Real-life effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis.

Atopic dermatitis (AD) is a common, chronic inflammatory condition with a substantial negative impact on the quality of life. Dupilumab, the first biologic approved for the treatment of moderate-to-severe AD, binds IL-4Rα and inhibits signaling of both IL-4 and IL-13. This study aimed to determine the real-life effectiveness and safety of dupilumab treatment in patients with moderate-to-severe AD. The results of the study indicates high effectiveness and safety of dupilumab in real-life conditions. The treatment was continued during the COVID-19 pandemic in most of the patients without any adverse outcome. The rate of conjunctivitis was higher compared to clinical trials, nevertheless treatment was not discontinued in any patients due to adverse effects.

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria.

INTRODUCTION: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. AIM: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. MATERIALS AND METHODS: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. RESULTS: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. CONCLUSIONS: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.

Public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID-19 pandemic: Insights from Google Trends.

Coronavirus disease 2019 (COVID-19) pandemic had substantial effect both on daily life and medical practice. Internet data have been used to analyze the trends in public interest in various medical conditions and treatments. The aim of this study is to analyze the public interest in dermatologic symptoms, conditions, treatments, and procedures during the COVID-19 pandemic. Google Trends was queried for a total of 120 dermatological search queries. Three periods of 2020 ([March 15-May 9], [May 10-July 4], and [July 5-October 31]) were compared with the previous 4 years (2016-2019). A significantly decreased interest in skin cancers and certain dermatologic conditions (eg, pityriasis rosea and scabies) was observed throughout the study period. Whereas a significant increase of interest in dry skin, hair shedding, oily hair, atopic dermatitis, and hand eczema was detected during the study. An initial decrease in interest was followed by a significant increase for acne, comedones, melasma, rosacea, botox, dermaroller, and peeling. The study demonstrated a significant impact of the COVID-19 pandemic on the public interest in dermatology. The present results would help to create healthcare policies and information sources, which can meet the public demand. The reasons for the observed trends and their effect on patient outcomes might be of interest for future studies.

Remission of chronic spontaneous urticaria following omalizumab with gradually extended dosing intervals: Real-life data.

Omalizumab is a well-established treatment option in chronic spontaneous urticaria unresponsive to antihistamines at standard or higher doses. However, characteristics of the remission and relapse following the withdrawal of omalizumab remain largely unknown. We aimed to define the characteristics of remission in CSU following omalizumab with gradually lengthened dosing intervals in this retrospective study of 102 patients who were treated with at least 3 doses of omalizumab between 2013 and 2020. Of 102 patients, 70 (68.6%) showed a CR to omalizumab at standard doses. Omalizumab could be discontinued in 47 of 70 patients using gradually lengthened dosing intervals. Following a mean follow-up duration of 12.2 months, 25 (58.1%) patients were still in remission while 18 (41.9%) had relapse (Follow-up data were not available in 4 patients). The relapses were unresponsive to antihistamines in 14 patients (77.7%), however, re-treatment with omalizumab led to complete control of symptoms. The patients younger than 40 were more likely to relapse. Despite the need for comparison with fixed-dosing intervals in larger, prospective studies, the results of this study imply that omalizumab with gradually extended dosing intervals might provide a long duration of remission in CSU.

Netherton syndrome: Temporary response to dupilumab.

Netherton syndrome (NS) is an orphan disease characterized by congenital ichthyosis, hair abnormalities, and atopy, with limited treatment options. We achieved temporary improvement only during the initial 6 weeks of treatment with dupilumab, which differs from the sustained improvement observed in 2 other recently published cases. Although the clinical presentation of atopy and increased pre-allergic cytokines in NS patients suggest that dupilumab may be beneficial, larger studies are required.

The impact of omalizumab on quality of life and its predictors in patients with chronic spontaneous urticaria: Real-life data.

BACKGROUND: Omalizumab is a third-line treatment for chronic spontaneous urticaria (CSU). However, the real-life data on the impact of omalizumab on CSU-related quality of life (QoL) remain scarce. OBJECTIVES: To investigate the impact of omalizumab on QoL and its predictors in CSU. A retrospective cohort study was done. The response to therapy was evaluated using urticaria activity score over 7 days (UAS7) and urticaria control test (UCT); the impairment in QoL was assessed using dermatology life quality index (DLQI) and chronic urticaria quality of life questionnaire (CU-Q2oL). RESULTS: Forty-two patients were included. All scores improved from baseline to first month and remained stable at the third month of treatment (p < .001). The gender, age, and angioedema had no significant effect on QoL, but the complete responders (UAS7:0-1) had better improvement rates in all scores compared to others. The baseline UAS7, DLQI, and CU-Q2oL scores were lower at the baseline in complete responders (p = .0001). CONCLUSIONS: A rapid and continual improvement in QoL was obtained with omalizumab treatment. A better UAS7, UCT, DLQI, and CU-Q2oL score at the baseline might be a predictor of a better response to omalizumab and more improvement in QoL.

