A Review on the Use of Topical Ruxolitinib for the Treatment of Vitiligo.

BACKGROUND: This article describes the clinical trial, safety, and efficacy of ruxolitinib 1.5% cream or repigmentation in patients with vitiligo. DATA SOURCES: A systematic review was done using ruxolitinib or Opzelura in MEDLINE (PubMed) and EMBASE. CLINICALTRIALS: gov was used to identify ongoing or unpublished studies. STUDY SELECTION AND DATA EXTRACTION: Studies included were written in English and relevant to pharmacology, clinical trials, safety, and efficacy. DATA SYNTHESIS: In two 52-week phase 3 trials, 52.0% of subjects had at least 75% improvement in their Facial Vitiligo Area Scoring Index (F-VASI). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Ruxolitinib is a topical Janus kinase (JAK) inhibitor newly approved by the US Food and Drug Administration for repigmentation in patients with vitiligo. CONCLUSION: Topical ruxolitinib is the first medication approved for repigmentation in patients with vitiligo. It is a safe and effective treatment; however, cost may be a barrier to some patients when prescribing this medication. Trials to compare the efficacy and side effect profile of topical ruxolitinib with other topical treatments are still needed. Grossmann MC, Haidari W, Feldman SR. A Review on the use of topical ruxolitinib for the treatment of vitiligo. J Drugs Dermatol. 2023;22(7):664-667. doi:10.36849/JDD.7268.

Allergens in Common Brands of Clobetasol.

BACKGROUND: Allergic contact dermatitis (ACD) may occur secondary to topical corticosteroids. This may be due to topical corticosteroids containing potential allergens in their vehicles. Variation of allergenic ingredients among various brands of a product has not been well characterized. OBJECTIVE: This study aimed to assess the frequency of allergenic ingredients in various brands and manufacturers of clobetasol propionate. METHODS: Common brands of clobetasol propionate were identified online on GoodRx website. Then, ingredient lists for these products were obtained from the US Food & Drug Administration’s Online Label Repository via a proprietary name search. A systematic literature review was performed using the ingredient name on Medline (PubMed) database to find reports of ACD confirmed by patch testing. CONCLUSIONS: Forty-nine different ingredients were identified among all 18 products included, with an average of 8.4 ingredients per product; 19 of these ingredients have allergenic potential, while one has protective effects. Two branded foam formulations contained the greatest number of potential allergens (5), while a shampoo formulation contained no potential allergens. Knowing which allergens are present in different products may be helpful when treating a patient with an allergy or suspected allergy to one of these ingredients. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.4651.

Hydrogen Peroxide 40% for the Treatment of Seborrheic Keratoses.

OBJECTIVE: Hydrogen peroxide 40% (HP40) was approved by the US Food and Drug Administration for topical treatment of seborrheic keratosis (SK) in December 2017. This article will review phase II and III clinical trials to assess the drug's efficacy, safety, and clinical application. DATA SOURCES: A systematic literature review was performed using the terms "Eskata AND seborrheic keratosis," and "hydrogen peroxide AND seborrheic keratosis" in the OVID MEDLINE, PubMed, Cochrane Library, EMBASE, and Web of Science databases. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. STUDY SELECTION AND DATA ABSTRACTION: Articles written in English between January 2000 and mid-June 2020 discussing phase II and phase III clinical trials were evaluated. DATA SYNTHESIS: In 2 phase III clinical trials, 4% and 8% of patients treated with HP40 had a Physician Lesion Assessment score of zero for all 4 SKs, respectively, compared with 0% in both vehicle groups at the primary end point of day 106 (P < 0.01; P < 0.0001). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: HP40, although less effective, has a better safety profile than other treatment options. It should be especially considered for treatment of facial SKs, where it is most efficacious and where other treatment modalities, such as cryotherapy, are more challenging. CONCLUSIONS: HP40 is a new, safe alternative treatment for SKs, although it is expensive and only modestly effective, both of which somewhat limit its overall utility. HP40 is a promising topical alternative, particularly for cosmetically sensitive locations, such as the face.

Trifarotene for the Treatment of Facial and Truncal Acne.

