K. O’Connell, R. Youssef, A. E. Torres, R. Huggins
In the United States, many individual vitiligo support groups have collaborated on a joint national US World Vitiligo Day since 2016. As part of the 2020 and 2021 US World Vitiligo Day virtual events, polls were conducted that solicited information from participants regarding their life with vitiligo. A majority (76% in 2020; 92% in 2021) would like a cure for vitiligo. In 2020 and 2021, 40% and 35% responded they both show and hide their vitiligo when asked how they display their skin. A minority, 14% in 2020 and 5% in 2021, reported their vitiligo treatments were fully covered by their insurance. When polled about acceptance, in 2021, 40% reported they were accepting of their vitiligo most days. In 2021, 20% were interested in trying treatments, even if they included moderate side effects and 29% were interested, if minimal side effects. Results herein suggest that while many patients are accepting of their disease, many also want a cure. Additionally, dermatologists should advocate for coverage of vitiligo treatment, while also taking insurance coverage into account when discussing treatment options. Further, vitiligo patients require individualized care considering some patients may be open to attempting more aggressive treatment, despite the side effect profiles, while others are not interested in treatment or only willing to attempt treatments without side effects.
{"title":"Perspectives of Vitiligo Patients: Voices from National Vitiligo Conferences","authors":"K. O’Connell, R. Youssef, A. E. Torres, R. Huggins","doi":"10.25251/skin.7.4.6","DOIUrl":"https://doi.org/10.25251/skin.7.4.6","url":null,"abstract":"In the United States, many individual vitiligo support groups have collaborated on a joint national US World Vitiligo Day since 2016. As part of the 2020 and 2021 US World Vitiligo Day virtual events, polls were conducted that solicited information from participants regarding their life with vitiligo. A majority (76% in 2020; 92% in 2021) would like a cure for vitiligo. In 2020 and 2021, 40% and 35% responded they both show and hide their vitiligo when asked how they display their skin. A minority, 14% in 2020 and 5% in 2021, reported their vitiligo treatments were fully covered by their insurance. When polled about acceptance, in 2021, 40% reported they were accepting of their vitiligo most days. In 2021, 20% were interested in trying treatments, even if they included moderate side effects and 29% were interested, if minimal side effects. Results herein suggest that while many patients are accepting of their disease, many also want a cure. Additionally, dermatologists should advocate for coverage of vitiligo treatment, while also taking insurance coverage into account when discussing treatment options. Further, vitiligo patients require individualized care considering some patients may be open to attempting more aggressive treatment, despite the side effect profiles, while others are not interested in treatment or only willing to attempt treatments without side effects.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49636029","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}
Pemphigus foliaceus (PF) is a rare, blistering autoimmune condition that occurs when desmoglein-1 autoantibodies target and lead to loss of intercellular connections, resulting in blister formation on the skin. Current standard of care consists of highly immunosuppressive therapies such as prednisone, rituximab, and mycophenolate mofetil. A 43-year-old male with new-onset PF was treated with upadacitinib, a JAK inhibitor. He saw resolution of his blisters within 12 weeks of treatment and remains in remission from his PF. Our case demonstrates that JAK inhibition may prove to be an effective strategy in preventing dsg-1-triggered blisters. JAK1 inhibitors also may prove to be a safer, less immunosuppressive alternative to the highly immunosuppressive agents available today. Larger studies will be required to study the drug’s efficacy in others with PF.
{"title":"Oral Jak Inhibitor Upadacitinib Use in Treatment of Pemphigus Foliaceus","authors":"Sophie Guenin, Syed Shah, M. Lebwohl","doi":"10.25251/skin.7.4.5","DOIUrl":"https://doi.org/10.25251/skin.7.4.5","url":null,"abstract":"Pemphigus foliaceus (PF) is a rare, blistering autoimmune condition that occurs when desmoglein-1 autoantibodies target and lead to loss of intercellular connections, resulting in blister formation on the skin. Current standard of care consists of highly immunosuppressive therapies such as prednisone, rituximab, and mycophenolate mofetil. A 43-year-old male with new-onset PF was treated with upadacitinib, a JAK inhibitor. He saw resolution of his blisters within 12 weeks of treatment and remains in remission from his PF. Our case demonstrates that JAK inhibition may prove to be an effective strategy in preventing dsg-1-triggered blisters. JAK1 inhibitors also may prove to be a safer, less immunosuppressive alternative to the highly immunosuppressive agents available today. Larger studies will be required to study the drug’s efficacy in others with PF.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47400518","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}
A 32-year-old male without significant past medical history presented with acute-onchronic, mildly tender, enlarging, draining nodules and sinus tracts on the right lower extremity. The lesions had been present for 2 years following a penetrating injury at a construction site in central Mexico. He sought local hospital attention after the injury and was treated with penicillin. He had temporary improvement in nodule formation and subsequent healing with atrophic scars; however, after the completion of antibiotics, the nodules redeveloped and progressed distally down the leg.
