Biologic Vs Conventional Therapies: Comparing Risk of Psoriasis-Associated Comorbidities.

Psoriasis is associated with multiple comorbidities. In this retrospective cohort analysis, we compared the comorbidities in patients who received biologic treatments with those who received conventional treatments. Our data indicates that biologics may be associated with lower rates of comorbidities in comparison to conventional therapy. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.7119.

Examining risk factors and preventive treatments for first venous leg ulceration: A cohort study.

BACKGROUND: Large studies that examine risk factors for first occurrence of venous leg ulcerations are needed to guide management. OBJECTIVE: To investigate factors associated with development of first occurrence of venous leg ulcerations. METHODS: A retrospective cohort study using a validated national commercial claims database of patients with venous insufficiency. Subjects were followed to determine whether they developed first occurrence of venous leg ulcerations, and risk and protective factors were analyzed. RESULTS: Adjusted hazard ratio (AHR) for comorbidities demonstrated an increased risk in men (AHR 1.838; 95% confidence interval [CI] 1.798-1.880), older age (45-54 years: AHR 1.316, 95% CI 1.276-1.358; 55-64 years, AHR 1.596, 95% CI 1.546-1.648), history of nonvenous leg ulceration (AHR 3.923; 95% CI 3.699-4.161), anticoagulant use (AHR 1.199; 95% CI 1.152-1.249), antihypertensive use (AHR 1.067; 95% CI 1.040-1.093), and preexisting venous insufficiency including chronic venous insufficiency (AHR 1.244; 95% CI 1.193-1.298), edema (AHR 1.224; 95% CI 1.193-1.256), and chronic venous hypertension (AHR 1.671; 95% CI 1.440-1.939). Possible protective factors were having venous surgery (AHR 0.454; 95% CI 0.442-0.467), using compression stockings (AHR 0.728; 95% CI 0.705-0.753), using prescribed statin medications (AHR 0.721; 95% CI 0.700-0.743), and using pain medications (AHR 0.779; 95% CI 0.757-0.777). LIMITATIONS: Risk of misclassification, given the use of International Classification of Diseases, Ninth Revision codes. Possible confounding factors such as body mass index could not be adequately controlled with these codes. CONCLUSION: The new evidence presented supports a paradigm shift toward venous leg ulceration prevention.

Skin changes and manifestations associated with the treatment of obesity.

In light of the increasing prevalence of obesity, a large proportion of patients are taking weight loss medications or undergoing weight loss procedures. The typical paradigm for treating obesity begins with lifestyle interventions and progresses to medical treatments, and when nonsurgical interventions have failed, procedural techniques are considered. The effect of these interventions on the skin and dermatologic conditions has not been reviewed in depth. Herein, we review the impact of weight loss on pre-existing dermatologic conditions, as well as the development of novel skin changes and consequences of redundant skin after these interventions.

Eccrine-Centric Melanocytic Nevus.

Benign melanocytic neoplasms present with a diverse array of well-known histopathologic patterns. It is imperative to recognize the benign patterns to render accurate diagnoses. We describe here an interesting and hitherto not described low-power architectural pattern of a benign melanocytic lesion: eccrine-centric melanocytic nevus. The patient was a 50-year-old African American woman who noticed a new mole on her foot that began as a dark speck but quickly grew larger. The lesion was excised to exclude the possibility of melanoma. Upon review of the specimen, the lesion was noted to demonstrate a distinctive pattern consistent with a melanocytic nevus of possible congenital onset. Remarkably, the ducts of eccrine glands were increased in density and the nests of melanocytes were found solely in a peri-eccrine distribution without melanocytes in any other locations (ie, interstitial, perifollicular). Additionally, all melanocytes in the nevus were rather heavily pigmented. Although this pattern demonstrated no atypical features that would cause one to consider it malignant to the trained eye, this presentation could implicate a metastatic disease (well-delineated nests in the dermis without concomitant interstitial component) and it is important to recognize.

Fifteen Minute Test May Save 15% or More on Rosacea Treatment.

Rosacea is a common inflammatory skin condition that impacts a large portion of fair-skinned populations. The redness associated with rosacea can be a significant challenge. Brimonidine sulfate and oxymetazoline HCL were both recently approved by the FDA for the management of facial redness. These agents, however, are costly, and not all patients respond to the medication. Herein, we describe a clinical pearl that helps to optimize patient selection for the medications. This saves the patient and the health care system both time and money. J Drugs Dermatol. 2018;17(5):692-693.

A review of monochromatic light devices for the treatment of alopecia areata.

There are many laser technologies that are being tested that claim to support hair regrowth for patients with alopecia areata (AA). In this paper, we will determine whether the body of evidence supports the use of devices using monochromatic light sources to treat AA. Articles were gathered from PubMed, Embase, and the Cochrane database using these keywords: lasers, excimer laser, low-level laser therapy (LLLT), low-level light therapy, alopecia, alopecia areata, and hair loss with a category modifier of English. Ten clinical trials and seven case reports/abstracts were assessed. Eight clinical trials and two case reports demonstrated hair regrowth with the 308-nm excimer laser/light in men, women, and children. One case report demonstrated hair regrowth with the ALBA 355® laser. One clinical trial and two case reports demonstrated hair regrowth with LLLT. While two case reports demonstrated hair regrowth with fractional laser therapy, one clinical trial showed no improvement. The 308-nm excimer laser is a safe and effective treatment for men, women, and children with refractory AA of the scalp and beard. Larger, double-blinded clinical trials should be conducted to compare excimer laser therapy to standard treatments. More data is needed to determine the efficacy of LLLT and fractional laser therapy in the treatment of AA.

