Faraz Yousefian, Mary Michael, Sujitha Yadlapati, Emily Sedaghat, Brad Glick
Relapsing Polychondritis (RP) is a rare autoimmune disease associated with recurring inflammatory episodes predominantly affecting cartilage and other tissues throughout the body, including proteoglycan-rich structures. It is characterized by gradual deformation of tissue that leads to impairment of normal function. Areas involved include, but are not limited to, the respiratory tract, eyes, nose, joints, and vascular system. The inflammation targets cartilage, most commonly causing auricular and nasal chondritis but can involve cartilage throughout the body. Diagnosis of RP is often hindered by the vast variety of symptoms associated with this systemic disease and subtle symptomatology. In this paper, we demonstrate a case of relapsing polychondritis masquerading as pseudolymphoma and review recent literature relating to pathogenesis, diagnosis and treatment.
复发性多软骨炎（RP）是一种罕见的自身免疫性疾病，炎症反复发作，主要影响软骨和全身其他组织，包括富含蛋白多糖的结构。其特点是组织逐渐变形，导致正常功能受损。涉及的部位包括但不限于呼吸道、眼睛、鼻子、关节和血管系统。炎症主要针对软骨，最常见的是耳软骨炎和鼻软骨炎，但也可累及全身软骨。由于这种全身性疾病的相关症状种类繁多，且症状表现不明显，因此 RP 的诊断往往受到阻碍。在本文中，我们展示了一例伪装成假淋巴瘤的复发性多软骨炎病例，并回顾了与发病机制、诊断和治疗相关的最新文献。
{"title":"Relapsing Polychondritis Masquerading as Auricular Pseudolymphoma: Case Report and Literature Review","authors":"Faraz Yousefian, Mary Michael, Sujitha Yadlapati, Emily Sedaghat, Brad Glick","doi":"10.25251/skin.8.4.16","DOIUrl":"https://doi.org/10.25251/skin.8.4.16","url":null,"abstract":"Relapsing Polychondritis (RP) is a rare autoimmune disease associated with recurring inflammatory episodes predominantly affecting cartilage and other tissues throughout the body, including proteoglycan-rich structures. It is characterized by gradual deformation of tissue that leads to impairment of normal function. Areas involved include, but are not limited to, the respiratory tract, eyes, nose, joints, and vascular system. The inflammation targets cartilage, most commonly causing auricular and nasal chondritis but can involve cartilage throughout the body. Diagnosis of RP is often hindered by the vast variety of symptoms associated with this systemic disease and subtle symptomatology. In this paper, we demonstrate a case of relapsing polychondritis masquerading as pseudolymphoma and review recent literature relating to pathogenesis, diagnosis and treatment.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"101 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812322","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.407
B. Strober, Shinichi Imafuku, Carle Paul, Melinda Gooderham, L. Spelman, S. J. Seo, T. Passeron, K. Hoyt, Matthew J Colombo, Subhashis Banerjee, Matthias Augustin, L. Stein Gold, Andrew Alexis, Diamant Thaçi, M. Lebwohl, Naiem T. Issa, Michael C. Cameron
Introduction: Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, was superior to placebo and apremilast in two global, phase 3 trials (POETYK PSO-1 and PSO-2) in moderate to severe plaque psoriasis. At Week 52, patients could enter the POETYK long-term extension (LTE) trial and receive open-label deucravacitinib. Long-term efficacy was maintained through 3 total years of continuous treatment with no new safety signals in the ongoing LTE. Methods: Efficacy was further evaluated through Week 208 (4 years; data cutoff, November 1, 2023) in patients from the pooled PSO-1/PSO-2 populations who received continuous deucravacitinib from Day 1, achieved ≥75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at Week 16 (primary endpoint) or Week 24 (peak response), and entered the LTE. Maintenance of response assessments included PASI 75, PASI 90, and sPGA 0/1 (static Physician Global Assessment score of 0 [clear]/1 [almost clear]). Efficacy is reported using modified nonresponder imputation in patients who reached or discontinued before Week 208. Results: Of 513 patients who received continuous deucravacitinib from Day 1 and entered the LTE, PASI 75 was achieved by 313 (61.0%) and 336 (65.5%) patients at Week 16 and Week 24. Among Week 16 PASI 75 responders, response rates were maintained well from Week 16 to Week 208 (PASI 75: 100%, 84.4%; PASI 90: 55.7%, 57.4%; sPGA 0/1: 82.8%, 65.4%). Among Week 24 PASI 75 responders, response rates were also maintained from Week 24 to Week 208 (PASI 75: 100%, 84.6%; PASI 90: 62.7%, 58.2%; sPGA 0/1: 82.5%, 66.0%). Conclusion: Clinical efficacy was generally maintained with continuous deucravacitinib in the vast majority of Week 16 and Week 24 PASI 75 responders from the parent trials through 4 years, supporting the long-term effectiveness and treatment durability of once-daily oral deucravacitinib for moderate to severe plaque psoriasis.
