A case study on the dermatoscopic findings of Darier's disease in skin type VI.

We present dermatoscopic findings of long-standing, untreated Darier's disease (DD) in skin type VI that differs from current findings in literature. Robust hyperkeratotic polygonal-shaped plugs without a surrounding white halo and classic vascular features were noted on the anterior scalp, neck, axilla, midline trunk, and extensors. Through this case, we aim to contribute to emerging literature in describing features of DD under dermatoscopy to augment diagnosis.

The Application of Dupilumab to Pediatric Patients Aged 6-11yrs with Moderate-to-Severe Atopic Dermatitis Whose Disease is Not Adequately Controlled: The Clinical Data so Far.

Background: While dupilumab has shown efficacy in improving atopic dermatitis, few studies have assessed the long-term clinical data of dupilumab use in pediatric patients. Objective: In the present study, we reviewed the current literature to assess reported efficacies, side effects, and risks of using dupilumab to treat atopic dermatitis in pediatric populations. Methods: Using PRISMA guidelines, the authors searched PubMed/MEDLINE and Embase for studies related to dupilumab treatment for atopic dermatitis in pediatric patients aged 6-11 years old. Results: A total of 512 pediatric patients (ages 6-11) were included. Outcome measures assessed by EASI, SCORAD, P-NRS, IGA and C-DLQI showed significant improvements in scores from those observed at baseline to the last treatment of dupilumab. Most reported adverse effects on dupilumab were conjunctivitis and infection site reactions. All studies reported that dupilumab was well-tolerated. Limitations: Limitations include the low number of studies available and observation periods of up to 16 weeks, which may be too short to evaluate the drug's effectiveness and occurrence of adverse effects. This also limits our knowledge on whether there are sustained benefits and/or diminished efficacy as well as long-term side effects. Conclusion: Thus far, the data demonstrates dupilumab to be safe and effective in the management of moderate-to-severe atopic dermatitis in children aged 6-11 years. Future studies should evaluate long-term dupilumab use and sustained effects.

Emerging medical treatments for hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous skin areas, and it is characterized by recurrent painful episodes of inflammatory drainage. Although the pathophysiology of HS is not fully understood, recent research points to an imbalance of cytokines as a contributing factor to the associated symptoms of purulent drainage and sinus tract formation. HS lesions are often characterized by a superimposed pathogenic/commensal bacterial infection that can improve with targeted antibiotic therapy. New medical treatments have emerged in recent years, many of which specifically work against a variety of proinflammatory mediators associated with HS. These newer, specified treatment options, in conjunction with surgery and lasers, are thought to provide positive outcomes and an overall improvement in quality of life in patients with HS.

Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum.

Importance: Hidradenitis suppurativa (HS) disproportionately affects women of childbearing potential. There is a paucity of data regarding the HS disease course during pregnancy and in the postpartum period. Objective: To explore the HS disease course during pregnancy and in the postpartum period. Design, Setting, and Participants: A retrospective cohort study was conducted on patients in the Henry Ford Health System, Detroit, Michigan-a large, academic, urban referral center. Women with a diagnosis of HS who became pregnant between January 1, 2008, and December 31, 2018, were included. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, were used for identification of the diagnosis. Exposures: Pregnancy in patients with HS. Main Outcomes and Measures: Hidradenitis suppurativa disease status during pregnancy and the postpartum period. Results: A total of 127 women with HS were included in this study and accounted for 202 pregnancies. Of the 202 pregnancies, 171 were in black women, 25 in white women, 3 in women of other race/ethnicity, and 3 had unreported data. Mean (SD) age at HS onset was 19.3 (5.6) years; at time of HS diagnosis, 24.4 (5.3) years; and at time of pregnancy, 25.9 (5.0) years. The disease worsened during pregnancy in 70 pregnancies (61.9%), did not change in 34 pregnancies (30.1%), and improved in 9 pregnancies (8.0%). Hidradenitis suppurativa exacerbated in the postpartum period after 82 of 124 pregnancies (66.1%). Dermatologists were involved in managing HS in 28 pregnancies (14.4%) and for a higher proportion of patients with more severe Hurley stage as compared with cases of mild disease (stage 3: 7 of 18 [38.9%] vs stage 1: 10 of 100 [10.0%] or stage 2: 11 of 67 [16.4%]; P = .004). In addition, HS medical treatment was administered during 77 pregnancies (38.1%), while HS procedural treatment was administered during 34 pregnancies (16.8%). A significantly higher proportion of patients whose care was managed by dermatologists vs those without dermatologist involvement received any HS medication (22 [78.6%] vs 53 [31.7%], P < .001) or any HS procedure (14 [50%] vs 19 [11.4%], P < .001) during pregnancy. Conclusions and Relevance: Despite a high rate of HS exacerbation during pregnancy and postpartum, this cohort study found that most of the patients did not receive HS-directed medical treatment or care from a dermatologist during pregnancy. Close monitoring and improved collaborative care between dermatology and obstetrics-gynecology services is warranted.

