Inherited ichthyosis as a paradigm of rare skin disorders: Genomic medicine, pathogenesis, and management.

Great advances have been made in the field of heritable skin disorders using next-generation sequencing (NGS) technologies (ie, whole-genome sequencing, whole-exome sequencing, whole-transcriptome sequencing, and disease-targeted multigene panels). When NGS first became available, the cost and lack of access to these technologies were limiting factors; however, with decreasing sequencing costs and the expanding knowledge base of genetic skin diseases, fundamental awareness of NGS has become prudent. The heritable ichthyoses comprise a genotypically and phenotypically heterogeneous group of monogenic keratinization disorders characterized by persistent scaling, with at least 55 distinct genes currently implicated in causing nonsyndromic and syndromic forms of the disease. By providing a simplified overview of available NGS techniques and applying them in the context of ichthyosis, one of the most common genodermatoses, we hope to encourage dermatologists to offer, when appropriate, genetic testing earlier in patients with unsolved presentations. With the aid of NGS, dermatologists can provide diagnostic certainty in cases of suspected genodermatoses and offer potentially life-changing genome-guided and targeted therapies as they become available.

"Slime" dermatitis, a fad-associated chronic hand dermatitis.

"Slime" is the colloquial name for a non-Newtonian viscoelastic putty-like substance that is currently a popular plaything among pre-teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime-associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.

Skin Cancer Education in the Rural Salon.

INTRODUCTION: Due to an increase in the incidence of skin cancer and a shortage of primary care and specialty physicians in rural areas, creative public health strategies must be employed to address disparities in skin cancer education, prevention, and detection. METHODS: Hair salons in eastern South Dakota communities with populations less than 15,000 were visited in-person by medical student facilitators. Hair professionals at these locations completed pre-survey assessments for baseline self-assessed comfort with detecting suspicious skin lesions and with educating patrons on skin cancer prevention strategies. Their likelihood to both alert patrons of suspicious skin lesions and encourage them to have their lesion evaluated by a physician was also assessed. A 20-minute educational PowerPoint presentation was given. Final assessment was evaluated with a post-presentation survey. RESULTS: Self-assessed hair professional comfort with identifying suspicious skin lesions was higher in post-survey results, in addition, the educational presentation increased comfort with sharing skin cancer prevention information with patrons. Hair professionals also reported increased likelihood that they would alert patrons to suspect skin lesions. Also, hair professionals reported increased likelihood that they would encourage patrons to seek medical care for their concerning lesions. CONCLUSIONS: Hair professionals may act as lay skin cancer educators in rural salons. Educational programs for hair professionals can increase their comfort with detecting lesions suspicious for skin cancer, increase their comfort with sharing skin protection information with patrons, and increase their likelihood of both alerting their patrons about suspicious skin lesions and encouraging their patrons to have their suspicious lesions evaluated.

Treatment of Skin Abscesses: A Review of Wound Packing and Post-Procedural Antibiotics.

OBJECTIVE: Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. We examine the available evidence investigating if I&D alone is sufficient as the sole management for the treatment of uncomplicated abscesses, specifically focusing on wound packing and post-procedural antibiotics. METHODS: We reviewed available literature for any published observational or randomized control trials on the treatment of abscesses via packing and antibiotics. Only recent manuscripts published in the English language and in the past 10 years (2004 through 2014) were included due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as one of the leading causative organism of soft tissue infections in the past decade. RESULTS: Three randomized control trials (RCT) and one observational study investigated wound packing versus no packing following I&D. None of the studies demonstrated a difference in treatment failure rates, recurrence rates, or need for secondary interventions in non-packed wounds; however, packing groups had more pain. Six studies investigated the post-procedural use of antibiotics. The RCTs failed to show decreases in treatment failure rates with antibiotics, but two studies demonstrated a short-term decrease in new lesion formation. The observational studies demonstrated mixed results regarding rates of treatment cure with appropriate antibiotic selection, specifically in patients with positive wound cultures for MRSA. DISCUSSION: Regardless of supplemental post-procedural treatment, all studies demonstrate high rates of clinical cure following I&D. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. Due to limited studies and conflicting data, we are unable to make a recommendation in support or opposition of adjunctive post-procedural packing and antibiotics in an immunocompromised patient.

Modern Interventions for Pediatric Atopic Dermatitis: An Updated Pharmacologic Approach.

Pediatric atopic dermatitis (AD) has historically challenged dermatologists given the variable response of patients to treatment and limited available therapeutic options, often with significant potential side effects. Over the last decade, targeted treatments including dupilumab and Janus kinase (JAK) inhibitors have emerged as significant treatment advances. An updated therapeutic approach for incorporating these new practice-changing medications can help clinicians manage these challenging patients. In this review, we discuss emerging topical and systemic (oral and injectable) treatments in pediatric AD, including topical PDE4 inhibitors and tapinarof, oral JAK inhibitors, and injected biologics including IL-4Rα inhibitor dupilumab, IL-13 inhibitor tralokinumab, IL-13Rα inhibitor lebrikizumab, IL-31Rα inhibitor nemolizumab, and IL-5Rα inhibitor benralizumab. We also review experimental agents in early clinical trials, such as targeted microbiome transplant lotions/antimicrobials, which may gain relevance in AD treatment. Finally, we propose a therapeutic approach for pediatric AD that incorporates newer therapies including dupilumab and JAK inhibitors, recognizing that these agents may not be universally available or approved. Further trials that include pediatric patients, especially head-to-head studies among therapeutic classes, are needed to clarify the role of emerging treatments.

Biologic therapy in psoriasis: navigating the options.

Psoriasis is a T cell-mediated inflammatory disease associated with comorbidities impacting the overall health and quality of life of those affected. This article offers a brief overview of treatment classes available and an approach to choosing biologic treatments based on individual patient characteristics, including disease severity, comorbidities, and ultimate treatment goals.