Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in a real-life French multicenter adult cohort.

BACKGROUND: Dupilumab is the first biologic available to treat atopic dermatitis (AD). Its effectiveness and safety were demonstrated in clinical trials. OBJECTIVE: We sought to assess the effectiveness and safety of dupilumab in adults with AD in a real-life French multicenter retrospective cohort. METHODS: We included patients treated during March 2017-April 2018. Efficacy outcomes, including Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores, were collected at baseline and 3 months when available. Adverse events (AEs) were recorded at follow-up. RESULTS: We included 241 patients. The median ± interquartile range (IQR) follow-up time was 3.8 ± 3.7 months. A ≥75% improvement in SCORAD was achieved in 27 of 163 (16.6%) patients, and a ≥75% improvement in EASI was achieved in 40 of 82 (48.8%) patients. The median SCORAD and EASI scores at 3 months were significantly lower than those at baseline (SCORAD ± IQR, 25 ± 21 vs 56 ± 27.4, P < 10-9 and EASI ± IQR, 4.1 ± 6.8 vs 17.9 ± 15.4, P < 10-9, respectively). Conjunctivitis was reported in 84 of 241 (38.2%) patients. The proportion with eosinophilia (>500 cells/mm3) during follow-up (57%) was higher than that at baseline (33.7%) (n = 172, P < 10-6). Dupilumab was stopped in 42 cases; 27 patients stopped because of AEs. LIMITATIONS: No control group, missing data. CONCLUSION: This real-life study demonstrated a similar dupilumab effectiveness as that seen in clinical trials, but it also revealed a higher frequency of conjunctivitis and eosinophilia.

Sporadic Porphyria in a patient with stage II melanoma treated with interferon α.

Porphyria cutanea tarda (PCT) is the most common form of human porphyria, due to reduced activity of uroporphyrinogen decarboxylase (UROD). There are many factors which can trigger PCT such as viral infections, excessive alcohol intake, iron overload, hepatotoxic drugs and hepatic tumours. Drug induced PCT is well documented but PCT induced by interferon α has rarely been described and only in cases of Hepatitis C Virus (HCV) infection or haematological malignancies. Here, we report the first case of de novo PCT induced by adjuvant interferon α (IFNα) therapy in a patient with stage II melanoma.

Solar urticaria: a time-extended retrospective series of 61 patients and review of literature.

BACKGROUND: Solar urticaria is a rare, disabling, chronic disease. Few large series are available. OBJECTIVE: To report the epidemiological, clinical, phototesting, treatment and patient outcome data of a large series. METHODS: Data from 61 patients' files were retrospectively retrieved in a tertiary referral centre. RESULTS: 43 women and 18 men were included (mean age at first symptoms: 34 y). 3 patients had a medical history of chronic urticaria and 29% of atopy. Urticaria occurred before the 15(th) minute of sun-exposure in 95% of the patients and resolved spontaneously after its interruption within 1h in 76.4%. Determination of the action spectra revealed UVA sensitization in 91.8% of the patients, alone (49.2%) or with UVB (24.6%) or visible light (14.75%). 61.7% of the patients received antihistamines, 75% noted a significant improvement. 36.2% benefited from UVA phototherapy and were satisfied. 3 patients reported complete remission after 4 to 11 years. CONCLUSIONS: Our study is the second largest in the literature. Main discrepancies with previous series concern the absence of associated photodermatoses and the predominance of UVA sensitization over visible light, which could be explained by suboptimal phototesting in the most ancient cases. Interpretation of our results is restricted because data were missing in 10 to 25% of the patients' files. The response to treatment was evaluated upon the dermatologist's observation, which highlights the need of validated tools to evaluate patients' disability and response to treatment.

[Actinic keratosis: when is a skin biopsy necessary?]. / Kératoses actiniques : quand biopsier ?

The diagnosis of actinic keratosis is generally established by clinical examination. However, actinic keratosis can progress into an invasive squamous cell carcinoma, therefore biopsy and histological examination may be needed. The risk of progression into an invasive carcinoma is not well established; it varies in the literature between 0.025% and 20% for a given lesion. Some clinical aspects suggest transformation into an invasive carcinoma; they include inflammation, induration, size > 1 cm, rapid enlargement of the lesion, bleeding or ulceration, and should prompt the clinician to perform a skin biopsy. In case of resistance after a well-driven treatment, a biopsy may be necessary. Finally, in cases of atypical clinical aspect, a biopsy may be useful in order to obtain a correct diagnosis.