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test.

Acute generalized exanthematous pustulosis (AGEP) is seen uncommonly in children and sometimes shows atypical clinical features in this population. Patch testing can be used effectively in children for the confirmation of the culprit drug in cases of multiple drug use. Here, we report a rare, pediatric case of ceftriaxone-induced AGEP confirmed by patch testing with subsequent recurrence of the skin eruption.

The Real-Life Effectiveness and Safety of Omalizumab Updosing in Patients With Chronic Spontaneous Urticaria.

BACKGROUND: Omalizumab is a third-line treatment for chronic spontaneous urticaria (CSU). Studies investigating the use of higher doses of omalizumab in patients unresponsive to regular doses are limited. OBJECTIVES: This study aims to investigate the effectiveness and safety of omalizumab 450 mg in CSU. METHODS: A retrospective cohort study was conducted. The response to therapy was evaluated using the Urticaria Activity Score over 7 days (UAS7) and the Urticaria Control Test (UCT). Patients showing complete response (CR) (UAS7: 0-1) to omalizumab 300 mg (Group 1) and patients receiving at least 3 doses of omalizumab 450 mg (Group 2) between 2016 and 2018 were included. RESULTS: A total of 72 patients (Group 1: 59; Group 2: 13) were included. In Group 2, the mean UAS7 score decreased from 18.6 to 5.1 and the mean UCT score increased from 8.6 to 12 after a mean 4.3 courses of 450 mg omalizumab treatment. Of the 13 patients in Group 2, 6 had CR and 3 had good disease control (UAS7: 2-6). The rate of patients with low baseline IgE levels (< 43 IU/mL) was significantly higher in Group 2. CONCLUSIONS: Higher doses of omalizumab are effective and safe in patients with CSU that is unresponsive to omalizumab 300 mg. Lower baseline total IgE levels might be used as a predictor of nonresponse to omalizumab and the need for higher doses.

Margin-Controlled, Staged Surgical Excision in the Treatment of High-Risk Basal Cell Carcinomas of the Head and Neck Region.

BACKGROUND: The most common skin cancer is basal cell carcinoma (BCC), and the gold-standard treatment for high-risk tumours is Mohs surgery. However, alternative methods are needed for high-risk tumours in countries where the performance rate of Mohs surgery is low. OBJECTIVES: The objective of this article is to investigate the feasibility, efficacy, and safety of margin-controlled, staged surgical excision (MCSSE) in high-risk tumours as a possible treatment alternative. METHODS: A retrospective cohort study, including patients diagnosed with high-risk BCC in the head and neck region and treated with MCSSE between 2003 and 2010, was conducted. RESULTS: During the study period 50 tumours in 47 patients were treated, with low adverse event rates and high patient satisfaction rates. Of the 50 tumours, 1 recurred at the 12-month follow-up. CONCLUSIONS: Despite the small sample size and relatively short follow-up period, the present study shows that MCSSE might be a feasible alternative for the treatment of high-risk BCCs in institutions where Mohs surgery is not performed. Future studies on long-term recurrence rates are needed.

The efficacy and safety of targeted narrowband UVB therapy: a retrospective cohort study

Background/aim: Phototherapy is a safe and effective treatment modality for numerous dermatological conditions. Recently, targeted phototherapy modalities have gained importance due to their advantages over conventional phototherapy.This retrospective study aimed to evaluate the safety and efficacy of targeted narrowband UVB phototherapy in patients with dermatological disorders Materials and methods: This single-center study included 173 patients who were treated with targeted narrowband UVB phototherapy. Demographic features, phototherapy parameters, and adverse effects were evaluated in all patients, and the treatment response was assessed in patients who attended at least one follow-up visit. Results: A total of 173 patients (102 females; 71 males) with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis vulgaris were included in the study. Among 73 patients, with whom the treatment was finalized by physician, an excellent response was obtained in 10%, 52.9%, 53.8%, 28.6%, and 40% of patients with vitiligo, alopecia areata, lichen simplex chronicus, palmoplantar psoriasis, and psoriasis, respectively. The treatment was generally well tolerated and was discontinued in only two patients due to adverse effects. Conclusion: This study demonstrates that targeted narrowband UVB therapy is a safe and effective treatment alternative, particularly for alopecia areata, lichen simplex chronicus, and palmoplantar and plaque-type psoriasis.

Acquired progressive lymphangioma: Case report with partial response to imiquimod 5% cream.

Acquired progressive lymphangioma (APL), or benign lymphangioendothelioma, is an unusual entity derived from vascular structures. Clinically and histopathologically it may resemble Kaposi's sarcoma and well-differentiated angiosarcoma, causing a diagnostic problem. We report an individual with APL initially diagnosed with Kaposi's sarcoma who underwent unnecessary laboratory testing. Imiquimod 5% cream stopped the progression of the lesion. Awareness of this rare entity may prevent patients from undergoing excessive testing. Imiquimod may be used as a safe, effective treatment option.