{"title":"Actinomycetoma Following Traumatic Inoculation of Nocardia Brasiliensis","authors":"M. Dirr, M. Dick, A. Boyd, Philip B Milam","doi":"10.25251/skin.7.4.21","DOIUrl":"https://doi.org/10.25251/skin.7.4.21","url":null,"abstract":"A 32-year-old male without significant past medical history presented with acute-onchronic, mildly tender, enlarging, draining nodules and sinus tracts on the right lower extremity. The lesions had been present for 2 years following a penetrating injury at a construction site in central Mexico. He sought local hospital attention after the injury and was treated with penicillin. He had temporary improvement in nodule formation and subsequent healing with atrophic scars; however, after the completion of antibiotics, the nodules redeveloped and progressed distally down the leg.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46981750","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: With the rapidly increasing incidence of pediatric diabetes mellitus (DM) in the United States, an understanding of the risk of long-term cutaneous consequences, particularly the risk of cutaneous fungal infections, is important. In this study, we evaluate the association between pediatric-onset Type 1 diabetes (T1D) and Type 2 diabetes (T2D) with the later development of cutaneous fungal infections. Methods: Through the All of Us electronic health record database, 300 de-identified participants with a diagnosis of T1D or T2D before the age of 18 were selected at random. These 300 participants, composing our pediatric-onset diabetes cohort, were diagnosed with T1D and/or T2D before the age of 18 and developed cutaneous fungal infections between less than 1 and 24 years later. Each case was age-, race-, and sex-matched to four control participants without T1D or T2D diagnoses, and we compared cutaneous fungal infections between pediatric-onset diabetic cases and controls. Results: Compared to the control cohort, participants with pediatric-onset diabetes were significantly more likely to present in adulthood with candidiasis of the mouth, onychomycosis, pityriasis versicolor, candidiasis of urogenital sites, and unspecified superficial mycosis, as well as dermatophytosis of the body, feet, and perianal regions than their non-diabetic counterparts. Conclusion: With the increasing incidence of pediatric DM, it will be important for clinicians to monitor the long-term cutaneous complications, including the risk of fungal infections, to improve dermatology patient outcomes. Further research is warranted to investigate the role of childhood diabetes intervention and glycemic control in mitigating dermatologic fungal complications through adulthood.
引言：随着美国儿童糖尿病（DM）发病率的迅速增加，了解长期皮肤后果的风险，特别是皮肤真菌感染的风险，是很重要的。在这项研究中，我们评估了儿童发病的1型糖尿病（T1D）和2型糖尿病（T2D）与皮肤真菌感染后期发展之间的关系。方法：通过All of Us电子健康记录数据库，随机选择300名18岁前诊断为T1D或T2D的未识别参与者。这300名参与者组成了我们的儿科发病糖尿病队列，他们在18岁之前被诊断为T1D和/或T2D，并在不到1到24年后出现皮肤真菌感染。每个病例的年龄、种族和性别与四名未诊断为T1D或T2D的对照组参与者相匹配，我们比较了儿科糖尿病病例和对照组之间的皮肤真菌感染。结果：与对照队列相比，患有儿童期糖尿病的参与者在成年后出现口腔念珠菌感染、甲真菌病、花斑癣、泌尿生殖道念珠菌感染、未指明的浅表真菌病以及身体、脚部和肛周皮肤癣菌病的可能性明显高于非糖尿病参与者。结论：随着儿童糖尿病发病率的增加，临床医生监测长期皮肤并发症，包括真菌感染的风险，以改善皮肤科患者的预后将非常重要。需要进一步研究儿童糖尿病干预和血糖控制在成年后减轻皮肤病真菌并发症中的作用。
