T. Norman, Jana Guenther, Marie D. Lafeir, Scott Worswick
Background: Despite the widespread adoption of virtual interviewing for dermatology residency in the United States (US), there are limited data on the perspectives of those affected. Objectives: Characterize the viewpoints regarding virtual interviewing of applicants, residents, and faculty who participated in the 2022-2023 US dermatology residency application cycle. Methods: Two anonymized surveys were created: one for applicants and the other for programs (residents, program directors, and other faculty). The program survey was distributed through the US Dermatology Program Director listserv in January 2023. The applicant survey was distributed through email in April 2023. Results: There were 336 respondents: 135 applicants, 63 program directors, 77 other faculty, and 61 residents. Overall, the largest proportion favored virtual-only interviewing (39%), followed by some combination of in-person and virtual interviews (28%) and in-person–only interviewing (20%). There was no significant difference between preferences of applicants and program directors (P=0.13). The respondents’ most supported changes for future application cycles were limiting the number of programs to which an applicant can apply (34%), limiting the number of interviews an applicant can accept (30%), and providing funding for applicants with demonstrated need (13%). Limitations: Our study may be limited by the response rates, estimated to be 21% for applicants and 45% for program directors. Conclusion: Given the range of preferences, we would not advocate for requiring virtual-only interviewing at this time for our specialty. Instead, reforms should prioritize the respondents’ most supported changes for future application cycles.
{"title":"Perspectives Regarding Virtual Interviewing for Dermatology Residency in the United States: A Survey of Applicants, Residents, Faculty, and Program Directors in the 2022-2023 Application Cycle","authors":"T. Norman, Jana Guenther, Marie D. Lafeir, Scott Worswick","doi":"10.25251/skin.8.4.6","DOIUrl":"https://doi.org/10.25251/skin.8.4.6","url":null,"abstract":"Background: Despite the widespread adoption of virtual interviewing for dermatology residency in the United States (US), there are limited data on the perspectives of those affected.\u0000Objectives: Characterize the viewpoints regarding virtual interviewing of applicants, residents, and faculty who participated in the 2022-2023 US dermatology residency application cycle.\u0000Methods: Two anonymized surveys were created: one for applicants and the other for programs (residents, program directors, and other faculty). The program survey was distributed through the US Dermatology Program Director listserv in January 2023. The applicant survey was distributed through email in April 2023.\u0000Results: There were 336 respondents: 135 applicants, 63 program directors, 77 other faculty, and 61 residents. Overall, the largest proportion favored virtual-only interviewing (39%), followed by some combination of in-person and virtual interviews (28%) and in-person–only interviewing (20%). There was no significant difference between preferences of applicants and program directors (P=0.13). The respondents’ most supported changes for future application cycles were limiting the number of programs to which an applicant can apply (34%), limiting the number of interviews an applicant can accept (30%), and providing funding for applicants with demonstrated need (13%).\u0000Limitations: Our study may be limited by the response rates, estimated to be 21% for applicants and 45% for program directors. \u0000Conclusion: Given the range of preferences, we would not advocate for requiring virtual-only interviewing at this time for our specialty. Instead, reforms should prioritize the respondents’ most supported changes for future application cycles.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atopic dermatitis (AD) is a relapsing and remitting inflammatory skin disease that can significantly impair an individual’s quality of life. Elderly-onset AD is increasing in prevalence in developed countries, likely due to aging populations. When disease is refractory to both topical steroids and dupilumab (a systemic IL-4R α inhibitor), there remains a lack of guidelines for treatment in elderly populations. Herein, we describe the treatment of five elderly patients (≥ 65-years-old) with upadacitinib, a novel JAK-inhibitor that is rarely used in elderly patients due to the elevated risk of systemic side effects. In this report, we found that upadacitinib successfully treated these patients’ atopic dermatitis, with minimal adverse effects. Presently, all five patients continue with this treatment.