{"title":"Deucravacitinib in Plaque Psoriasis: Maintenance of Response Over 4 Years in the Phase 3 POETYK PSO-1, PSO-2, and LTE Trials","authors":"B. Strober, Shinichi Imafuku, Carle Paul, Melinda Gooderham, L. Spelman, S. J. Seo, T. Passeron, K. Hoyt, Matthew J Colombo, Subhashis Banerjee, Matthias Augustin, L. Stein Gold, Andrew Alexis, Diamant Thaçi, M. Lebwohl, Naiem T. Issa, Michael C. Cameron","doi":"10.25251/skin.8.supp.407","DOIUrl":"https://doi.org/10.25251/skin.8.supp.407","url":null,"abstract":"Introduction: Deucravacitinib, an oral, selective, allosteric TYK2 inhibitor, was superior to placebo and apremilast in two global, phase 3 trials (POETYK PSO-1 and PSO-2) in moderate to severe plaque psoriasis. At Week 52, patients could enter the POETYK long-term extension (LTE) trial and receive open-label deucravacitinib. Long-term efficacy was maintained through 3 total years of continuous treatment with no new safety signals in the ongoing LTE. \u0000Methods: Efficacy was further evaluated through Week 208 (4 years; data cutoff, November 1, 2023) in patients from the pooled PSO-1/PSO-2 populations who received continuous deucravacitinib from Day 1, achieved ≥75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) at Week 16 (primary endpoint) or Week 24 (peak response), and entered the LTE. Maintenance of response assessments included PASI 75, PASI 90, and sPGA 0/1 (static Physician Global Assessment score of 0 [clear]/1 [almost clear]). Efficacy is reported using modified nonresponder imputation in patients who reached or discontinued before Week 208. \u0000Results: Of 513 patients who received continuous deucravacitinib from Day 1 and entered the LTE, PASI 75 was achieved by 313 (61.0%) and 336 (65.5%) patients at Week 16 and Week 24. Among Week 16 PASI 75 responders, response rates were maintained well from Week 16 to Week 208 (PASI 75: 100%, 84.4%; PASI 90: 55.7%, 57.4%; sPGA 0/1: 82.8%, 65.4%). Among Week 24 PASI 75 responders, response rates were also maintained from Week 24 to Week 208 (PASI 75: 100%, 84.6%; PASI 90: 62.7%, 58.2%; sPGA 0/1: 82.5%, 66.0%). \u0000Conclusion: Clinical efficacy was generally maintained with continuous deucravacitinib in the vast majority of Week 16 and Week 24 PASI 75 responders from the parent trials through 4 years, supporting the long-term effectiveness and treatment durability of once-daily oral deucravacitinib for moderate to severe plaque psoriasis.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810614","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.414
James Q. Del Rosso, L. Kircik, Emil A. Tanghetti, Z. Draelos, April Armstrong, Valerie D. Callender, Neal Bhatia, Steven R Feldman
Introduction: Acne vulgaris and related sequelae negatively impact quality of life and are associated with increased rates of anxiety and depression. However, treatment of acne can be difficult due to its long time course, chronicity, and low patient adherence. While national acne guidelines have been recently updated, there is a need for practical, easy-to-use guidance for healthcare practitioners who treat patients with acne. Methods: A roundtable discussion with a panel of eight clinicians and dermatologists was held to provide recommendations for the diagnosis and treatment of acne, including appropriate pharmaceutical treatments based on clinical presentation and patient population, patient discussion points, and advice for clinicians regarding acne treatment. Results: The consensus was that successful acne treatment is contingent upon meeting three core goals: 1) correct diagnosis; 2) proper treatment regimen; and 3) patient adherence and education. 1: Acne should be diagnosed using both quantitative and qualitative assessments, taking into consideration the patient’s lived experience with acne. Quantitative assessments include acne duration; lesion type and location; inflammation; acne-related sequelae; and family history of scarring. Qualitative assessments determine how bothersome acne and/or sequelae are to patients and how much they impact quality of life. Differential diagnoses should be performed to rule out acneiform lesions, genetic disorders, infections, and certain types of medications. 2: For most patients, a combination topical treatment containing benzoyl peroxide and a retinoid and/or an antibiotic is recommended to address the multiple acne pathological processes, though sequelae and patient characteristics should be considered (eg, post-inflammatory hyperpigmentation in patients with skin of color). Fixed-dose combinations are preferred to ensure proper skin coverage, simplify treatment complexity, and improve adherence. 3: For optimal outcomes, patients should be educated about their treatments and consequences of non-adherence; realistic treatment goals should be established to manage patient expectations. A patient handout on skin care best practices can be used to detail their overall skin care regimen, treatments, and subsequent visits. Conclusions: This practical guidance aims to assist clinicians in the successful diagnosis and treatment of acne as well as patient management/education.