{"title":"Cutaneous Fungal Infections Associated with Pediatric-onset Diabetes: A Case-control Study in the All of Us Research Program","authors":"Emily Strouphauer, R. Katta","doi":"10.25251/skin.7.4.4","DOIUrl":"https://doi.org/10.25251/skin.7.4.4","url":null,"abstract":"Introduction: With the rapidly increasing incidence of pediatric diabetes mellitus (DM) in the United States, an understanding of the risk of long-term cutaneous consequences, particularly the risk of cutaneous fungal infections, is important. In this study, we evaluate the association between pediatric-onset Type 1 diabetes (T1D) and Type 2 diabetes (T2D) with the later development of cutaneous fungal infections.\u0000Methods: Through the All of Us electronic health record database, 300 de-identified participants with a diagnosis of T1D or T2D before the age of 18 were selected at random. These 300 participants, composing our pediatric-onset diabetes cohort, were diagnosed with T1D and/or T2D before the age of 18 and developed cutaneous fungal infections between less than 1 and 24 years later. Each case was age-, race-, and sex-matched to four control participants without T1D or T2D diagnoses, and we compared cutaneous fungal infections between pediatric-onset diabetic cases and controls.\u0000Results: Compared to the control cohort, participants with pediatric-onset diabetes were significantly more likely to present in adulthood with candidiasis of the mouth, onychomycosis, pityriasis versicolor, candidiasis of urogenital sites, and unspecified superficial mycosis, as well as dermatophytosis of the body, feet, and perianal regions than their non-diabetic counterparts.\u0000Conclusion: With the increasing incidence of pediatric DM, it will be important for clinicians to monitor the long-term cutaneous complications, including the risk of fungal infections, to improve dermatology patient outcomes. Further research is warranted to investigate the role of childhood diabetes intervention and glycemic control in mitigating dermatologic fungal complications through adulthood.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45160981","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}
Janus kinases (JAKs) are non-receptor tyrosine kinases that work together with signal transducers and activators of transcription (STAT) proteins to form the JAK/STAT pathway. Together, this pathway is responsible for mediating a wide range of downstream cytokines and growth factors, and inhibition of various components of this pathway has been a major area of research focus in recent years. Each of the major enzymes of the family – which include JAK1, JAK2, JAK3, and Tyrosine Kinase 2 (TYK2) – or combinations of JAKs is responsible for its own set of most strongly-associated inflammatory mediators, and inhibition of specific JAKs or combination of JAKs can therefore also potentially allow for modulation of specific inflammatory factors and their associated conditions. To date, JAK inhibitors have particularly been studied in the treatment of atopic dermatitis (felt to be primarily driven by IL-4, IL-13, and IL-5), psoriasis (IL-12/IL-23), alopecia areata (IL-2, IL-15, and IFN-γ), and vitiligo (IL-15 and IFN-γ), given that these factors can all be found downstream of specific JAK/STAT pathways as shown in Figure 1. By providing a concise review of the inflammatory factors affected by each JAK, this article aims to support clinicians as they engage in the ever-growing body of research around the use of JAK inhibitors for potential treatment of dermatologic conditions.