特应性皮炎（AD）是一种复发性和缓解性炎症性皮肤病，会严重影响患者的生活质量。在发达国家，老年特应性皮炎的发病率越来越高，这可能是由于人口老龄化所致。当局部类固醇激素和杜必鲁单抗（一种全身用 IL-4R α 抑制剂）均难治时，仍缺乏针对老年人群的治疗指南。在此，我们介绍了用达达替尼治疗五名老年患者（≥ 65 岁）的情况，达达替尼是一种新型 JAK 抑制剂，由于全身副作用风险较高，很少用于老年患者。在本报告中，我们发现达达替尼成功治疗了这些患者的特应性皮炎，且不良反应极小。目前，所有五名患者都在继续接受这种治疗。
{"title":"Use of Upadacitinib to Treat Atopic Dermatitis Refractory to Dupilumab in Elderly Patients","authors":"M. Hren, S. Khattri","doi":"10.25251/skin.8.4.17","DOIUrl":"https://doi.org/10.25251/skin.8.4.17","url":null,"abstract":"Atopic dermatitis (AD) is a relapsing and remitting inflammatory skin disease that can significantly impair an individual’s quality of life. Elderly-onset AD is increasing in prevalence in developed countries, likely due to aging populations. When disease is refractory to both topical steroids and dupilumab (a systemic IL-4R α inhibitor), there remains a lack of guidelines for treatment in elderly populations. Herein, we describe the treatment of five elderly patients (≥ 65-years-old) with upadacitinib, a novel JAK-inhibitor that is rarely used in elderly patients due to the elevated risk of systemic side effects. In this report, we found that upadacitinib successfully treated these patients’ atopic dermatitis, with minimal adverse effects. Presently, all five patients continue with this treatment.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pruritis, characterized by persistent itchiness lasting more than six weeks, affects up to 15% of the population, significantly impairing quality of life. Despite its prevalence and impact, there is an absence of FDA-approved medications specifically for the treatment of chronic pruritus, highlighting a significant unmet need in dermatology. Advancements in dermatologic medications, however, including the development of biologics and Janus kinase (JAK) inhibitors, signal potential breakthroughs in pruritus management through a radically different mechanism of action that focuses on their effect on the nervous system. Currently, the most commonly utilized treatments for pruritis are sedating antihistamines, which have been largely ineffective for non-histamine-induced itch, underscoring the necessity for novel approaches. This editorial reviews key studies and clinical trials with a particular focus on cases of prurigo nodularis, where itch serves as the primary pathology rather than just a symptom. The effectiveness of dupilumab in phase III trials for treating prurigo nodularis, independent of its effects on dermatitis or atopic background, alongside the success of JAK inhibitors in managing chronic idiopathic pruritus, indicates a shift towards therapies that directly and specifically target itch nerve pathways instead of indirectly via immune system modulation or sedation. These developments suggest that significant progress may be on the horizon for treating chronic itch, providing hope for those suffering from pruritis, the number one cause of misery in dermatology.
{"title":"Treating Chronic Pruritus: Are We at the Threshold of a Breakthrough?","authors":"Payton Smith","doi":"10.25251/skin.8.4.11","DOIUrl":"https://doi.org/10.25251/skin.8.4.11","url":null,"abstract":"Chronic pruritis, characterized by persistent itchiness lasting more than six weeks, affects up to 15% of the population, significantly impairing quality of life. Despite its prevalence and impact, there is an absence of FDA-approved medications specifically for the treatment of chronic pruritus, highlighting a significant unmet need in dermatology. Advancements in dermatologic medications, however, including the development of biologics and Janus kinase (JAK) inhibitors, signal potential breakthroughs in pruritus management through a radically different mechanism of action that focuses on their effect on the nervous system. Currently, the most commonly utilized treatments for pruritis are sedating antihistamines, which have been largely ineffective for non-histamine-induced itch, underscoring the necessity for novel approaches. This editorial reviews key studies and clinical trials with a particular focus on cases of prurigo nodularis, where itch serves as the primary pathology rather than just a symptom. The effectiveness of dupilumab in phase III trials for treating prurigo nodularis, independent of its effects on dermatitis or atopic background, alongside the success of JAK inhibitors in managing chronic idiopathic pruritus, indicates a shift towards therapies that directly and specifically target itch nerve pathways instead of indirectly via immune system modulation or sedation. These developments suggest that significant progress may be on the horizon for treating chronic itch, providing hope for those suffering from pruritis, the number one cause of misery in dermatology.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Pityriasis rubra pilaris (PRP) is an inflammatory eruption of unknown origin; rare cases of COVID-19 vaccine-induced PRP have been reported. Here, we present a case of COVID-19 vaccine-induced pityriasis rubra pilaris inadequately managed with acitretin, successfully treated with the IL-4/IL-13 inhibitor dupilumab. Case Report: A 76-year-old male presented to an outpatient dermatology clinic with a 2-month history of a profoundly pruritic worsening rash characterized by large, orange-salmon-colored follicular papules with scale coalescing into plaques covering approximately 80% of the body surface area. The plaques had well-defined borders and multiple islands of sparing characteristic of PRP. Multiple therapies were trialed with no improvement, including oral prednisone, mycophenolate, topical corticosteroids, antiparasitics, antifungals, doxepin, and UVB treatments. A trial of oral acitretin resulted in improvement of the skin plaques and keratoderma, but the patient remained uncontrollably pruritic. Dupilumab was initiated which provided rapid relief, and the patient has remained clear for several months. Conclusion: Clinicians should be aware of dupilumab’s potential for effective treatment of PRP with recalcitrant pruritus.
