Whan B. Kim

Adverse events resulting in withdrawal of biologic therapy for psoriasis in real-world clinical practice: A Canadian multicenter retrospective study

BACKGROUND Safety profiles of biologics for treatment of psoriasis are limited to data from randomized controlled trials. There is a need for comparative safety reports of biologics based on data from clinical practice. OBJECTIVE We sought to estimate and compare the incidence of adverse events (AEs) leading to withdrawal of biologics (etanercept, infliximab, adalimumab, and ustekinumab) in the treatment of psoriasis. METHODS We conducted a multicenter retrospective chart review from September 2005 to September 2014. Incidence proportion and rate of AEs leading to withdrawal by biologic agent and AE were calculated. RESULTS For 545 treatments administered in 398 patients, 22 (4.04%) AEs were associated with withdrawal, for a rate of 1.97/100 patient-years (95% confidence interval [CI] 1.32-2.94). Common AEs were injection-/infusion-site reactions (0.55%, 0.92%, 0%, and 0% for etanercept, infliximab, adalimumab, and ustekinumab, respectively); infections (0%, 0.18%, 0.55%, 0.18%); and malignancies (0.18%, 0.18%, 0%, 0.37%). LIMITATIONS Possible incompleteness of chart details and small study population limit the conclusiveness of findings. CONCLUSION Biologic agents for treatment of psoriasis are safe; AEs associated with withdrawal occurred in 4% of all administered biologic therapies. It does not appear that real-world patients encounter more AEs with biologics than patients in clinical trials.

Risk of Malignancy in Dermatomyositis and Polymyositis: A Systematic Review and Meta-Analysis

Background: There is variation in the risk of malignancy in dermatomyositis (DM) and polymyositis (PM) in the existing literature. Objective: To conduct a meta-analysis to estimate the risk of malignancy in DM and PM as compared with the general population. Methods: Medline and Embase Database abstracts were searched through August 2014 using the search terms myositis, neoplasms, and paraneoplastic syndromes. Population-based, observational studies in English were included. Meta-analyses were conducted using random-effects models. Results: A total of 5 studies with 4538 DM or PM patients were included in the analysis. The overall relative risk was 4.66 for DM and 1.75 for PM. By gender, the standardized incidence ratio (SIR) of malignancy among DM patients was 5.29 for males and 4.56 for females; the SIR of malignancy among PM patients was 1.62 for males and 2.02 for females. By time since diagnosis, the SIR of malignancy among DM patients was 17.29 in the first year, 2.7 between 1 and 5 years, and 1.37 after 5 years. By age group, the SIR among DM patients was 2.79 for patients between 15 and 44 years and 3.13 beyond 45 years. Conclusions: Both DM and PM are associated with increased risk of malignancy, but the risk is higher in DM. The risk of malignancy is present in both genders and all age groups and is highest in the first year after diagnosis but persists beyond the fifth year in DM. Adults should be evaluated for malignancy at diagnosis, followed by long-term surveillance.

Clinical Features and Patient Outcomes of Hidradenitis Suppurativa: A Cross-Sectional Retrospective Study.

Background: Despite the high burden of disease associated with hidradenitis suppurativa (HS), epidemiologic data are scarce. Objective: The objective was to review demographic features and clinical findings in 80 HS patients from 2 referral centres in Ontario, Canada, from October 2013 to September 2014, and to assess for factors that are associated with more advanced disease. Methods: Multicentre cross-sectional study. The data on demographic and clinical features were obtained by questionnaires and chart review. Results: Of a total of 80 patients (67.5% females), percentages of patients in Hurley stages I, II, and III were 15.4%, 55.8%, and 28.9%, respectively. Most patients were not diagnosed for more than 1 year (70.1%). Patients with more severe disease were more likely to be females and to have a greater number of lesions and were less likely to be diagnosed initially by a dermatologist. Conclusions: This study documents the common demographic and clinical features of HS to optimize resource allocation and patient outcomes.

Survival rates of biological therapies for psoriasis treatment in real-world clinical practice: A Canadian multicentre retrospective study

Data on biologic drug survival in real‐world psoriasis treatment are limited. There is a need to evaluate long‐term trends of biologic use outside the realm of clinical trials.

Epidermolysis Bullosa Pruriginosa: Case Series and Review of the Literature.

