Sensory Neurons Co-opt Classical Immune Signaling Pathways to Mediate Chronic Itch.

Mammals have evolved neurophysiologic reflexes, such as coughing and scratching, to expel invading pathogens and noxious environmental stimuli. It is well established that these responses are also associated with chronic inflammatory diseases, including asthma and atopic dermatitis. However, the mechanisms by which inflammatory pathways promote sensations such as itch remain poorly understood. Here, we show that type 2 cytokines directly activate sensory neurons in both mice and humans. Further, we demonstrate that chronic itch is dependent on neuronal IL-4Rα and JAK1 signaling. We also observe that patients with recalcitrant chronic itch that failed other immunosuppressive therapies markedly improve when treated with JAK inhibitors. Thus, signaling mechanisms previously ascribed to the immune system may represent novel therapeutic targets within the nervous system. Collectively, this study reveals an evolutionarily conserved paradigm in which the sensory nervous system employs classical immune signaling pathways to influence mammalian behavior.

Pacemakers, Deep Brain Stimulators, Cochlear Implants, and Nerve Stimulators: A Review of Common Devices Encountered in the Dermatologic Surgery Patient.

BACKGROUND: In dermatologic and procedural surgery settings, there are commonly encountered devices in patients. Safe surgical planning requires familiarity with these devices. OBJECTIVE: To review the current implanted devices in patients and recommendations for surgical planning around these devices. METHODS AND MATERIALS: A comprehensive review using PubMed and published device recommendations was performed, searching for those most relevant to dermatologic surgery. RESULTS: Devices such as pacemakers and implantable cardiac defibrillators, deep brain stimulators, cochlear implants, and various nerve stimulators are potential devices that may be encountered in patients and specific recommendations exist for each of these devices. CONCLUSION: Dermatologic surgeons' knowledge of implanted devices in patients is paramout to safe surgical procedures.

An open-label study of anakinra for the treatment of moderate to severe hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by sterile abscesses and fistulae predominantly affecting the axillae and groin. Various biologic agents have been attempted for HS, but there is still no definitive treatment. OBJECTIVES: We sought to evaluate the efficacy, safety, and tolerability of anakinra in the treatment of moderate to severe HS. METHODS: Six patients with moderate to severe HS were enrolled in an open-label study with all patients receiving active treatment for 8 weeks with an additional 8 weeks of follow-up off therapy. RESULTS: The 5 patients who completed the 8-week therapy showed a significant mean decrease in their modified Sartorius score of 34.8 points. The physician and patient global assessment of overall activity showed significant reductions between baseline and 8 weeks of therapy: 45.8 points and 35.6 points, respectively. The Dermatology Life Quality Index showed a significant reduction after 8 weeks of treatment with anakinra. Functional T-cell analysis revealed that patients had increased percentages of CD3(+) T cells in lesional skin compared with nonlesional skin before therapy. LIMITATIONS: The limited number of patients and lack of control group are limitations. CONCLUSIONS: Anakinra demonstrated decreased HS disease activity by both objective and subjective measures.

Intravascular involvement of cutaneous squamous cell carcinoma.

We present a case of a 72-year-old man who was found to have intravascular invasion during Mohs micrographic surgery (MMS) of cutaneous squamous cell carcinoma (cSCC) on the left side of the forehead. The patient was subsequently treated with adjuvant radiation without evidence of disease recurrence. We present a case review to discuss treatment options for high-risk features of cSCC with the aim to assist in treatment guidelines.

Autoinflammatory diseases in dermatology: CAPS, TRAPS, HIDS, FMF, Blau, CANDLE.

Autoinflammatory diseases, including CAPS, TRAPS, HIDS, FMF, Blau, and CANDLE, have unique dermatologic presentations that can be a clue to diagnosis. Although these conditions are rare, the morbidity and mortality can be severe, and well-informed physicians can place these conditions in their differential diagnosis when familiar with the dermatologic manifestations. This review article presents a brief overview of each condition, clues to diagnosis that focus of dermatologic manifestations and clinical images, basic laboratory tests and follow-up, a brief review of treatments, and concludes with an overview for these autoinflammatory conditions and their differential diagnoses.

Side effects of common acne treatments.

INTRODUCTION: A variety of acne treatments exist, including topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, isotretinoin, and procedural therapies, such as light and laser therapies. Although each of these treatment modalities confer various benefits for the management of acne, it is important for healthcare providers to be aware of their potential side effects, including ones that are most common and most serious, so that these medications can be prescribed in a safe manner. AREAS COVERED: A systematic literature review was performed to identify publications discussing the side effects of the different treatment modalities used for acne vulgaris. Acne treatments reviewed included benzoyl peroxide gel, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, isotretinoin, and light/laser treatments. EXPERT OPINION: A comprehensive overview of acne treatments' side effects is imperative for healthcare professionals and scientists working with and prescribing acne treatments. Side effects to be aware of when prescribing range from local irritation with topical treatments to systemic side effects including liver function abnormalities and teratogenic side effects. The best available options are those that address acne severity while minimizing side effects for the patient. Consequently, personalized medicine must be strongly emphasized to healthcare providers developing patients' treatment plans.