{"title":"Pityriasis Rubra Pilaris Following Administration of the Pfizer-BioNTech COVID-19 Vaccine Successfully Treated with Acitretin and Dupilumab","authors":"Raquel Hoopes, Ellen De Moll","doi":"10.25251/skin.8.4.14","DOIUrl":"https://doi.org/10.25251/skin.8.4.14","url":null,"abstract":"Introduction: Pityriasis rubra pilaris (PRP) is an inflammatory eruption of unknown origin; rare cases of COVID-19 vaccine-induced PRP have been reported. Here, we present a case of COVID-19 vaccine-induced pityriasis rubra pilaris inadequately managed with acitretin, successfully treated with the IL-4/IL-13 inhibitor dupilumab. \u0000Case Report: A 76-year-old male presented to an outpatient dermatology clinic with a 2-month history of a profoundly pruritic worsening rash characterized by large, orange-salmon-colored follicular papules with scale coalescing into plaques covering approximately 80% of the body surface area. The plaques had well-defined borders and multiple islands of sparing characteristic of PRP. Multiple therapies were trialed with no improvement, including oral prednisone, mycophenolate, topical corticosteroids, antiparasitics, antifungals, doxepin, and UVB treatments. A trial of oral acitretin resulted in improvement of the skin plaques and keratoderma, but the patient remained uncontrollably pruritic. Dupilumab was initiated which provided rapid relief, and the patient has remained clear for several months. \u0000Conclusion: Clinicians should be aware of dupilumab’s potential for effective treatment of PRP with recalcitrant pruritus. ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.25251/skin.8.supp.413
P. Lio, Alexandra Golant, Raj Chovatiya, Bob Geng, Louise DeLuca-Carter, Zach Dawson, E. Pierce, James Haughton, Peter Anderson, James Piercy, Linda Stein-Gold
Background: Given the changing treatment landscape in atopic dermatitis (AD), it is important to understand real-world disease severity and health care professional (HCP) and patient treatment expectations and goals. This study assesses HCP-reported current disease severity and rates of HCP and patient dissatisfaction with current disease control in patients with a history of moderate-to-severe AD. Methods: This study was an analysis of data from the United States Adelphi AD Disease Specific Programme™, a cross-sectional, descriptive, real-world study of HCP-completed medical records and patient surveys including retrospective data. The study included patients with a current diagnosis or a history of moderate-to-severe AD. HCPs provided information on current AD severity and treatments. Both HCPs and patients provided information on satisfaction with disease control on current treatment, and reasons for any dissatisfaction. Patients were stratified by their current treatment (systemic + topicals, systemic only, or topicals only). Systemic treatments included injectable biologics, oral small molecules, oral and injected corticosteroids, and immunosuppressants; topical treatments included corticosteroids, calcineurin inhibitors, crisaborole, and ruxolitinib. Results A total of 146 HCPs (70 dermatologists, 19 allergists/immunologists, and 57 primary care practitioners) provided data for 747 patients, 215 of whom filled out a patient survey. Based on defined systemic and topical treatments, there were 191 (26%) patients on systemic + topical therapy, 143 (19%) patients on systemics only, and 200 (27%) patients on topicals only. Dissatisfaction rates for AD disease control on current treatment were reported by HCPs and patients for systemic + topicals [20%, 21%], systemic only [10%, 11%], and topicals only [23%, 30%]). The most common reasons for patient dissatisfaction with AD control were the “constant problem of itch,” “lack of clear skin,” “skin lesions that were visible to other people,” and “unresolved flaring.” Despite extended mean treatment duration (MTD), HCPs reported current moderate-to-severe disease severity in 64% of patients on systemic + topicals (MTD 496 days), 50% on systemics only (MTD 456 days), and 61% on topicals only (MTD 268 days). Conclusion: These descriptive results suggest that many patients still have moderate-to-severe AD despite available treatments. A higher proportion of HCPs and patients were dissatisfied with the current level of disease control when topical therapies alone were prescribed. Patient dissatisfaction with disease control was due to itch, lack of clear skin, visible skin lesions, and flares.
