Emerging therapeutics in the management of connective tissue disease. Part I. Lupus erythematosus and Sjögren syndrome.

The management of connective tissue diseases is dramatically evolving with the advent of biologics and novel oral systemic therapeutics. Despite involvement in the care of these complex patients, there is a knowledge gap in the field of dermatology regarding these emerging agents. The first article in this continuing medical education series discusses new and emerging therapeutics for lupus erythematosus and Sjögren syndrome that target cells, intracellular signaling pathways, and cytokines.

Emerging therapeutics in the management of connective tissue disease. Part II: Dermatomyositis and scleroderma.

The management of connective tissue diseases is dramatically evolving with the advent of biologics and novel oral systemic therapeutics. Despite involvement in the care of these complex patients, there is a knowledge gap in the field of dermatology regarding these emerging agents. The second article in this continuing medical education series discusses new and emerging therapeutics for dermatomyositis and scleroderma that target cells, intracellular signaling pathways, and cytokines.

Melanoma: An update on systemic therapies.

Despite advances in early detection as described in part 1 of this continuing medical education series, melanoma continues to be a large contributor to cutaneous cancer-related mortality. In a subset of patients with unresectable or metastatic disease, surgical clearance is often not possible; therefore, systemic and local therapies are considered. The second article in this series provides dermatologists with an up-to-date working knowledge of the treatment options that may be prescribed by oncologists for patients with unresectable stage III, stage IV, and recurrent melanoma.

Melanoma: How and when to consider clinical diagnostic technologies.

In response to rising rates of melanoma worldwide, novel noninvasive melanoma detection techniques are emerging to facilitate the early detection of melanoma and decrease unnecessary biopsies of benign pigmented lesions. Because they often report similar study findings, it may be difficult to determine how best to incorporate these technologies into clinical practice based on their supporting studies alone. The first article in this continuing medical education series provides practical advice on how and when to use various noninvasive melanoma detection techniques in clinical practice.

Dupilumab Facial Redness/Dupilumab Facial Dermatitis: A Guide for Clinicians.

Dupilumab facial redness (DFR), or the development of an eczematous rash of the face and neck with dupilumab use, has been observed in recent case reports. It is estimated to impact between 4 and 43.8% of dupilumab users, including children and adults. Aside from reviewing the pathogenesis and clinical presentation, we present potential diagnostic steps (such as skin scraping, serologies, biopsy, and patch testing) and management options for DFR ranging from allergen avoidance to dupilumab interruption. It is hoped that this article will serve as a means for clinicians to familiarize themselves with DFR regarding the differential diagnosis, diagnostic tools, and treatment options associated with this phenomenon.

The Handshake Test: A Nonverbal Assessment of Coping Strategies and Functional Status in Patients with Atraumatic Upper-Extremity Conditions.

Background: Maladaptive coping strategies can lead to less functional improvement after upper-extremity surgery. It remains uncertain how well surgeons can recognize signs of less effective coping strategies in patients in the absence of formalized questionnaires. Our purpose is to determine if the "Handshake Test" can be used to identify patients with less effective coping strategies. We hypothesize that a simple physical examination finding (a refusal or inability to shake hands) is associated with higher pain level, maladaptive coping strategies and decreased functional status. Methods: We prospectively analyzed 246 consecutive new patients presenting to one of three surgeons with atraumatic upper-extremity conditions. Patients completed a pain scale (NPRS) and PROMIS instruments including Self-Efficacy (SE) for Managing Symptoms, Pain Interference (PI) and Upper Extremity (UE). Each surgeon recorded a refusal to shake hands as part of a normal greeting, referred to as a "positive Handshake Test". Results: 200 patients (81%) patients completed all outcome measures and were included in our analysis. 8% demonstrated a positive Handshake Test. Patients with a positive Handshake Test were more likely to use tobacco; otherwise baseline demographics were similar between the two groups. Patients with a positive Handshake Test demonstrated higher pain scores (NPRS and PROMIS PI), lower levels of self-efficacy and worse self-reported functional status on the PROMIS UE. Conclusions: For patients with atraumatic upper-extremity conditions, those with a positive Handshake Test report higher pain levels, lower self-efficacy, and decreased self-reported functional status than patients who can perform a handshake. This simple test can aid in identifying patients with less effective coping strategies, allowing surgeons to guide patients towards interventions to improve both illness behavior and functional outcomes.Level of Evidence: II.