{"title":"Therapeutic Recommendations for the Treatment of Acne Vulgaris in the US","authors":"James Q. Del Rosso, L. Kircik, Emil A. Tanghetti, Z. Draelos, April Armstrong, Valerie D. Callender, Neal Bhatia, Steven R Feldman","doi":"10.25251/skin.8.supp.414","DOIUrl":"https://doi.org/10.25251/skin.8.supp.414","url":null,"abstract":"Introduction: Acne vulgaris and related sequelae negatively impact quality of life and are associated with increased rates of anxiety and depression. However, treatment of acne can be difficult due to its long time course, chronicity, and low patient adherence. While national acne guidelines have been recently updated, there is a need for practical, easy-to-use guidance for healthcare practitioners who treat patients with acne.\u0000Methods: A roundtable discussion with a panel of eight clinicians and dermatologists was held to provide recommendations for the diagnosis and treatment of acne, including appropriate pharmaceutical treatments based on clinical presentation and patient population, patient discussion points, and advice for clinicians regarding acne treatment.\u0000Results: The consensus was that successful acne treatment is contingent upon meeting three core goals: 1) correct diagnosis; 2) proper treatment regimen; and 3) patient adherence and education.\u00001: Acne should be diagnosed using both quantitative and qualitative assessments, taking into consideration the patient’s lived experience with acne. Quantitative assessments include acne duration; lesion type and location; inflammation; acne-related sequelae; and family history of scarring. Qualitative assessments determine how bothersome acne and/or sequelae are to patients and how much they impact quality of life. Differential diagnoses should be performed to rule out acneiform lesions, genetic disorders, infections, and certain types of medications.\u00002: For most patients, a combination topical treatment containing benzoyl peroxide and a retinoid and/or an antibiotic is recommended to address the multiple acne pathological processes, though sequelae and patient characteristics should be considered (eg, post-inflammatory hyperpigmentation in patients with skin of color). Fixed-dose combinations are preferred to ensure proper skin coverage, simplify treatment complexity, and improve adherence.\u00003: For optimal outcomes, patients should be educated about their treatments and consequences of non-adherence; realistic treatment goals should be established to manage patient expectations. A patient handout on skin care best practices can be used to detail their overall skin care regimen, treatments, and subsequent visits.\u0000Conclusions: This practical guidance aims to assist clinicians in the successful diagnosis and treatment of acne as well as patient management/education.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"12 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813469","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}
Background: Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory condition of the skin. Pain in HS is one of the most common symptoms and has a devastating effect on quality of life. Here, we present a unique case of a patient with HS and pain management guidelines used to treat her condition. Case Report: This is a 42-year-old woman with a history of HS, hypertension, depression who presented with one month of pain in her groin crease, vulva, and rectum. She was recently discharged from the hospital for HS superinfection. She was treated with intravenous and oral antibiotics. She previously tried treatment with acetaminophen, lidocaine 2% jelly, gabapentin 400 mg TID, oxycodone, dilaudid, adalimumab, infliximab, topical clindamycin, intralesional steroid injections, and doxycycline. The pain management specialist recommended continuing treatment with gabapentin 400 mg TID and titrate to 600 mg TID as tolerated, and to follow up with the dermatology team to restart infliximab. Discussion: This case demonstrates a complicated, refractory HS condition that necessitates first, second, and third line treatment modalities. Pain control in HS starts by having best control of the underlying disease. The United States and Canadian Hidradenitis Suppurativa Foundations clinical guidelines suggest acute pain management should include topical analgesics (ie, lidocaine), oral acetaminophen, and oral nonsteroidal anti-inflammatory drugs. Chronic pain management should focus on a multidisciplinary approach. Clinical guidelines recommend escalating oral analgesics for pain that doesn’t respond to first-line agents. Opiate use should follow the World Health Organization pain ladder of tramadol, codeine, hydrocodone, and morphine. Neuropathic pain can be treated with pregabalin or gabapentin, titrated as tolerated by patients. Chronic HS lesions can be treated with wide local scalpel, CO2, or electrosurgical excision, and recurrent nodules can be deroofed or excised. Superior hypogastric plexus block and/or ganglion impar block can be considered for refractory cases. Conclusion: HS is an extremely painful condition severely affecting quality of life. Adequate pain management is vital, and a stepwise approach is recommended.