背景：鉴于特应性皮炎（AD）的治疗环境不断变化，了解真实世界的疾病严重程度以及医护人员（HCP）和患者的治疗期望和目标非常重要。本研究评估了有中度至重度特应性皮炎病史的患者中由医护人员报告的当前疾病严重程度以及医护人员和患者对当前疾病控制的不满意率。方法：本研究分析了美国阿德尔菲AD疾病专项计划（Adelphi AD Disease Specific Programme™）的数据，该计划是一项横断面、描述性、真实世界研究，研究对象是由HCP填写的医疗记录和患者调查，包括回顾性数据。研究对象包括目前已确诊或有中重度注意力缺失症病史的患者。保健医生提供了有关当前注意力缺失症严重程度和治疗方法的信息。保健医生和患者均提供了对当前治疗的疾病控制满意度的信息，以及不满意的原因。患者按其当前治疗方法（全身治疗+局部治疗、仅全身治疗或仅局部治疗）进行了分层。全身治疗包括注射用生物制剂、口服小分子药物、口服和注射皮质类固醇激素以及免疫抑制剂；局部治疗包括皮质类固醇激素、降钙素抑制剂、脆铂和芦索利替尼。结果 共有 146 名保健医生（70 名皮肤科医生、19 名过敏/免疫科医生和 57 名初级保健医生）提供了 747 名患者的数据，其中 215 人填写了患者调查表。根据确定的全身和局部治疗方法，有 191 名（26%）患者接受全身+局部治疗，143 名（19%）患者只接受全身治疗，200 名（27%）患者只接受局部治疗。保健医生和患者对目前治疗中 AD 疾病控制的不满意率分别为：全身用药+局部用药[20%，21%]，只用全身用药[10%，11%]，只用局部用药[23%，30%]）。患者对 AD 控制不满意的最常见原因是 "一直有痒的问题"、"皮肤不光滑"、"其他人能看到皮损 "和 "未解决的皮损"。尽管延长了平均疗程（MTD），但据高级保健医生报告，64%的患者目前的疾病严重程度为中度至重度，其中64%的患者接受了全身用药+外用药治疗（MTD为496天），50%的患者仅接受了全身用药治疗（MTD为456天），61%的患者仅接受了外用药治疗（MTD为268天）。结论这些描述性结果表明，尽管有可用的治疗方法，但仍有许多患者患有中度至重度注意力缺失症。如果仅使用外用疗法，则有较高比例的保健医生和患者对目前的疾病控制水平不满意。患者对疾病控制不满意的原因包括瘙痒、皮肤不光滑、皮损明显和复发。
{"title":"Atopic Dermatitis Treatment with Topical Therapy Alone Results in Persistent Elevated Disease Severity and High Disease Control Dissatisfaction: Real-World Health Care Professional and Patient Perspectives","authors":"P. Lio, Alexandra Golant, Raj Chovatiya, Bob Geng, Louise DeLuca-Carter, Zach Dawson, E. Pierce, James Haughton, Peter Anderson, James Piercy, Linda Stein-Gold","doi":"10.25251/skin.8.supp.413","DOIUrl":"https://doi.org/10.25251/skin.8.supp.413","url":null,"abstract":"Background: Given the changing treatment landscape in atopic dermatitis (AD), it is important to understand real-world disease severity and health care professional (HCP) and patient treatment expectations and goals. This study assesses HCP-reported current disease severity and rates of HCP and patient dissatisfaction with current disease control in patients with a history of moderate-to-severe AD. \u0000Methods: This study was an analysis of data from the United States Adelphi AD Disease Specific Programme™, a cross-sectional, descriptive, real-world study of HCP-completed medical records and patient surveys including retrospective data. The study included patients with a current diagnosis or a history of moderate-to-severe AD. HCPs provided information on current AD severity and treatments. Both HCPs and patients provided information on satisfaction with disease control on current treatment, and reasons for any dissatisfaction. Patients were stratified by their current treatment (systemic + topicals, systemic only, or topicals only). Systemic treatments included injectable biologics, oral small molecules, oral and injected corticosteroids, and immunosuppressants; topical treatments included corticosteroids, calcineurin inhibitors, crisaborole, and ruxolitinib. \u0000Results A total of 146 HCPs (70 dermatologists, 19 allergists/immunologists, and 