OBJECTIVE: This article reviews clinical trials to assess the efficacy, safety, and clinical application of trifarotene 0.005% cream (Aklief). DATA SOURCES: A systematic review of the literature was performed using the terms trifarotene OR Aklief OR CD5789 in MEDLINE (PubMed) and EMBASE databases. Articles prior to May 2020 were considered for inclusion. Bibliographies and ClinicalTrials.gov were also searched to identify further studies. STUDY SELECTION AND DATA EXTRACTION: Relevant English language and human studies related to pharmacology, clinical trials, and safety were considered. DATA SYNTHESIS: In the 52-week phase III trial, treatment success rates for facial acne (Investigator Global Assessment [IGA] rating of no or almost no acne) and truncal acne (Physician's Global Assessment [PGA] rating of no or almost no acne) were 65.1% and 66.9%, respectively. Overall success rates (IGA and PGA success in the same patient) were 57.9%; 52.8% of patients had a Dermatology Quality of Life Index score of 0 or 1, compared with 22.6% at baseline. Trifarotene was well tolerated, with pruritus, irritation, and sunburn as the most common adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Trifarotene is a newly Food and Drug Administration-labeled fourth-generation topical retinoid that shows particular promise in the treatment of facial and truncal acne vulgaris. It is an effective and safe addition to currently available retinoids. CONCLUSION: Trifarotene is effective and safe for treatment of facial and truncal acne. Future trials should compare its efficacy and tolerability with that of the older, clinically established retinoids. Despite efficacy, cost may be a prohibitive factor.

The effect of the COVID-19 pandemic on perceptions of teledermatology.

There is limited information of the effect of the COVID-19 pandemic on the general population's perceptions towards teledermatology. This study aims to assess the pandemic's impact on people's willingness to use teledermatology as well as to investigate influencing factors. We recruited 544 participants through Amazon Mechanical Turk (MTurk) and surveyed them using REDCap. Participants' willingness to use teledermatology before, during, and after the COVID-19 pandemic was measured via a 5-point Likert scale. The survey also included questions regarding factors influencing participants' attitudes towards teledermatology and their sociodemographic characteristics. Of the 185 participants who reported unwillingness to use teledermatology prior to the COVID-19 pandemic, 79.2% and 66.5% became either neutral or willing to use teledermatology during and after the pandemic, respectively. Less than half of prior satisfactory telemedicine users reported willingness to use teledermatology before the pandemic; willingness to use teledermatology increased to 80.1% and 63.8% during and after the COVID-19 pandemic, respectively. The top reason for lack of interest in teledermatology was concern for security and privacy (24.4%). Although a useful tool, teledermatology has been met with reluctance by the public. However, the unique circumstances of the COVID-19 pandemic have improved the public's perceptions and readiness to use teledermatology.

Risankizumab for the Treatment of Moderate to Severe Plaque Psoriasis.

Objective: Risankizumab (Skyrizi), an interleukin-23 (IL-23) antagonist, was approved by the Food and Drug Administration (FDA) for the treatment of moderate to severe plaque psoriasis in April 2019. This article will review phase II and III clinical trials to assess the efficacy, safety, and clinical application of this drug. Data Sources: A systematic literature review was performed using the terms "psoriasis AND risankizumab" in the OVID MEDLINE, PubMed, Cochrane Library, EMBASE, and Web of Science databases. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. Study Selection and Data Extraction: Articles written in English between January 2000 and October 2019 discussing phase II and phase III clinical trials were evaluated. Data Synthesis: By the primary end point at week 16 in phase III trials, more patients achieved Psoriasis Area and Severity Index 90 receiving 150 mg risankizumab (72%-75%) compared with placebo (2.0%-4.9%, P < 0.001), 45 or 90 mg ustekinumab (42.0%-48%, P < 0.0001), and 40 mg adalimumab (47%, P < 0.0001). More patients achieved a static Physician's Global Assessment score of 0 or 1 receiving 150 mg risankizumab (84%-88%) compared with placebo (5.1%-7.8%, P < 0.001), 45 or 90 mg ustekinumab (62%-63%, P < 0.0001), and 40 mg adalimumab (60%, P < 0.0001). Risankizumab was well tolerated across all studies. Conclusion: Risankizumab is a newly FDA-approved IL-23 inhibitor that shows particular promise in the treatment of plaque psoriasis. Based on this review, it is an effective and safe addition to the armamentarium of biologics that are currently available.

Sarecycline Review.

