Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review.

The IL-17 pathway is a potential therapeutic target shown to be implicated in hidradenitis suppurativa (HS), however, it remains unclear whether evidence from mechanistic studies may translate into clinical practice. This systematic review summarizes available treatment outcomes of IL-17 inhibitors in patients with HS. Embase, MEDLINE, PubMed, and clinicaltrials.gov were comprehensively searched on February 26, 2021 to include 16 original studies representing 128 patients with HS (mean age: 36.5 years; age range: 21-47 years; male: 50.0%). Treatment outcomes were reported for the following biologics: secukinumab (n = 105), brodalumab (n = 22), and ixekizumab (n = 1). Patients were classified as responders or non-responders according to achievement of a positive response/improvement based on criteria established for each included study. For secukinumab 57.1% (n = 60/105) of patients were responders in a mean response period of 16.2 weeks and 42.9% (n = 45/105) were non-responders; for brodalumab, 100.0% (n = 22/22) of patients were responders within 4.4 weeks; and the one patient treated with ixekizumab was a responder within 10 weeks. In conclusion, IL-17 inhibitors may serve as an effective therapeutic target in approximately two-thirds of patients with HS and can be considered in those who are refractory to other treatment modalities. We also stress the importance of consistent outcome measures to enhance evidence synthesis, decrease reporting bias, provide potential for future meta-analysis, and ultimately improve clinical outcomes for patients with HS.

Clinical manifestations and treatment outcomes in prurigo pigmentosa (Nagashima disease): A systematic review of the literature.

BACKGROUND: Prurigo pigmentosa (PP) is a rare inflammatory dermatosis characterized by pruritic erythematous papules that coalesce to form a reticulate pattern. PP is often misdiagnosed, and patients are treated with ineffective therapies. Although the majority of reports about PP are from East Asia, patients of all backgrounds can be affected. OBJECTIVES: To perform a systematic review of reported PP cases with the purpose of summarizing the clinical presentation and treatment of PP. METHODS: MEDLINE and Embase were searched for original articles describing PP. We identified 115 studies from 24 countries representing 369 patients to include in the analysis. RESULTS: Of the 369 patients included in the analysis, the mean age was 25.6 years (range: 13-72 years) with 72.1% (266 of 369) female. Risk factors or aggravating factors were described in 52.3% (193 of 369) of patients and included dietary changes (25.5%, 94 of 369), friction (8.4%, 31 of 369), sweat (7.6%, 28 of 369), and ketonuria (5.1%, 19 of 369). Of those patients who experienced PP following dietary changes, 40.4% (38 of 94) started a ketogenic diet. Minocycline monotherapy was the most frequently prescribed treatment for PP (20.9%, 77 of 369), achieving complete resolution in 48.1% (37 of 77) of patients. CONCLUSIONS: PP is sometimes associated with ketogenic diets and can be effectively managed with oral tetracyclines.

A case of sporotrichosis infection mimicking pyoderma gangrenosum and the role of tissue culture in diagnosis: A case report.

Sporotrichosis infections may cause cutaneous lesions mimicking other infectious or non-infectious causes such as pyoderma gangrenosum. We present a case of cutaneous sporotrichosis misdiagnosed as pyoderma gangrenosum and treated with immunosuppressants for 17 months leading to exacerbation and atypical morphology mimicking Histoplasma organisms on biopsy. Exclusion of infection prior to diagnosing pyoderma gangrenosum is important to prevent iatrogenic immunosuppression, demonstrating the challenges with application of the updated pyoderma gangrenosum diagnostic criteria.

Toy gun ocular injuries associated with festive holidays in Kuwait.

BACKGROUND: Ocular trauma is one of the important causes of preventable blindness and visual impairment among children worldwide. Prevalence of pediatric ocular trauma associated with toy guns appear to be on the rise, although they are fully preventable. The purpose of this study is to report ocular trauma secondary to toy-gun pellets in Kuwait. METHODS: We conducted a non-comparative case series based on review of the medical records of children who suffered ocular injury from toy-gun pellets and were admitted to a tertiary eye center during a 7-day Eid el-Fitr holiday season in Kuwait. RESULTS: A total of 19 children were identified. Mean age was 7.8 years. Mean days of admission per patient was 3.6 days, with a total of 68 days of hospitalization. Variable anterior segment findings were identified, including lid edema, sub-conjunctival hemorrhage, corneal abrasion, and abnormal intraocular pressure. Most notably, different grades of hyphaema were seen in all patients, and traumatic cataract was identified in a 30-month-old child. The final visual acuity was 6/18 or better in nine patients and worse than 6/18 in eight patients. CONCLUSIONS: Eye trauma with toy guns resulted in significant injuries that required medical intervention and hospitalization for variable lengths of time, with a potential of causing long-term ocular complications. Our findings should assist public health workers in formulating specific prevention strategies, including a health educational program to make parents and health care professionals aware of the potential harm of these toys.