57 primary care practitioners) provided data for 747 patients, 215 of whom filled out a patient survey. Based on defined systemic and topical treatments, there were 191 (26%) patients on systemic + topical therapy, 143 (19%) patients on systemics only, and 200 (27%) patients on topicals only. Dissatisfaction rates for AD disease control on current treatment were reported by HCPs and patients for systemic + topicals [20%, 21%], systemic only [10%, 11%], and topicals only [23%, 30%]). The most common reasons for patient dissatisfaction with AD control were the “constant problem of itch,” “lack of clear skin,” “skin lesions that were visible to other people,” and “unresolved flaring.” Despite extended mean treatment duration (MTD), HCPs reported current moderate-to-severe disease severity in 64% of patients on systemic + topicals (MTD 496 days), 50% on systemics only (MTD 456 days), and 61% on topicals only (MTD 268 days). \u0000Conclusion: These descriptive results suggest that many patients still have moderate-to-severe AD despite available treatments. A higher proportion of HCPs and patients were dissatisfied with the current level of disease control when topical therapies alone were prescribed. Patient dissatisfaction with disease control was due to itch, lack of clear skin, visible skin lesions, and flares.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shivkar Amara, Ariana Sapoznik, S. Guénin, Nilesh Kodali, M. Lebwohl
Background: Janus Kinase (JAK) inhibitors interfere with the JAK-STAT signaling pathway, which is vital in regulating inflammation and immune function. Notably, upadacitinib, a JAK inhibitor, has been increasingly used as a treatment modality for refractory inflammatory diseases. Methods: A literature review was conducted on Pubmed and Clinical Trials.gov using the keywords “upadacitinib” combined with “off-label”, “dermatology”, “skin”, or “cutaneous” from October 1st, 2021, to October 1st, 2023. 941 articles were reviewed, and 50 articles were included. Results: The systematic search revealed 20 different dermatology conditions treated with off-label use of upadacitinib. Most of these conditions showed drastic improvement by actively decreasing the inflammatory response involved in the pathogenesis of that condition. The most common side effects reported for the medication were elevated creatine kinase, headaches, urinary tract infections, and acne. Patients should also be advised to consider the shingles vaccines prior to upadacitinib treatment. Conclusion: Upadacitinib shows potential utility in the treatment of refractory inflammatory dermatologic conditions, treatment-resistant pruritus, and medication-induced skin reactions. Further large-scale, controlled clinical trials are needed to evaluate the further indications of upadacitinib and its safety profile.