Epidermolysis bullosa (EB) pruriginosa is a rare clinical subtype of dystrophic epidermolysis bullosa (DEB) that is characterized by intense pruritus resulting in hypertrophic, lichenified, prurigo-like plaques and nodules secondary to scratching. The variability in the age of onset, rarity of intact bullae, histologic ambiguities, and close resemblance to other conditions such as acquired inflammatory dermatoses may make diagnosis difficult for this unusual condition, for which fewer than 100 cases have been documented. In this report, we describe 3 cases of EB pruriginosa and review the current literature.

Skin Necrosis from Intra-articular Hyaluronic Acid Injection.

Background Tissue necrosis is a rare yet potentially serious complication of intra-articular (IA) hyaluronic acid (HA) injections for treatment of knee osteoarthritis. Objective To report a case of a patient with cutaneous necrosis after IA HA injection for treatment of knee osteoarthritis, presenting as a livedoid violaceous patch on the right knee. Method We report a case of cutaneous necrosis as a rare complication of IA HA injection for treatment of knee osteoarthritis. A literature review was undertaken of similar cases. Results Use of HA IA injections in the treatment of osteoarthritis can result in similar skin necrosis at uncommon anatomic locations corresponding to the site of HA injection. Conclusion Although tissue necrosis is a rare complication, physicians need to be aware of this possibility as a complication of HA IA injections in the treatment of osteoarthritis and should be mindful of potential treatment options to manage this adverse event.

Public Engagement with Dermatology Contents on Facebook

Background The growing presence of dermatology platforms on Facebook has been acknowledged; however, little is known about the extent to which different types of content influence the level of engagement with online users. Objective To assess the level of public engagement with different types of content posted on Facebook pages devoted to dermatology. Methods A search on Facebook identified existing pages for dermatology academic journals, professional societies, and patient-centered groups. Then the engagement rate was calculated for each content type published on the selected pages. Results The median engagement rates were 63.8% for educational posts, 41.3% for interactive posts, 27.4% for news articles, 11. 8% for academic articles, and 9.3% for others. Conclusion Educational posts engaged with online users the most effectively. The level of engagement is a key determinant of knowledge dissemination via online tools, and the type of content may influence the level of engagement.

Use of facebook as a tool for knowledge dissemination in dermatology.

Background: The presence of dermatology-related platforms in social media has been acknowledged; however, the level of engagement of the public with these platforms has not been evaluated. Objective: To use the Engagement Rate to assess the level of engagement of the public with Facebook pages devoted to dermatology. Methods: A search on Facebook identified Facebook pages for dermatology academic journals, professional societies, and patient-centered groups with the highest number of Facebook likes. Then the Yearly Page Engagement Rate was calculated for each Facebook page. Results: The robust average of the Yearly Page Engagement Rate was 0.673 for academic journals, 0.313 for professional societies, and 1.563 for patient-centered groups. Conclusion: Patient-centered groups engaged with their fans most effectively. Engagement is a key determinant of a fans exposure to the contents of the page and hence a gauge of whether the fans who “liked” the page continue to remain engaged or not.

Lupus Miliaris Disseminatus Faciei With Isolated Axillary Involvement.

Background: Lupus miliaris disseminatus faciei (LMDF) is a chronic, granulomatous inflammatory disorder, commonly localized to the face. Objective: To present an unusual manifestation of LMDF and review the literature. Methods: We document a 41-year-old woman with LMDF with isolated axillary involvement. A literature review was conducted using Pubmed, Medline, Embase, and Google Scholar for similar cases using search terms lupus miliaris disseminatus faciei, LMDF, acne agminata, and acnitis. Results: Extrafacial LMDF without concomitant facial involvement is rare; there has been only 1 other report of LMDF with exclusive axillary involvement to date. In addition, we report the successful use of doxycycline monohydrate combined with topical tacrolimus in the treatment of LMDF. Conclusion: Physicians should note that LMDF can occur in body sites other than the face and should be aware of the available treatment options to manage this condition.

Nodular Amyloidosis of the Penis: A Case Demonstrating Keratinocyte Origin

Lace bug infestations may have health consequences, including nuisance biting and cutaneous and systemic reactions. Clinicians should be aware of the existence of this insect with its newly recognized bloodsucking ability as potentially responsible for skin lesions and pruritus that can cause real discomfort and anxiety. Bites from the lace bug may also be considered in the differential diagnosis of bedbug bites5 and scabies.8