Objective: Sarecycline is a new oral tetracycline antibiotic recently approved by the US Food and Drug Administration. The aim of this article was to evaluate the data from published clinical trials of sarecycline in the treatment of acne, review the drug's pharmacology, and understand how this new medication may apply to clinical practice. Data Sources: A systematic literature review was performed using the terms sarecycline (Seysara), P005672, and WC-3035 in the MEDLINE and EMBASE databases. ClinicalTrials.gov was searched to identify ongoing or nonpublished studies. Study Selection and Data Extraction: Articles in English between January 2000 and April 2019 relating to clinical trials, pharmacology, safety, and microbiological profile were evaluated. Data Synthesis: In a phase 3 clinical trial (SC1401), absolute change from baseline in facial inflammatory lesion count at week 12 was -15.3 for the sarecycline arm and -10.1 for placebo (P < 0.01). In another phase 3 clinical trial (SC1402), the absolute change in this category was -15.7 for sarecycline and -10.7 for placebo (P < 0.01). Mean percentage change in facial inflammatory lesion count was higher in the sarecycline group than in the placebo group in both studies (P < 0.01). Relevance to Patient Care and Clinical Practice: The 1.5-mg/kg sarecycline dose has efficacy in reducing inflammatory lesions, is well tolerated, and has more targeted antimicrobial activity, which may help reduce the risk of developing antibiotic resistance. Conclusions: This novel, once-daily treatment may represent a useful treatment for patients with moderate to severe acne.

Management of Residual Psoriasis in Patients on Biologic Treatment

While biologics are highly effective, most psoriasis patients do not achieve complete skin clearance with their biologic monotherapy. How to achieve complete skin clearance in psoriasis patients who fail their biologic is not well characterized. To describe treatment approaches in psoriasis patients who fail to achieve complete clearance from their biologic, we modeled and assessed the efficacy, cost, and safety of three treatment approaches­ adding a topical agent with their biologic, escalating the biologic dose, and switching to a different biologic. Efficacy of each approach was obtained from literature identifying complete clearance defined as 100% improvement in Psoriasis Area and Severity Index and/or Physician's Global Assessment score of clear. Cost of each treatment approach was calculated using medication wholesale acquisition cost obtained from Medi-Span Price Rx. Safety was assessed by adverse event (AE) rates. Complete clearance in patients not cleared on their initial biologic was achieved when adding calcipotriene/betamethasone dipropionate (Cal/BD) foam (28%), switching to guselkumab (20%), and switching to infliximab (15.8%). Adding Cal/BD foam to the initial biologic ($3,780 per additional patient cleared) was a less costly approach compared to the lowest cost dose escalation (guselkumab; $73,370 per additional patient cleared) or switching the initial failed biologic to the lowest cost alternative biologic (infliximab; $88,250 per additional patient cleared). There were no treatment-related or serious AEs when adding Cal/BD foam. Adding a topical agent may be an efficacious, low cost, and safe approach to achieve complete clearing in psoriasis patients who previously failed to clear on their biologic. J Drugs Dermatol. 2020;19(2)188-194. doi:10.36849/JDD.2020.3989

Allergic Contact Dermatitis Secondary to Moisturizers.

Background: Moisturizers are cosmetic products used routinely to manage various skin conditions. Even though moisturizers are often thought to have minimal or no adverse reactions, allergic contact dermatitis (ACD) to these products can develop in some cases. Methods: We studied ingredients included in 3 of the most commonly used moisturizer brands, identified their presence in standard patch testing series, and evaluated their allergenic potential, categorizing the allergens as frequent or infrequent. The standard patch testing series used as reference were the Thin-layer Rapid Use Epicutaneous patch test (T.R.U.E. test), the North American Contact Dermatitis Group (NACDG) screening standard series, and the American Contact Dermatitis Society (ACDS) core allergen series. Results: Aveeno, Cetaphil, and Cerave products had a total of 12, 14, and 9 potential allergens, respectively, the majority of which were infrequent and not included in standard patch testing series. Conclusion: Being aware of the allergenic potential of commonly used moisturizers may help healthcare providers when evaluating patients with ACD. Further testing is recommended in a targeted manner when suspecting ACD with negative standard patch testing series or when ACD is refractory to treatment.

Cutis marmorata telangiectasia congenita with painful ulcerations.

Cutis marmorata telangiectatica congenita (CMTC) is a rare, congenital, vascular disorder that may sometimes be associated with ulcerations of the involved skin. We present a case of CMTC, asymptomatic since birth, that began developing painful ulcerations during adolescence. Although laser therapy may benefit the superficial aspect of this vascular anomaly, the presence of deeper involvement in lesions with ulcerations may not respond favorably to laser therapy and the best approach needs to be further evaluated.