{"title":"Off-Label Uses of Upadacitinib","authors":"Shivkar Amara, Ariana Sapoznik, S. Guénin, Nilesh Kodali, M. Lebwohl","doi":"10.25251/skin.8.4.1","DOIUrl":"https://doi.org/10.25251/skin.8.4.1","url":null,"abstract":"Background: Janus Kinase (JAK) inhibitors interfere with the JAK-STAT signaling pathway, which is vital in regulating inflammation and immune function. Notably, upadacitinib, a JAK inhibitor, has been increasingly used as a treatment modality for refractory inflammatory diseases. \u0000Methods: A literature review was conducted on Pubmed and Clinical Trials.gov using the keywords “upadacitinib” combined with “off-label”, “dermatology”, “skin”, or “cutaneous” from October 1st, 2021, to October 1st, 2023. 941 articles were reviewed, and 50 articles were included. \u0000Results: The systematic search revealed 20 different dermatology conditions treated with off-label use of upadacitinib. Most of these conditions showed drastic improvement by actively decreasing the inflammatory response involved in the pathogenesis of that condition. The most common side effects reported for the medication were elevated creatine kinase, headaches, urinary tract infections, and acne. Patients should also be advised to consider the shingles vaccines prior to upadacitinib treatment. \u0000Conclusion: Upadacitinib shows potential utility in the treatment of refractory inflammatory dermatologic conditions, treatment-resistant pruritus, and medication-induced skin reactions. Further large-scale, controlled clinical trials are needed to evaluate the further indications of upadacitinib and its safety profile. ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-23DOI: 10.25251/skin.8.supp.412
Andrew Blauvelt, Chih-ho Hong, Ketty Peris, Norito Katoh, Marie Tauber, Mahreen Ameen, Melinda Gooderham, C. Øland, Ann-Marie Tindberg, Le Gjerum, Kristian Reich
Introduction: To ensure minimal residual disease and to prevent relapses, recently published consensus reports have defined optimal long-term treatment targets for atopic dermatitis (AD).1,2 Tralokinumab, a monoclonal antibody specifically neutralizing interleukin-13, is approved for the treatment of moderate-to-severe AD. ECZTEND (NCT03587805) is an ongoing open-label, 5-year extension trial investigating the long-term safety and efficacy of tralokinumab 300 mg every other week (Q2W) plus optional topical corticosteroids (TCS). Objectives of this analysis were to determine the proportion of patients treated for up to 4 years with tralokinumab in AD clinical trials who: 1) exhibit stable improvement, with no or minimal fluctuations, in lesion extent and severity long-term (ie, response in ≥80% of attended visits), and 2) exhibit a stable long-term composite response (ie, up to 4 years of tralokinumab treatment and response in ≥80% of attended trial visits) in signs and symptoms of AD, and quality of life based on recent treat-to-target recommendations (EASI ≤7 and either DLQI ≤5 or Itch NRS ≤4). Methods: This post hoc analysis included 347 patients who were continuously treated with tralokinumab for 52 weeks in the identically designed phase 3 monotherapy trials ECZTRA 1&2 and subsequently for up to 152 weeks in ECZTEND as of the April 30, 2022 data cutoff. Stability of long-term response, with no or minimal fluctuations, was defined as meeting the target endpoints at ≥80% of attended visits between Weeks 16-152 in ECZTEND. Endpoints analyzed were EASI ≤7, EASI ≤2, and a composite long-term treatment target: EASI ≤7 and either DLQI ≤5 or worst weekly pruritus NRS ≤4. Results: A stable EASI ≤7 response (at ≥80% of attended visits) was observed in 70.2% (233/332) of tralokinumab-treated patients over Weeks 16-152 of ECZTEND. A stable EASI ≤2 response was observed in 34.0% (113/332) of patients, and a long-term optimal composite target, EASI ≤7 and either DLQI ≤5 or Itch NRS ≤4, was observed in 60.5% (201/332) of patients. Conclusions: High proportions of clinical trial patients maintained stable responses, with no or minimal fluctuations in efficacy, with continued tralokinumab 300 mg Q2W plus optional TCS for up to 4 years of treatment.