{"title":"The JAK-Cytokine Interface – A Review and Update on Prospective Clinical Considerations","authors":"David Hashemi, N. Bhatia","doi":"10.25251/skin.7.4.16","DOIUrl":"https://doi.org/10.25251/skin.7.4.16","url":null,"abstract":"Janus kinases (JAKs) are non-receptor tyrosine kinases that work together with signal transducers and activators of transcription (STAT) proteins to form the JAK/STAT pathway. Together, this pathway is responsible for mediating a wide range of downstream cytokines and growth factors, and inhibition of various components of this pathway has been a major area of research focus in recent years. Each of the major enzymes of the family – which include JAK1, JAK2, JAK3, and Tyrosine Kinase 2 (TYK2) – or combinations of JAKs is responsible for its own set of most strongly-associated inflammatory mediators, and inhibition of specific JAKs or combination of JAKs can therefore also potentially allow for modulation of specific inflammatory factors and their associated conditions. To date, JAK inhibitors have particularly been studied in the treatment of atopic dermatitis (felt to be primarily driven by IL-4, IL-13, and IL-5), psoriasis (IL-12/IL-23), alopecia areata (IL-2, IL-15, and IFN-γ), and vitiligo (IL-15 and IFN-γ), given that these factors can all be found downstream of specific JAK/STAT pathways as shown in Figure 1. By providing a concise review of the inflammatory factors affected by each JAK, this article aims to support clinicians as they engage in the ever-growing body of research around the use of JAK inhibitors for potential treatment of dermatologic conditions.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48262001","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: Grover’s disease, or transient acantholytic dermatosis, is a common benign papulovesicular disorder that often affects elderly men. It is typically managed with topical therapeutics in this population. We present here an uncommon case of Grover’s disease, occurring in a relatively younger patient, that was recalcitrant to typical therapeutics modalities. Case Report: A 45-year-old woman presented to our clinic with a several month history of discrete, pink, ill-defined pruritic papules on her torso with sparing of her extremities. Grover’s disease was diagnosed based on her clinical presentation and subsequently biopsy-confirmed. She failed multiple topical medications, oral acitretin, and only experience minimal relief when transitioned to Naltrexone. Dupilumab was added to her regimen, with rapid improvement. She was eventually transitioned down to dupilumab monotherapy, and has remained clear since. Conclusion: Grover’s disease is not common among middle-aged women. Novel therapies, such as biologics, have been efficacious in elderly (especially male) populations with this condition. Our case demonstrates the importance of attempting new treatment modalities such as dupilumab for patients with recalcitrant disease. Novel application of these biologic treatments may be needed in particular for atypical cases, such as when patients do not fit the known epidemiologic profile.
{"title":"Recalcitrant Grover’s Disease Successfully Managed with Dupilumab and Naltrexone in a Middle-Aged Woman: A Case Study","authors":"K. Beiter, Christy Behnam, B. Shields","doi":"10.25251/skin.7.4.7","DOIUrl":"https://doi.org/10.25251/skin.7.4.7","url":null,"abstract":"Introduction: Grover’s disease, or transient acantholytic dermatosis, is a common benign papulovesicular disorder that often affects elderly men. It is typically managed with topical therapeutics in this population. We present here an uncommon case of Grover’s disease, occurring in a relatively younger patient, that was recalcitrant to typical therapeutics modalities.\u0000Case Report: A 45-year-old woman presented to our clinic with a several month history of discrete, pink, ill-defined pruritic papules on her torso with sparing of her extremities. Grover’s disease was diagnosed based on her clinical presentation and subsequently biopsy-confirmed. She failed multiple topical medications, oral acitretin, and only experience minimal relief when transitioned to Naltrexone. Dupilumab was added to her regimen, with rapid improvement. She was eventually transitioned down to dupilumab monotherapy, and has remained clear since. \u0000Conclusion: Grover’s disease is not common among middle-aged women. Novel therapies, such as biologics, have been efficacious in elderly (especially male) populations with this condition. Our case demonstrates the importance of attempting new treatment modalities such as dupilumab for patients with recalcitrant disease. Novel application of these biologic treatments may be needed in particular for atypical cases, such as when patients do not fit the known epidemiologic profile.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44570374","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 : 2023-07-17DOI: 10.25251/skin.7.supp.224
M. Senna, S. Forman, L. Bordone, P. de la Cueva Dobao, R. Wolk, S. Zwillich, Fan Zhang, Haytham Mohamed Ahmed, L. Takiya
Background: This post hoc analysis of the ALLEGRO phase 2b/3 study (NCT03732807) assessed response to ritlecitinib, an oral JAK3/TEC family kinase inhibitor, between Weeks 28-48 among patients with alopecia areata (AA) who did not meet target efficacy response criteria at Week 24. Methods: Patients aged ≥12 years with AA and ≥50% scalp hair loss received daily ritlecitinib 10 mg (included for dose ranging only), 30 or 50 mg (±4-week 200-mg daily loading dose), or placebo for 24 weeks. After Week 24, ritlecitinib groups continued their assigned doses and the placebo group switched to ritlecitinib 200/50 or 50 mg through Week 48. This analysis included patients receiving ritlecitinib 30 or 50 mg (±4-week 200-mg daily loading dose) who had not responded at Week 24, based on Severity of Alopecia Tool (SALT) score ≤20 (≤20% scalp without hair), SALT score ≤10, or eyebrow (EBA) or eyelash (ELA) assessment (normal or ≥2-grade improvement from baseline among patients with abnormal EBA or ELA score at baseline), and followed them through Week 48. Results: Of the patients in the ritlecitinib groups who did not meet SALT ≤20 response at Week 24, 5-8% had response at Week 28, with rates increasing to 22-34% at Week 48. A similar trend was observed for SALT ≤10 (6-12% and 20-25%), EBA (8-14% and 20-33%), and ELA (4-15% and 17-30%) at Weeks 28 and 48, respectively, for patients not achieving the respective response at Week 24. Ritlecitinib was well tolerated through Week 48. Most common adverse events were upper respiratory tract infection, nasopharyngitis, and headache. Conclusion: Patients with AA treated with ritlecitinib who don’t meet target efficacy response at Week 24 may achieve response at later time points with continued ritlecitinib treatment.
