites. We agree that age is an important feature of the disease. As was pointed out, MIRM patients are typically young. A child with atypical pneumonia and classic features of rash and mucositis between the age of 2 and 20 years would be highly suspect of having MIRM. There is, however, a broad age range for patients presenting with MIRM and this diagnosis should remain in the differential in patients who have classic MIRM symptoms even if they are not in the typical age range for this disease. Age may thus serve as a useful minor diagnostic criterion. Dr Norton accurately points out that atypical pneumonia infection is often diagnosed solely on the bases of physical exam findings and chest radiograph, and that the decision to treat empirically with azithromycin for community acquired pneumonia may not require mycoplasma polymerase chain reaction or serology testing. While this is a highly practical suggestion for the management of pneumonia, we feel that is it important to emphasize that definitive identification of Mycoplasma pneumoniae infection is a crucial step for accurately diagnosing the cause of the associated rash and mucositis—specifically, in differentiating MIRM from drug-induced SJS/ TEN (Stevens Johnson syndrome/toxic epidermal necrolysis). Many young patients who ultimately present with rash and mucositis may have recently had empirical treatment with antibiotics and antipyretics for an upper respiratory infection. Therefore, differentiating between druginduced SJS/TEN and MIRM would require a reliable diagnosis of M. pneumoniae infection. Moreover, it is important to note that SJS/TEN

Photodynamic therapy effective for the treatment of actinic keratosis and basal cell carcinoma in bullous pemphigoid patients

Treating skin cancers and extensive actinic keratosis in patients with bullous pemphigoid (BP) can be challenging. Treatment options pose unique risks in these patients as surgical wounds can have delayed wound healing and photodynamic therapy (PDT) may exacerbate their blistering disease. We report the successful use of PDT to treat actinic keratosis and skin cancers in two patients with BP, both of whom had excellent response to PDT and tolerated treatment without any bullous disease flares. Carefully selected patients with skin cancers and stable, well controlled BP can be safely considered for treatment using PDT.

ALK-positive primary cutaneous anaplastic large cell lymphoma: a case report and review of the literature

Anaplastic large cell lymphoma (ALCL) limited to the skin is a distinct disease that is designated primary cutaneous ALCL (pcALCL). It has an indolent course with a significantly better prognosis compared to systemic ALCL (sALCL). Anaplastic lymphoma kinase (ALK) expression in lesions of cutaneous ALCL is classically considered to be a marker for skin involvement by sALCL. However, recent reports of patients with ALK‐positive pcALCL challenge this concept and raise prognostic and therapeutic dilemmas. Herein, we report a case of ALK‐positive pcALCL in a 45‐year‐old woman who was treated with local radiotherapy. We review previously reported cases in the literature to better characterize this rare variant. Overall, the rates of cutaneous recurrence, systemic dissemination, and disease‐related mortality in ALK‐positive pcALCL do not differ from those previously reported in pcALCL. ALK‐positive pcALCL is diagnosed at younger age and has a better disease course in children compared to adults with lower incidences of skin recurrence and progression to systemic disease. We conclude that ALK‐positivity in cutaneous ALCL does not necessarily imply systemic disease. ALK‐positive pcALCL has an excellent prognosis and should be treated by excision and/or radiotherapy. However, patients must remain under close long‐term follow‐up as recurrence and progression to systemic disease may occur.

Lichen Planopilaris in the Setting of Hair Sunscreen Spray

Lichen planopilaris (LPP) is a scarring alopecia seen classically in older Caucasian women. Frontal fibrosing alopecia (FFA) is a distinct disease that shares the histologic and trichoscopic features of LPP but differs in its clinical presentation in that it involves the frontal scalp and occasionally the eyelashes and eyebrows of older Caucasian women. Several recent studies have described a link between FFA and the use of sunscreen. Here we report a case of LPP arising in the part line of the scalp of a woman with a history of long-term daily application of spray-on sunscreen to the hair part line.

Single-Center, Prospective, Blinded Study Comparing the Efficacy and Compatibility of Efinaconazole 10% Solution in Treating Onychomycosis with and without Concurrent Nail Polish Use

Background: Topical efinaconazole 10% solution is a promising new treatment for distal lateral subungual onychomycosis (DLSO). However, it is unknown whether this treatment is both compatible and efficacious in individuals wearing toenail polish. Materials and Methods: We evaluated the efficacy and compatibility of efinaconazole 10% solution with concurrent nail polish use in treating DLSO over 52 weeks. Efficacy was assessed using the onychomycosis severity index (OSI) and by measuring nail growth and thickness, while compatibility with nail polish was evaluated with questionnaires. Results: Eleven patients completed the study; 6 wore nail polish regularly and 5 abstained from polish. The efficacy of efinaconazole was not diminished by concurrent nail polish use as measured by OSI, nail growth, and thickness. However, this treatment produced undesirable cosmetic changes to the quality of nail polish over time. Conclusions: While efinaconazole 10% solution is an effective treatment of DLSO in patients wearing nail polish, this treatment may diminish the quality of the polish. Further research and development is needed to enhance the compatibility of topical onychomycosis treatments with nail polish use.

Recognizing melanoma: Diagnosis and treatment options.

Melanoma is a malignant tumor that is usually cutaneous in origin and is associated with significant morbidity and mortality. As one of the most common cancers seen in young adults, melanoma represents a major public health concern in terms of years of lost productivity.