{"title":"Stability of Long-Term Therapeutic Responses to Tralokinumab in Adults with Moderate-to-Severe Atopic Dermatitis","authors":"Andrew Blauvelt, Chih-ho Hong, Ketty Peris, Norito Katoh, Marie Tauber, Mahreen Ameen, Melinda Gooderham, C. Øland, Ann-Marie Tindberg, Le Gjerum, Kristian Reich","doi":"10.25251/skin.8.supp.412","DOIUrl":"https://doi.org/10.25251/skin.8.supp.412","url":null,"abstract":"Introduction: To ensure minimal residual disease and to prevent relapses, recently published consensus reports have defined optimal long-term treatment targets for atopic dermatitis (AD).1,2 Tralokinumab, a monoclonal antibody specifically neutralizing interleukin-13, is approved for the treatment of moderate-to-severe AD. ECZTEND (NCT03587805) is an ongoing open-label, 5-year extension trial investigating the long-term safety and efficacy of tralokinumab 300 mg every other week (Q2W) plus optional topical corticosteroids (TCS). Objectives of this analysis were to determine the proportion of patients treated for up to 4 years with tralokinumab in AD clinical trials who: 1) exhibit stable improvement, with no or minimal fluctuations, in lesion extent and severity long-term (ie, response in ≥80% of attended visits), and 2) exhibit a stable long-term composite response (ie, up to 4 years of tralokinumab treatment and response in ≥80% of attended trial visits) in signs and symptoms of AD, and quality of life based on recent treat-to-target recommendations (EASI ≤7 and either DLQI ≤5 or Itch NRS ≤4). \u0000Methods: This post hoc analysis included 347 patients who were continuously treated with tralokinumab for 52 weeks in the identically designed phase 3 monotherapy trials ECZTRA 1&2 and subsequently for up to 152 weeks in ECZTEND as of the April 30, 2022 data cutoff. Stability of long-term response, with no or minimal fluctuations, was defined as meeting the target endpoints at ≥80% of attended visits between Weeks 16-152 in ECZTEND. Endpoints analyzed were EASI ≤7, EASI ≤2, and a composite long-term treatment target: EASI ≤7 and either DLQI ≤5 or worst weekly pruritus NRS ≤4. \u0000Results: A stable EASI ≤7 response (at ≥80% of attended visits) was observed in 70.2% (233/332) of tralokinumab-treated patients over Weeks 16-152 of ECZTEND. A stable EASI ≤2 response was observed in 34.0% (113/332) of patients, and a long-term optimal composite target, EASI ≤7 and either DLQI ≤5 or Itch NRS ≤4, was observed in 60.5% (201/332) of patients. \u0000Conclusions: High proportions of clinical trial patients maintained stable responses, with no or minimal fluctuations in efficacy, with continued tralokinumab 300 mg Q2W plus optional TCS for up to 4 years of treatment.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Confluent and reticulated papillomatosis (CRP) is a rare dermatosis initially that typically affects young adults and is characterized by scaly, hyperpigmented macules or papillomatous papules combining into patches typically involving the upper trunk and neck. Herein, we report two cases of CRP successfully treated with topical minocycline. The most widely accepted treatment of CRP to date is oral minocycline. Due to the chronic nature of CRP, topical minocycline could be considered a better first-line treatment option. This alternative treatment offers the advantage of a targeted, local application for enhanced skin bioavailability and efficacy. This case supports the possibility of topical minocycline use as an alternative to long-term oral antibiotics for treatment of CRP.
{"title":"Use of Topical Minocycline for Treatment of Confluent and Reticulated Papillomatosis","authors":"Shannon Meledathu, Helen Nguyen, Zain Husain","doi":"10.25251/skin.8.4.21","DOIUrl":"https://doi.org/10.25251/skin.8.4.21","url":null,"abstract":"Confluent and reticulated papillomatosis (CRP) is a rare dermatosis initially that typically affects young adults and is characterized by scaly, hyperpigmented macules or papillomatous papules combining into patches typically involving the upper trunk and neck. Herein, we report two cases of CRP successfully treated with topical minocycline. The most widely accepted treatment of CRP to date is oral minocycline. Due to the chronic nature of CRP, topical minocycline could be considered a better first-line treatment option. This alternative treatment offers the advantage of a targeted, local application for enhanced skin bioavailability and efficacy. This case supports the possibility of topical minocycline use as an alternative to long-term oral antibiotics for treatment of CRP.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Katherine De Jong, Mojahed M. K. Shalabi, Dale Schaefer
Erythema Elevatum Diutinum (EED) is a distinctive form of chronic leukocytoclastic vasculitis characterized by red to brown papules, plaques, and nodules that favor the extensor aspect of the extremities. EED is a benign condition but may be associated with several systemic diseases, including hematologic disorders, infections, and autoimmune conditions. EED is a rare entity of vasculitis, with less than 400 cases being reported in world literature to date. We present a rare case of a 61-year-old male with IgA monoclonal gammopathy of undetermined significance (MGUS) and a 17-year history of EED that improved significantly with dapsone treatment.
