Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib.

BACKGROUND: Existing therapies for vitiligo are limited in efficacy and can be associated with undesirable side effects. Topical Janus kinase inhibitors may offer a new therapeutic option for vitiligo. OBJECTIVE: We sought to assess the role of topical ruxolitinib 1.5% cream, a Janus kinase inhibitor, in vitiligo treatment. METHODS: This 20-week, open-label, proof-of-concept trial of twice-daily topical ruxolitinib 1.5% cream was conducted in 12 patients with a minimum of 1% affected body surface area of vitiligo. The primary outcome was percent improvement in Vitiligo Area Scoring Index from baseline to week 20. RESULTS: Of 12 patients screened, 11 were enrolled and 9 completed the study (54.5% men; mean age, 52 years). Four patients with significant facial involvement at baseline had a 76% improvement in facial Vitiligo Area Scoring Index scores at week 20 (95% confidence interval, 53-99%; P = .001). A 23% improvement in overall Vitiligo Area Scoring Index scores was observed in all enrolled patients at week 20 (95% confidence interval, 4-43%; P = .02). Three of 8 patients responded on body surfaces and 1 of 8 patients responded on acral surfaces. Adverse events were minor, including erythema, hyperpigmentation, and transient acne. LIMITATIONS: Limitations of the study include the small sample size and open-label study design. CONCLUSIONS: Topical ruxolitinib 1.5% cream provided significant repigmentation in facial vitiligo and may offer a valuable new treatment for vitiligo.

Acitretin for the treatment of recalcitrant plantar warts.

Plantar warts caused by human papilloma virus (HPV)may be challenging to treat when conventionalmodalities fail. We report a case of severely recalcitrantplantar warts, successfully treated with oral acitretinand topical 40% urea cream.

Intradermal Syringocystadenoma Papilliferum on the Popliteal Fossa: A Rare Dermal Variant in an Atypical Location.

Syringocystadenoma papilliferum (SCAP) is a benign adnexal tumor commonly found on the scalp and face, and often associated with nevus sebaceous, with about half of cases appearing in early childhood. SCAP exhibits cystic invaginations with papillary structures and a double-layered glandular epithelium linked to the epidermal surface and stromal plasma cells. We are reporting a rare instance of intradermal SCAP in a 55-year-old male. He sought evaluation for a long-standing asymptomatic dark-pink papule in his left popliteal fossa, measuring 0.7 x 0.5 x 0.4 cm. A shave biopsy revealed papillary dermal fibrosis, glandular epithelium with apocrine secretion, and papillary projections without an epidermal connection. Infundibulofollicular keratinization was observed, along with stromal plasma cells. The patient chose local excision as the treatment option. This case highlights the rarity of intradermal SCAP, especially in the left popliteal fossa, with only one other reported case in the literature.

Improving health literacy and treatment understanding of hidradenitis suppurativa using group educational interventions.

Background: Hidradenitis suppurativa (HS) is a chronic immune-mediated skin disorder characterized by inflamed, painful abscesses most commonly located in the intertriginous regions that may lead to significant scarring and social stigma. It is unclear how much patients with HS understand about their disease. Objective: We sought to evaluate baseline knowledge of patients who have HS, as well as to evaluate if an educational intervention of a teaching session about the disease will help increase patient's knowledge of their ailment and treatment options. These sessions also act as a support group for the participants, during which they have time to connect with one another and discuss their experiences with HS. Methods: Participants were recruited at Tufts Medical Center by searching for an ICD-10 code of HS or were identified via advertisement. Eligible subjects were given a study specific questionnaire pre- and post an educational lecture on HS. Results: Twenty subjects participated in the study, conducted from June 2017 through January 2018. Mean test score improved from 62.7% to 82.7% (p < .0001). Additionally, participants reported an average of 20.3% (p = .0002) improvement in their knowledge of HS postintervention. Conclusions: Group information sessions can be an effective means to educate patients with hidradenitis suppurativa and were preferable to the majority of participants in this study.