{"title":"Pain Management of Refractory Hidradenitis Suppurativa: Case Report","authors":"Aaron Burshtein, Paul Shekane","doi":"10.25251/skin.8.4.7","DOIUrl":"https://doi.org/10.25251/skin.8.4.7","url":null,"abstract":"Background: Hidradenitis suppurativa (HS) is a chronic, relapsing, and painful inflammatory condition of the skin. Pain in HS is one of the most common symptoms and has a devastating effect on quality of life. Here, we present a unique case of a patient with HS and pain management guidelines used to treat her condition. \u0000Case Report: This is a 42-year-old woman with a history of HS, hypertension, depression who presented with one month of pain in her groin crease, vulva, and rectum. She was recently discharged from the hospital for HS superinfection. She was treated with intravenous and oral antibiotics. She previously tried treatment with acetaminophen, lidocaine 2% jelly, gabapentin 400 mg TID, oxycodone, dilaudid, adalimumab, infliximab, topical clindamycin, intralesional steroid injections, and doxycycline. The pain management specialist recommended continuing treatment with gabapentin 400 mg TID and titrate to 600 mg TID as tolerated, and to follow up with the dermatology team to restart infliximab.\u0000Discussion: This case demonstrates a complicated, refractory HS condition that necessitates first, second, and third line treatment modalities. Pain control in HS starts by having best control of the underlying disease. The United States and Canadian Hidradenitis Suppurativa Foundations clinical guidelines suggest acute pain management should include topical analgesics (ie, lidocaine), oral acetaminophen, and oral nonsteroidal anti-inflammatory drugs. Chronic pain management should focus on a multidisciplinary approach. Clinical guidelines recommend escalating oral analgesics for pain that doesn’t respond to first-line agents. Opiate use should follow the World Health Organization pain ladder of tramadol, codeine, hydrocodone, and morphine. Neuropathic pain can be treated with pregabalin or gabapentin, titrated as tolerated by patients. Chronic HS lesions can be treated with wide local scalpel, CO2, or electrosurgical excision, and recurrent nodules can be deroofed or excised. Superior hypogastric plexus block and/or ganglion impar block can be considered for refractory cases.\u0000Conclusion: HS is an extremely painful condition severely affecting quality of life. Adequate pain management is vital, and a stepwise approach is recommended.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"36 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141814103","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}
Summer Wong, Christopher Kowalczyk, Rehan Karim, Stanley Skopit, Francisco Kerdel
Background: Sweet's syndrome (SS) is a relatively rare, self-limiting dermatological condition predominantly affecting women aged 30-50. It is characterized by the sudden onset of erythematous plaques, nodules, or papules on the skin and is often accompanied by fever, leukocytosis, and systemic symptoms. While most SS cases are idiopathic, approximately 5% are drug-induced. Case: This case report describes a 34-year-old female with a medical history significant for epilepsy who presented with diffuse erythematous papules on the bilateral upper extremities. The onset of these symptoms coincided with the initiation of Xcopri (cenobamate tablets) in her medication regimen. Conclusion: To our knowledge, this report highlights the first case of Xcopri-induced SS. We interpret this patient's presentation as a cutaneous response secondary to an adverse drug reaction and aim to emphasize the importance of obtaining a thorough medication history at each clinical consultation.