{"title":"Scalp, eyebrow, and eyelash hair regrowth with continued ritlecitinib treatment among patients with alopecia areata without target efficacy response at Week 24: post hoc analysis of the ALLEGRO phase 2b/3 study","authors":"M. Senna, S. Forman, L. Bordone, P. de la Cueva Dobao, R. Wolk, S. Zwillich, Fan Zhang, Haytham Mohamed Ahmed, L. Takiya","doi":"10.25251/skin.7.supp.224","DOIUrl":"https://doi.org/10.25251/skin.7.supp.224","url":null,"abstract":"Background: This post hoc analysis of the ALLEGRO phase 2b/3 study (NCT03732807) assessed response to ritlecitinib, an oral JAK3/TEC family kinase inhibitor, between Weeks 28-48 among patients with alopecia areata (AA) who did not meet target efficacy response criteria at Week 24. \u0000Methods: Patients aged ≥12 years with AA and ≥50% scalp hair loss received daily ritlecitinib 10 mg (included for dose ranging only), 30 or 50 mg (±4-week 200-mg daily loading dose), or placebo for 24 weeks. After Week 24, ritlecitinib groups continued their assigned doses and the placebo group switched to ritlecitinib 200/50 or 50 mg through Week 48. This analysis included patients receiving ritlecitinib 30 or 50 mg (±4-week 200-mg daily loading dose) who had not responded at Week 24, based on Severity of Alopecia Tool (SALT) score ≤20 (≤20% scalp without hair), SALT score ≤10, or eyebrow (EBA) or eyelash (ELA) assessment (normal or ≥2-grade improvement from baseline among patients with abnormal EBA or ELA score at baseline), and followed them through Week 48. \u0000Results: Of the patients in the ritlecitinib groups who did not meet SALT ≤20 response at Week 24, 5-8% had response at Week 28, with rates increasing to 22-34% at Week 48. A similar trend was observed for SALT ≤10 (6-12% and 20-25%), EBA (8-14% and 20-33%), and ELA (4-15% and 17-30%) at Weeks 28 and 48, respectively, for patients not achieving the respective response at Week 24. Ritlecitinib was well tolerated through Week 48. Most common adverse events were upper respiratory tract infection, nasopharyngitis, and headache. \u0000Conclusion: Patients with AA treated with ritlecitinib who don’t meet target efficacy response at Week 24 may achieve response at later time points with continued ritlecitinib treatment.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44589990","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}
M. Moloney, Rebeca W. Teplitz, Brian How, Suzanne Sirota-Rozenberg
Introduction: Yaws is an endemic non-venereal treponematoses, which is caused by Treponema pallidum, subspecies pertenue and is spread from person-to-person through direct skin contact with an infected lesion. Yaws causes a chronic skin infection that is characterized by papillomas and ulcers and if left untreated can be disfiguring and debilitating. Cases typically occur in warm, humid, tropical climates and cases are commonly seen in children under 15 years old. However, due to migration, cases can be seen outside of its endemic region. Case Description: We present a case of a 39-year-old African American male who presented with painless bilateral ulcers on his dorsal feet that began as blisters approximately 1-2 weeks prior to presentation at our clinic. Our patient had recent travel history to Jamaica and reported potential sources of trauma to his feet by walking barefoot on the beach and roofing in sandals prior to onset. These findings led to the clinical diagnosis of Yaws. A regimen of azithromycin and basic wound care led to significant improvement. Discussion: Non-venereal endemic treponematoses, such as Yaws, are typically not seen outside of their endemic region. However, due to migration and the ease of travel non-venereal endemic treponematoses can be found elsewhere and it is important for healthcare workers to keep these diseases on their differential, especially in a patient with travel history. After making the diagnosis of Yaws, proper treatment and basic wound care can result in rapid significant improvement and prevent the progression of Yaws lesions to the subsequent stage.