Prevalence of obesity in paediatric psoriasis and its impact on disease severity and progression.

BACKGROUND/OBJECTIVES: The current literature suggests there is a possible connection between paediatric psoriasis and obesity. However, there is a paucity of research on the influence of increased adiposity on the severity of paediatric psoriasis and disease progression. We aimed to compare the prevalence of being overweight or obese in paediatric psoriasis patients and controls and assess the potential impact of being overweight/obese on disease severity and progression of disease. METHODS: This multicentre prospective case-control study included 289 psoriasis patients (aged < 18 years) treated and followed up by one of the four university hospitals in Turkey. The control group consisted of 151 consecutive age-matched and sex-matched children who lacked a personal or family history of psoriasis. The participants' characteristics, psoriasis-related parametres (e.g., initial subtype, psoriasis area and severity index, presence of psoriatic arthritis) and body mass index were determined. RESULTS: The difference between the prevalence of being overweight/obese among psoriatics (28%) and the control group (19%) was significant (P = 0.024). Being overweight/obese had no significant impact on disease severity and unresponsiveness to topical treatment. Within a median follow-up time of 12 months, 23% of our patients with localised disease at disease onset progressed to generalised disease. The impact of being overweight/obese on disease progression was found to be non-significant; however, disease duration was found to have a significant impact on disease progression (P = 0.026). CONCLUSIONS: Although it is not associated with disease severity and course, increased bodyweight may be a health problem for psoriatic children.

Alopecia universalis unresponsive to treatment with tofacinitib: report of a case with a brief review of the literature.

Janus kinase inhibitors are emerging treatment alternatives in various immune-mediated diseases including alopecia universalis. Herein, we report a patient with psoriasis and alopecia universalis in whom treatment with tofacitinib led to remission of psoriasis without improvement in alopecia universalis. Despite the promising potential in alopecia areata treatment, research evaluating the efficacy of different Janus kinase inhibitors and possible prognostic factors related with a more favorable response are warranted.

Successful treatment of pityriasis lichenoides chronica with narrow-band ultraviolet B therapy in a patient with Keratitis-Ichthyosis-Deafness syndrome: a case report.

Keratitis-ichthyosis-deafness (KID) syndrome is a rare genodermatosis causing ichthyosis-like skin lesions, keratitis, and deafness. Herein, we report a patient with this rare syndrome in association with pityriasis lichenoides chronica, which was succesfully treated with narrow-band ultraviolet B phototherapy despite our concerns regarding the increased risk of squamous cell carcinoma, hyperpyrexia, and keratitis.

Emerging Systemic Treatment Options in Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory condition that significantly affects the quality of life of both patients and their families or caregivers. Recently, treatment for moderate-to-severe AD were limited to conventional immunosuppressive therapies. However, currently, with the approval of biologic treatments and oral small molecules in the past decade, the effective and safe management of patients with AD is possible. Despite these advancements, challenges and unmet needs in clinical practice remain. This includes patients who do not respond well to or cannot tolerate existing treatment options and inadequate therapies that can modify the disease course. This review aimed to provide an overview of the current treatment approach for AD, highlight the current challenges in treatment, and discuss the rationale for novel treatment options and emerging evidence on systemic treatment options for AD.

Biomarkers to predict therapeutic response in chronic spontaneous urticaria: a review.

Chronic spontaneous urticaria (CSU) is a relatively common dermatological disorder characterized by sudden and unpredictable onset of pruritic wheals and/or angioedema, for more than six weeks. It is a mast cell-mediated histaminergic disorder, considerably worsening patients' quality of life. Current treatment options include anti-histamines, omalizumab and cyclosporine, in a step-wise algorithmic approach, aimed at complete symptom control. Patients do not respond uniformly to these therapeutic options due to phenotypic and endotypic heterogeneity, and often remain uncontrolled/poorly controlled. Recent research is focused on identifying certain biomarkers to predict therapeutic response and facilitate patient-targeted personalized treatment, for maximum benefit. The current article summarizes various biomarkers explored to date, and also elaborates their role in predicting therapeutic response to anti-histamines, omalizumab and cyclosporine, in CSU patients. High disease activity, elevated CRP/ESR and elevated D-dimer are the most important predictors of non/poor-response to antihistamines. Low and very low baseline IgE, elevated CRP/ESR, ASST+, BAT/BHRA+, basopenia, eosinopenia, and elevated D-dimer are predictors of poor and good response to omalizumab and cyclosporine, respectively. Additionally, normal or slightly elevated baseline IgE and FceR1 overexpression are predictors of a faster response with omalizumab. However, none of these predictors have so far been completely validated and are not yet recommended for routine use. Thus, large-scale prospective studies are needed to confirm these predictive biomarkers and identify new ones to achieve the goal of personalized medicine for CSU.