{"title":"Drug-Induced Sweet’s Syndrome by Xcopri","authors":"Summer Wong, Christopher Kowalczyk, Rehan Karim, Stanley Skopit, Francisco Kerdel","doi":"10.25251/skin.8.4.15","DOIUrl":"https://doi.org/10.25251/skin.8.4.15","url":null,"abstract":"Background: Sweet's syndrome (SS) is a relatively rare, self-limiting dermatological condition predominantly affecting women aged 30-50. It is characterized by the sudden onset of erythematous plaques, nodules, or papules on the skin and is often accompanied by fever, leukocytosis, and systemic symptoms. While most SS cases are idiopathic, approximately 5% are drug-induced. \u0000Case: This case report describes a 34-year-old female with a medical history significant for epilepsy who presented with diffuse erythematous papules on the bilateral upper extremities. The onset of these symptoms coincided with the initiation of Xcopri (cenobamate tablets) in her medication regimen. \u0000Conclusion: To our knowledge, this report highlights the first case of Xcopri-induced SS. We interpret this patient's presentation as a cutaneous response secondary to an adverse drug reaction and aim to emphasize the importance of obtaining a thorough medication history at each clinical consultation.","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"129 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811529","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.415
L. Kircik, Julie C. Harper, Hilary Baldwin, L. Eichenfield, Emil A. Tanghetti, Emmy Graber, Heather C. Woolery-Lloyd, Z. Draelos
Introduction: Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel is the first fixed-dose, triple-combination formulation approved for the treatment of acne. In three clinical studies of participants with moderate-to-severe acne, CAB gel demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability. As acne pathogenesis and treatment outcomes can vary with age, this post hoc analysis was performed to evaluate the efficacy and safety of CAB in pediatric and adolescent participants (aged 9-24 years) versus adult participants (≥25 years). This age cutoff was chosen as acne in patients aged 18-24 years is more similar to adolescents than adults, and age 25 is often used to define “adult acne”. Methods: In a phase 2 (NCT03170388) and two phase 3 (NCT04214652, NCT04214639) studies, participants aged ≥9 years with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel. Endpoints included percentage of participants achieving treatment success (defined as ≥2-grade reduction from baseline in Evaluator’s Global Severity Score and clear/almost clear skin) and least-squares mean percent change from baseline in inflammatory/noninflammatory lesion counts at week 12. Treatment-emergent adverse events (TEAEs) were also assessed. Pooled data across all three studies were analyzed for participants aged 9-24 years (CAB: n=297; vehicle: n=218) or ≥25 years (n=91; n=51). Results: At week 12, approximately half of CAB-treated participants in both age groups achieved treatment success (9-24 years: 50.6%; ≥25: 49.0%) versus less than one-fourth with vehicle (15.7% and 20.6%; P<0.01, both). Treatment with CAB resulted in >70% reductions from baseline in inflammatory and noninflammatory lesions in both age groups, versus 45%-62% with vehicle (P≤0.001, all). There were no significant differences between CAB-treated participants in the two age groups across any of these efficacy endpoints (P=0.68-0.97). Most TEAEs with CAB were of mild-moderate severity, with no age-related trends in safety/tolerability. Conclusions: Fixed-dose, triple-combination CAB gel was efficacious and well tolerated in participants with moderate-to-severe acne, regardless of age. Approximately half of pediatric/adolescent and adult participants achieved clear/almost clear skin with CAB, and lesion count reductions of >70% were observed. Funding: Ortho Dermatologics
{"title":"Impact of Age on Efficacy and Safety of Fixed-Dose Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel in Participants with Moderate-to-Severe Acne","authors":"L. Kircik, Julie C. Harper, Hilary Baldwin, L. Eichenfield, Emil A. Tanghetti, Emmy Graber, Heather C. Woolery-Lloyd, Z. Draelos","doi":"10.25251/skin.8.supp.415","DOIUrl":"https://doi.org/10.25251/skin.8.supp.415","url":null,"abstract":"Introduction: Topical clindamycin phosphate 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% (CAB) gel is the first fixed-dose, triple-combination formulation approved for the treatment of acne. In three clinical studies of participants with moderate-to-severe acne, CAB gel demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability. As acne pathogenesis and treatment outcomes can vary with age, this post hoc analysis was performed to evaluate the efficacy and safety of CAB in pediatric and adolescent participants (aged 9-24 years) versus adult participants (≥25 years). This age cutoff was chosen as acne in patients aged 18-24 years is more similar to adolescents than adults, and age 25 is often used to define “adult acne”. \u0000Methods: In a phase 2 (NCT03170388) and two phase 3 (NCT04214652, NCT04214639) studies, participants aged ≥9 years with moderate-to-severe acne were randomized to once-daily CAB or vehicle gel. Endpoints included percentage of participants achieving treatment success (defined as ≥2-grade reduction from baseline in Evaluator’s Global Severity Score and clear/almost clear skin) and least-squares mean percent change from baseline in inflammatory/noninflammatory lesion counts at week 12. Treatment-emergent adverse events (TEAEs) were also assessed. Pooled data across all three studies were analyzed for participants aged 9-24 years (CAB: n=297; vehicle: n=218) or ≥25 years (n=91; n=51). \u0000Results: At week 12, approximately half of CAB-treated participants in both age groups achieved treatment success (9-24 years: 50.6%; ≥25: 49.0%) versus less than one-fourth with vehicle (15.7% and 20.6%; P<0.01, both). Treatment with CAB resulted in >70% reductions from baseline in inflammatory and noninflammatory lesions in both age groups, versus 45%-62% with vehicle (P≤0.001, all). There were no significant differences between CAB-treated participants in the two age groups across any of these efficacy endpoints (P=0.68-0.97). Most TEAEs with CAB were of mild-moderate severity, with no age-related trends in safety/tolerability. \u0000Conclusions: Fixed-dose, triple-combination CAB gel was efficacious and well tolerated in participants with moderate-to-severe acne, regardless of age. Approximately half of pediatric/adolescent and adult participants achieved clear/almost clear skin with CAB, and lesion count reductions of >70% were observed. \u0000Funding: Ortho Dermatologics","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"122 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812112","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}