{"title":"A Suspected Case of Imported Yaws in New York","authors":"M. Moloney, Rebeca W. Teplitz, Brian How, Suzanne Sirota-Rozenberg","doi":"10.25251/skin.7.4.10","DOIUrl":"https://doi.org/10.25251/skin.7.4.10","url":null,"abstract":"Introduction: Yaws is an endemic non-venereal treponematoses, which is caused by Treponema pallidum, subspecies pertenue and is spread from person-to-person through direct skin contact with an infected lesion. Yaws causes a chronic skin infection that is characterized by papillomas and ulcers and if left untreated can be disfiguring and debilitating. Cases typically occur in warm, humid, tropical climates and cases are commonly seen in children under 15 years old. However, due to migration, cases can be seen outside of its endemic region. \u0000Case Description: We present a case of a 39-year-old African American male who presented with painless bilateral ulcers on his dorsal feet that began as blisters approximately 1-2 weeks prior to presentation at our clinic. Our patient had recent travel history to Jamaica and reported potential sources of trauma to his feet by walking barefoot on the beach and roofing in sandals prior to onset. These findings led to the clinical diagnosis of Yaws. A regimen of azithromycin and basic wound care led to significant improvement. \u0000Discussion: Non-venereal endemic treponematoses, such as Yaws, are typically not seen outside of their endemic region. However, due to migration and the ease of travel non-venereal endemic treponematoses can be found elsewhere and it is important for healthcare workers to keep these diseases on their differential, especially in a patient with travel history. After making the diagnosis of Yaws, proper treatment and basic wound care can result in rapid significant improvement and prevent the progression of Yaws lesions to the subsequent stage.","PeriodicalId":74803,"journal":{"name":"Skin (Milwood, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41594981","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 : 2023-07-17DOI: 10.25251/skin.7.supp.222
L. Stein Gold, L. Kircik, W. Werschler, H. Baldwin, V. Callender, L. Green, N. Sadick, Jeffrey Sugarman, Z. Draelos, E. Tanghetti, N. Bhatia
Introduction: IDP-126 (clindamycin phosphate 1.2%/benzoyl peroxide [BPO] 3.1%/adapalene 0.15%) polymeric mesh gel is the first triple-combination, fixed-dose topical acne treatment in development. IDP-126 demonstrated superior efficacy to vehicle and component dyads, with good safety/tolerability, in a phase 2 and two phase 3 studies of participants with moderate-to-severe acne. The objective of this analysis was to assess the impact of age or sex on efficacy and safety/tolerability of IDP-126 gel. Methods: This post hoc analysis evaluated effect of age or sex on efficacy/safety of IDP-126 using data pooled from two phase 3, double-blind, randomized, 12-week studies (NCT04214639, N=183; NCT04214652, N=180). Participants aged ≥9 years with moderate-to-severe acne were randomized 2:1 to once-daily IDP-126 gel or vehicle gel. Data were analyzed by age (pediatric [9-17 years]: n=178; adult [≥18 years]: n=185) or sex (females: n=212; males: n=151). Endpoints included ≥2-grade reduction from baseline in Evaluator’s Global Severity Score and clear/almost clear skin (treatment success) and least-squares mean percent change from baseline in inflammatory and noninflammatory lesion counts. Treatment-emergent adverse events (TEAEs) were also assessed. Results: At week 12, over half of pediatric and almost half of adult IDP-126-treated participants achieved treatment success (52.7% and 45.9%, respectively) versus one-fourth with vehicle (24.0% and 23.5%; P<0.01, both). Results by sex were similar (IDP‑126 vs vehicle: females: 53.7% vs 23.0%; males: 43.1% vs 24.6%; P<0.05, both). IDP‑126 provided >70% reductions in inflammatory and noninflammatory lesions in all subgroups, versus 41%-63% with vehicle (P≤0.001, all). Differences between sex or age groups were not statistically significant. Most TEAEs were of mild-moderate severity in all groups. Conclusions: Fixed-dose, triple-combination IDP-126 gel was efficacious and well tolerated in participants with moderate-to-severe acne, regardless of age or sex, with approximately half of participants achieving clear/almost clear skin. Funding: Ortho Dermatologics
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