Disease Severity and Quality of Life Outcome Measurements in Patients With Keloids: A Systematic Review.

BACKGROUND: Keloids have been assessed by numerous methods and severity indices resulting in a lack of standardization across published research. OBJECTIVE: This study aims to evaluate published keloid randomized controlled trials (RCTs) and identify the need for a gold standard of assessment. METHODS AND MATERIALS: PubMed, MEDLINE, and Embase were searched for human RCTs on keloid treatment during a 10-year period. Eligible studies were English language RCTs reporting disease severity outcome measures after keloid treatments. RESULTS: A total of 40 disease outcome measures were used in 41 included RCTs. Twenty-four (59%) of the included studies used more than one disease severity scale. The most frequently used outcome measures were the Vancouver Scar Scale (34%) (n = 14), followed by serial photography (24%) (n = 10). These were followed by adverse events and complications (20%) (n = 8), Visual Analogue Scale (12%) (n = 5), keloid dimensions (12%) (n = 5), and Patient and Observer Scar Assessment Scale (10%) (n = 4). Only one study reported quality of life outcomes. CONCLUSION: There is wide variation in keloid outcome measures in the published literature. A standardized method of assessment should be implemented to reduce the disparities between studies and to better be able to compare the numerous treatment modalities.

What's New in Pigmentary Disorders.

Pigmentary disorders are common and can be very distressing to patients. There is a need for better, standardized therapies. The authors review the most recent data for topical, systemic, light, and laser treatments for vitiligo, melasma, and postinflammatory hyperpigmentation. There is a paucity of large-scale, well-designed, randomized, controlled trials for these treatments. Treatment options are often drawn from smaller trials and case series. The treatments described in this article are promising candidates for larger follow-up studies.

Patient-reported outcomes in hidradenitis suppurativa.

Hidradenitis suppurativa, also known as acne inversa, is a chronic recurrent inflammatory disease of the skin making management challenging and continuously evolving. A large number of modalities exist aimed at quantifying the efficacy of treatment in studies on hidradenitis suppurativa. Both physician-reported and patient-reported outcomes are used as endpoints in these studies; however, the vast majority of the modalities used to survey these reported outcomes lack validation and congruence between studies. Heterogeneity of outcome measures and lack of standardization from study to study make it difficult to design future hidradenitis suppurativa trials and to compare results. This high variability between studies further contributes to the lack of high-quality evidence available to guide clinical management decisions of this inflammatory skin disease. Therefore this review aims to assess the modalities frequently used to assess patient-reported treatment outcomes in hidradenitis suppurativa. Patient-reported outcomes in hidradenitis suppurativa include outcomes regarding symptoms and disease progression, measures of treatment satisfaction, quality of life surveys, impairment of function, pain, and patient-reported outcomes combined with physician-reported outcomes. Nearly all surveys demonstrate significant heterogeneity, lack standardization, and many are not validated or constructed specifically for the assessment of hidradenitis suppurativa. Yet patient-reported outcomes on symptoms and disease severity, treatment satisfaction, and quality of life are instrumental in evaluating hidradenitis suppurativa treatment efficacy in clinical trials. As such, standardization and validation of patient-reported outcome instruments are essential for comparability among studies and improved quality of evidence.

Successful treatment of solar urticaria with UVA1 hardening in three patients.

Solar urticaria (SU) is an uncommon photodermatosis that presents with sensitivity to ultraviolet (UV) or visible light which triggers urticarial lesions. Treatment of SU is a challenge and usually involves antihistamines and photoprotection as a first-line treatment. Phototherapy regimens are recommended if these first-line treatments fail to control the disease. Induction of tolerance by phototherapy (UV hardening) has been commonly described as a treatment modality. UVA1 has deeper penetration to the dermis than UVA or NB-UVB; its use in SU has not been previously reported. We present 3 patients with SU who were successfully treated with UVA1.