Rama Abdin, Navina DeLight, James Del Rosso, Douglas Hansen, Naiem Issa
{"title":"Hypertrophic Lichen Planus Due to Koebnerization After Percutaneous Vascular Procedure","authors":"Rama Abdin, Navina DeLight, James Del Rosso, Douglas Hansen, Naiem Issa","doi":"10.25251/skin.8.4.25","DOIUrl":"https://doi.org/10.25251/skin.8.4.25","url":null,"abstract":"","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"96 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812220","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}
Foday. Y. Koroma, Hayden Fung, Shivkar Amara, M. Lebwohl
Abstract Introduction: Acrodermatitis Enteropathica is a rare condition traditionally expressed by perioral or acral dermatitis, diarrhea, and alopecia. Acrodermatitis Enteropathica can be inherited or acquired, with the acquired form linked to zinc deficiency. The pull-through procedure is a method used to treat Hirschsprung’s disease, a condition in which the large intestine is missing nerve cells that make it difficult to pass stool, which can lead to obstruction and absorption issues. Complications of pull-through procedures have been associated with bowel obstruction and malabsorption of essential nutrients, including zinc. Case Report: We present a 16-month-old male who developed perioral dermatitis, well-demarcated erythematous plaques, and alopecia after a pull-through procedure related to Hirschsprung’s disease. Discussion: Acrodermatitis Enteropathica can present with various cutaneous lesions, and dermatologists should be familiar with the differing morphologies. In this paper, we encourage dermatologists to consider Acrodermatitis Enteropathica as a differential diagnosis for patients who develop cutaneous lesions following pull-through procedures. Keywords: Acrodermatitis Enteropathica, Hirschsprung’s Disease, zinc deficiency, case report
{"title":"Acrodermatitis Enteropathica Following a Pull-Through Procedure","authors":"Foday. Y. Koroma, Hayden Fung, Shivkar Amara, M. Lebwohl","doi":"10.25251/skin.8.4.13","DOIUrl":"https://doi.org/10.25251/skin.8.4.13","url":null,"abstract":"Abstract \u0000Introduction: Acrodermatitis Enteropathica is a rare condition traditionally expressed by perioral or acral dermatitis, diarrhea, and alopecia. Acrodermatitis Enteropathica can be inherited or acquired, with the acquired form linked to zinc deficiency. The pull-through procedure is a method used to treat Hirschsprung’s disease, a condition in which the large intestine is missing nerve cells that make it difficult to pass stool, which can lead to obstruction and absorption issues. Complications of pull-through procedures have been associated with bowel obstruction and malabsorption of essential nutrients, including zinc. \u0000Case Report: We present a 16-month-old male who developed perioral dermatitis, well-demarcated erythematous plaques, and alopecia after a pull-through procedure related to Hirschsprung’s disease. \u0000Discussion: Acrodermatitis Enteropathica can present with various cutaneous lesions, and dermatologists should be familiar with the differing morphologies. In this paper, we encourage dermatologists to consider Acrodermatitis Enteropathica as a differential diagnosis for patients who develop cutaneous lesions following pull-through procedures. \u0000 \u0000Keywords: Acrodermatitis Enteropathica, Hirschsprung’s Disease, zinc deficiency, case report","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"33 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141814133","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}
Background: “Eczema” encompasses many dermatological conditions and usually manifests with spongiosis histologically. Dermatopathologists often receive biopsy specimens with requests to “rule out eczema.” However, this broad term is limiting and lacks the necessary clinical context for precise diagnoses. Objective: This study explored the conditions implied by “rule out eczema” when rendered by clinicians and whether they regard it as synonymous with atopic dermatitis or other spongiotic conditions. Understanding this distinction is vital for guiding appropriate treatment which differs among disparate conditions appearing similar histologically. Method: 63 clinicians (54 dermatologists, 5 physician assistants, 4 nurse practitioners) completed a web-based questionnaire. Participants identified conditions considered when requesting to “rule out eczema,” who completed requisition forms, and whether they modify automated EMR phrases to specify these conditions. Results: 83% (52/63) included atopic dermatitis in the differential diagnosis, with “rule out eczema” also referencing nummular eczema (65%), dyshidrotic eczema (54%), contact dermatitis (51%), neurodermatitis (22%), and seborrheic dermatitis (14%). Other conditions included mycosis fungoides, psoriasis, and tinea infections. Most forms were completed by medical assistants (51%) or dermatologists (43%). 81% were modified from the suggested EMR diagnosis before submission. Conclusion: Because “rule out eczema” is nonspecific and conditions may not be readily distinguished with histology alone, it’s recommended that the phrase be discarded in favor of specifying which disorder the clinician is presumptively diagnosing clinically. Because nonspecific phrases such as “dermatitis unspecified” generated by EMR programs are of limited value, it is not recommended to provide these options for clinicians when submitting biopsy specimens.