{"title":"Erythema Elevatum Diutinum in Association with IgA Monoclonal Gammopathy of Undetermined Significance","authors":"Katherine De Jong, Mojahed M. K. Shalabi, Dale Schaefer","doi":"10.25251/skin.8.4.24","DOIUrl":"https://doi.org/10.25251/skin.8.4.24","url":null,"abstract":"Erythema Elevatum Diutinum (EED) is a distinctive form of chronic leukocytoclastic vasculitis characterized by red to brown papules, plaques, and nodules that favor the extensor aspect of the extremities. EED is a benign condition but may be associated with several systemic diseases, including hematologic disorders, infections, and autoimmune conditions. EED is a rare entity of vasculitis, with less than 400 cases being reported in world literature to date. We present a rare case of a 61-year-old male with IgA monoclonal gammopathy of undetermined significance (MGUS) and a 17-year history of EED that improved significantly with dapsone treatment. ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cutaneous lupus erythematosus (CLE) is a heterogeneous disorder that can present alone as cutaneous disease or in conjunction with systemic lupus erythematosus (SLE). Despite CLE often being severe and worsening quality of life, there is still no FDA approved drug for CLE. Anifrolumab, a fully humanized IgG1κ monoclonal antibody, has become a drug of interest because of its significant skin improvement in the SLE trials. We performed a retrospective chart review of a cohort of twenty-four patients initiating anifrolumab infusion therapy from January to November 2022. Twenty-two patients were also identified as having CLE in addition to SLE. Chart review occurred up to August 21, 2023. Of the twenty-two patients, thirteen (59%) were able to reduce or stop either prednisone or a disease-modifying antirheumatic drug (DMARD). Specifically, eight patients (36%) of the twenty-two completely stopped at least one DMARD. Notably sixteen patients (70%) started anifrolumab on prednisone with eight (50%) being able to discontinue prednisone completely. Seventeen (77%) of the twenty-two had improvement of skin lesions by resolution of rash, no flares since therapy initiation, repigmentation, hair regrowth, or decrease in erythema and scale. Two of the total twenty-four patients reviewed did not have clear evidence of cutaneous lupus although did have cutaneous disease likely related to SLE, therefore were not included in data analysis although are represented in Table 2. The decrease in disease burden, ability to decrease other therapies, and overall tolerability of anifrolumab makes it a promising therapy for those with CLE.
{"title":" A Retrospective Review of 22 patients on Anifrolumab in Refractory Cutaneous Lupus","authors":"Elliott Herron, Lauren Graham, Andrew Fortugno","doi":"10.25251/skin.8.4.2","DOIUrl":"https://doi.org/10.25251/skin.8.4.2","url":null,"abstract":"Cutaneous lupus erythematosus (CLE) is a heterogeneous disorder that can present alone as cutaneous disease or in conjunction with systemic lupus erythematosus (SLE). Despite CLE often being severe and worsening quality of life, there is still no FDA approved drug for CLE. Anifrolumab, a fully humanized IgG1κ monoclonal antibody, has become a drug of interest because of its significant skin improvement in the SLE trials. We performed a retrospective chart review of a cohort of twenty-four patients initiating anifrolumab infusion therapy from January to November 2022. Twenty-two patients were also identified as having CLE in addition to SLE. Chart review occurred up to August 21, 2023. \u0000 \u0000Of the twenty-two patients, thirteen (59%) were able to reduce or stop either prednisone or a disease-modifying antirheumatic drug (DMARD). Specifically, eight patients (36%) of the twenty-two completely stopped at least one DMARD. Notably sixteen patients (70%) started anifrolumab on prednisone with eight (50%) being able to discontinue prednisone completely. Seventeen (77%) of the twenty-two had improvement of skin lesions by resolution of rash, no flares since therapy initiation, repigmentation, hair regrowth, or decrease in erythema and scale. Two of the total twenty-four patients reviewed did not have clear evidence of cutaneous lupus although did have cutaneous disease likely related to SLE, therefore were not included in data analysis although are represented in Table 2. The decrease in disease burden, ability to decrease other therapies, and overall tolerability of anifrolumab makes it a promising therapy for those with CLE. ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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