Digital future of dermatology.

Evolution of technology in the past several decades has undeniably transformed the practice of medicine. Dermatology, a field relying on visual cues, has been particularly impacted by advancement in imaging technologies. The purpose of this study was to review the current status as well as digital future of dermatology. The PubMed database was searched for articles pertaining to digital dermatology using search terms digital dermatology, teledermatology, and dermatopathology education. Digital dermatology has found a role in almost every aspect of dermatology: research, dermatology education and training, and clinical practice including disease prevention, diagnosis, treatment, and patient follow-up. Smartphone applications such VisualDx, MyDermPath, YouDermoscopy serve as diagnostic aid tools and can also help increase the user's knowledge of dermatology. Tools such as multispectral digital skin lesion analysis (MSDSLA) improve diagnostic accuracy and lead to fewer unnecessary biopsies. Teledermatology increases patient satisfaction, as they are able to experience shorter waits times and decreased costs. Underserved communities and those in rural settings are more likely to have a dermatologic evaluation by a specialist via teledermatology. Addressing important topics such as legal framework and updating reimbursement policies will allow for a smoother incorporation of digital dermatology into clinical practice and likely benefit patient care.

Resolution of Guttate Psoriasis Plaques After One-time Administration of Guselkumab

Guttate psoriasis is an acute subtype of plaque psoriasis characterized by eruption of small, scaly plaques, and papules, 5 to 10 mm in size over the trunk and proximal extremities.1 It often arises in children and young adults concomitantly with or shortly after a streptococcal throat infection or tonsillitis. Patients with chronic plaque psoriasis can also experience guttate flares following streptococcal throat infections.1,2 Controlling guttate psoriasis with topical corticosteroids is difficult to achieve due to numerous widespread lesions. Other treatment options include phototherapy and short term use of cyclosporine or methotrexate, as guttate variants of psoriasis can remit with these treatments.1,2 Guselkumab, an inhibitor of the p19 cytokine subunit of interleukin-23 and interleukin-39, produces dramatic resolutions of plaque psoriasis with long lasting effects.3 This case report describes a patient with a guttate variant of plaque psoriasis that resolved after a single administration of guselkumab and continues to remain clear more than 6 months after treatment with guselkumab.

Diet and psoriasis.

BACKGROUND: Patients with psoriasis have a growing interest in managing their disease through diet. OBJECTIVE: This review paper aims to analyze dietary interventions for psoriasis and their outcome. METHODS: Terms "psoriasis AND diet" were used to search PubMed database and 63 articles describing dietary changes influencing psoriasis were selected. RESULTS: Low calorie diet (LCD) improves Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) in conjunction with topical or systemic therapy, although LCD was unsuccessful in maintaining disease remission when patients discontinued concomitant cyclosporine or methotrexate therapy. A fish oil diet improved baseline PASI of 7.7 to 5.3 at three months and 2.6 at 6 months compared to control (PASI: 8.9, 7.8, and 7.8, respectively). A randomized, double-blind, placebo-controlled study investigating selenium supplementation in psoriasis provided no PASI improvement. Zinc supplementation with concomitant betamethasone valerate 0.0025% ointment in a randomized, double-blind, placebo-controlled study provided a mean PASI of 11.2 in the intervention group and 8.0 in the control group with no significant difference between both arms. Gluten free diet and vitamin D supplementation were also efficacious dietary changes although results were mixed. CONCLUSIONS: Dietary changes alone do not cause a large effect in psoriasis but may become an important adjunct to current first line treatments.

Contact dermatitis: one for the books.

Allergic contact dermatitis (ACD) is a frequent problem, often caused from repeated exposure to an object or substance related to the patient's routine activities. We present a case of a well-demarcated, erythematous, scaly plaque on a finger caused from reading with an e-book device. Although metal from mobile devices can cause ACD, mobile device cases may cause irritation or contain additives that can also cause contact dermatitis. Similar presentations of contact dermatitis may become more common as technology use increases.

The rise in subscription skin care services.

Subscription skin care services are a rising niche of direct-to-consumer telehealth models. The explosion of such services may be a reflection of the increasing demand by patients to have accessible, affordable dermatological care. These models come with both benefits and risks to patients. A thorough understanding of how subscription skin care services work may benefit dermatologists in addressing patients' questions regarding alternative care options.