{"title":"What Do Clinicians Mean When Submitting a Biopsy as “Rule Out Eczema”","authors":"Kaycee Nguyen, Clay Cockerell","doi":"10.25251/skin.8.4.4","DOIUrl":"https://doi.org/10.25251/skin.8.4.4","url":null,"abstract":"Background: “Eczema” encompasses many dermatological conditions and usually manifests with spongiosis histologically. Dermatopathologists often receive biopsy specimens with requests to “rule out eczema.” However, this broad term is limiting and lacks the necessary clinical context for precise diagnoses. \u0000Objective: This study explored the conditions implied by “rule out eczema” when rendered by clinicians and whether they regard it as synonymous with atopic dermatitis or other spongiotic conditions. Understanding this distinction is vital for guiding appropriate treatment which differs among disparate conditions appearing similar histologically. \u0000Method: 63 clinicians (54 dermatologists, 5 physician assistants, 4 nurse practitioners) completed a web-based questionnaire. Participants identified conditions considered when requesting to “rule out eczema,” who completed requisition forms, and whether they modify automated EMR phrases to specify these conditions. \u0000Results: 83% (52/63) included atopic dermatitis in the differential diagnosis, with “rule out eczema” also referencing nummular eczema (65%), dyshidrotic eczema (54%), contact dermatitis (51%), neurodermatitis (22%), and seborrheic dermatitis (14%). Other conditions included mycosis fungoides, psoriasis, and tinea infections. Most forms were completed by medical assistants (51%) or dermatologists (43%). 81% were modified from the suggested EMR diagnosis before submission. \u0000Conclusion: Because “rule out eczema” is nonspecific and conditions may not be readily distinguished with histology alone, it’s recommended that the phrase be discarded in favor of specifying which disorder the clinician is presumptively diagnosing clinically. Because nonspecific phrases such as “dermatitis unspecified” generated by EMR programs are of limited value, it is not recommended to provide these options for clinicians when submitting biopsy specimens. ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810600","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.404
Kenneth B Gordon, Diamant Thaçi, Melinda Gooderham, Yukari Okubo, B. Strober, Luke Peterson, D. Deherder, José M. López Pinto, Paolo Gisondi
Introduction: Psoriasis is a chronic condition requiring long-term management; evaluating long-term safety of treatments is important. We report the first 4-year (yr) safety data for bimekizumab (BKZ) in patients with moderate to severe plaque psoriasis. Methods: Data were pooled from 5 trials: BE SURE/BE VIVID/BE READY, their open-label extension (OLE) BE BRIGHT (4‑yr data; cut-off 14Nov2022), and BE RADIANT (3‑yr data; cut‑off 6May2022).1-5 Patients received BKZ 320mg every 4 weeks (wks)(Q4W) or Q8W; all received Q8W from Wk64 (BE RADIANT)/OLE Wk48 (BE BRIGHT) or next scheduled visit. Treatment-emergent adverse events (TEAEs) are presented as exposure-adjusted incidence rates (EAIRs)/100 patient‑yrs (PY) for all patients who received ≥1 BKZ dose, and evaluated separately for Yr1/Yr2/Yr3/Yr4 (Wks0-52/52-104/104-156/156-208) of treatment. Results: Total BKZ exposure was 6,324.3PY (N=2,186) (Yr1: 2,053.3PY [n=2,186]; Yr2: 1,904.3PY [n=2,013]; Yr3: 1,521.1PY [n=1,803]; Yr4: 819.5PY [n=1,309]). Overall, TEAEs occurred at an EAIR of 170.5/100PY (Yr1, Yr2, Yr3, Yr4: 230.9/100PY, 137.7/100PY, 107.1/100PY, 99.9/100PY), serious TEAEs at 5.5/100PY (6.5/100PY, 5.9/100PY, 5.8/100PY; 5.6/100PY), and TEAEs leading to discontinuation at 2.9/100PY (4.6/100PY, 2.3/100PY, 2.3/100PY, 1.1/100PY). The most common TEAEs were nasopharyngitis at 12.7/100PY (25.8/100PY, 13.2/100PY, 5.4/100PY, 5.9/100PY), oral candidiasis at 8.9/100PY (18.9/100PY, 10.7/100PY, 6.8/100PY, 5.4/100PY), and upper respiratory tract infection at 5.7/100PY (10.4/100PY, 5.7/100PY, 3.7/100PY, 3.9/100PY). Throughout, fewer TEAEs occurred with BKZ Q8W vs Q4W (115.4/100PY vs 224.4/100PY), including for oral candidiasis (6.5/100PY vs 16.7/100PY). Conclusions: BKZ demonstrated good tolerability and a consistent safety profile over 4 yrs in patients with plaque psoriasis. EAIRs of TEAEs remained consistent/decreased with longer BKZ exposure; no new safety findings were identified.
{"title":"Bimekizumab Safety and Tolerability in Moderate to Severe Plaque Psoriasis: Pooled Analysis from Up to 4 Years of Treatment in 5 Phase 3/3b Clinical Trials","authors":"Kenneth B Gordon, Diamant Thaçi, Melinda Gooderham, Yukari Okubo, B. Strober, Luke Peterson, D. Deherder, José M. López Pinto, Paolo Gisondi","doi":"10.25251/skin.8.supp.404","DOIUrl":"https://doi.org/10.25251/skin.8.supp.404","url":null,"abstract":"Introduction: Psoriasis is a chronic condition requiring long-term management; evaluating long-term safety of treatments is important. We report the first 4-year (yr) safety data for bimekizumab (BKZ) in patients with moderate to severe plaque psoriasis. \u0000Methods: Data were pooled from 5 trials: BE SURE/BE VIVID/BE READY, their open-label extension (OLE) BE BRIGHT (4‑yr data; cut-off 14Nov2022), and BE RADIANT (3‑yr data; cut‑off 6May2022).1-5 Patients received BKZ 320mg every 4 weeks (wks)(Q4W) or Q8W; all received Q8W from Wk64 (BE RADIANT)/OLE Wk48 (BE BRIGHT) or next scheduled visit. Treatment-emergent adverse events (TEAEs) are presented as exposure-adjusted incidence rates (EAIRs)/100 patient‑yrs (PY) for all patients who received ≥1 BKZ dose, and evaluated separately for Yr1/Yr2/Yr3/Yr4 (Wks0-52/52-104/104-156/156-208) of treatment. \u0000Results: Total BKZ exposure was 6,324.3PY (N=2,186) (Yr1: 2,053.3PY [n=2,186]; Yr2: 1,904.3PY [n=2,013]; Yr3: 1,521.1PY [n=1,803]; Yr4: 819.5PY [n=1,309]). Overall, TEAEs occurred at an EAIR of 170.5/100PY (Yr1, Yr2, Yr3, Yr4: 230.9/100PY, 137.7/100PY, 107.1/100PY, 99.9/100PY), serious TEAEs at 5.5/100PY (6.5/100PY, 5.9/100PY, 5.8/100PY; 5.6/100PY), and TEAEs leading to discontinuation at 2.9/100PY (4.6/100PY, 2.3/100PY, 2.3/100PY, 1.1/100PY). The most common TEAEs were nasopharyngitis at 12.7/100PY (25.8/100PY, 13.2/100PY, 5.4/100PY, 5.9/100PY), oral candidiasis at 8.9/100PY (18.9/100PY, 10.7/100PY, 6.8/100PY, 5.4/100PY), and upper respiratory tract infection at 5.7/100PY (10.4/100PY, 5.7/100PY, 3.7/100PY, 3.9/100PY). Throughout, fewer TEAEs occurred with BKZ Q8W vs Q4W (115.4/100PY vs 224.4/100PY), including for oral candidiasis (6.5/100PY vs 16.7/100PY). \u0000Conclusions: BKZ demonstrated good tolerability and a consistent safety profile over 4 yrs in patients with plaque psoriasis. EAIRs of TEAEs remained consistent/decreased with longer BKZ exposure; no new safety findings were identified. \u0000 ","PeriodicalId":22013,"journal":{"name":"SKIN The Journal of Cutaneous Medicine","volume":"67 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141812705","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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