Low-level laser therapy for the treatment of androgenic alopecia: a review.

There are many new low-level laser technologies that have been released commercially that claim to support hair regrowth. In this paper, we will examine the clinical trials to determine whether the body of evidence supports the use of low-level laser therapy (LLLT) to treat androgenic alopecia (AGA). A literature search was conducted through Pubmed, Embase, and Clinicaltrials.gov for clinical trials using LLLT to treat AGA. Thirteen clinical trials were assessed. Review articles were not included. Ten of 11 trials demonstrated significant improvement of androgenic alopecia in comparison to baseline or controls when treated with LLLT. In the remaining study, improvement in hair counts and hair diameter was recorded, but did not reach statistical significance. Two trials did not include statistical analysis, but showed marked improvement by hair count or by photographic evidence. Two trials showed efficacy for LLLT in combination with topical minoxidil. One trial showed efficacy when accompanying finasteride treatment. LLLT appears to be a safe, alternative treatment for patients with androgenic alopecia. Clinical trials have indicated efficacy for androgenic alopecia in both men and women. It may be used independently or as an adjuvant of minoxidil or finasteride. More research needs to be undertaken to determine the optimal power and wavelength to use in LLLT as well as LLLT's mechanism of action.

Ocrelizumab-induced psoriasiform dermatitis in a patient with multiple sclerosis.

Multiple Sclerosis (MS) is a chronic autoimmune disease that presents with a wide variety of sensory and motor deficiencies. New medications targeting B cells have been approved to treat MS, but the side effect profile has not been widely explored. Herein, we report a case of drug-induced psoriasiform dermatitis following ocrelizumab treatment. Physicians should be cognizant of this possible side effect in patients receiving treatment for MS.

Sexual side effects of 5-α-reductase inhibitors finasteride and dutasteride: A comprehensive review.

The 5-α-reductase inhibitors finasteride and dutasteride are frequently used in the treatment of androgenetic alopecia and benign prostatichyperplasia. These drugs are effective at reducing levels of dihydrotestosterone, the primary androgen responsible for the pathogenesis of both these conditions. However, finasteride and dutasteride have also been shown to produce an increase in the incidence of sexual dysfunction, namely, impotence, decreased libido, and ejaculation disorder. The purpose of this study is to review the existing medical literature with regard to the sexual side effects of 5-α-reductase inhibitor therapy. This review is an extensive look at the sexual effects of 5-α-reductase inhibitors and compares outcomes for finasteride versus dutasteride in addition to comparing sexualside effects for each of the different dosages prescribed of finasteride and dutasteride.

Wound odor: current methods of treatment and need for objective measures.

Chronic wounds are an enormous burden to society, costing billions of dollars annually in the USA alone. Despite the extensive research into methods to heal chronic wounds, many remain unhealed for months to years. There is a need to focus on patient reported outcomes to improve quality of life in patients with non-healing wounds. Wound odor has a significant impact on patient quality of life; however, relatively little information is available on the management of wound odor. We review the current data available on wound odor and discuss the need for standardized objective measures of odor to improve research quality. An independent search of the PubMed and Embase databases was conducted using combinations of the following words or phrases: "wounds," "chronic wounds," "diabetic ulcers," "venous leg ulcers (VLUs)," "malignant ulcers," "odor," "odour," "smell," "malodor," "artificial olfaction," "electronic nose," and "e-nose." Article references were also searched for significance. There are few overall studies on wound odor, and fewer randomized controlled trials. Current trials on odor have consistent weaknesses such as subjective measures and poor methodology. No single odor treatment modality has been demonstrated to be widely effective for wound odor or superior to other methods. Future research should incorporate objective measures of odor such as electronic noses into clinical trials.

Comparison of 3-dimensional Wound Measurement With Laser-assisted and Hand Measurements: A Retrospective Chart Review.

Wound area measurements provide an objective assessment of wound healing; however, most commonly used measurement techniques are imprecise. PURPOSE: A new portable 3-dimensional (3D) wound measurement device was tested against laser- and hand-measurement methods. METHODS: A retrospective comparative analysis was conducted to analyze the difference in wound measurements using records of patients seen at the University of Miami Hospital (Miami, FL) outpatient wound healing clinic between November 2017 and February 2018 who had wounds of various etiologies measured using 3 different techniques during a single visit: the 3D device, a laser-assisted wound measurement device (laser), and standard hand measurements. Patients with circumferential wounds were excluded (the laser and 3D devices are incapable of assessing these wounds). Differences were compared using paired t tests. RESULTS: The wounds ranged in area from 0.8 cm² (hand measurements) and 0.2 cm² (3D and laser devices) to 100.94 cm², 61.9 cm², and 65 cm² by hand measurement, 3D, and laser device, respectively. Among the 23 wounds measured, the majority (16) were venous ulcers. No statistically significant difference was noted between the 3D measurements compared with the laser (P = .340). Statistically significant differences in the measurements between the 3D device and hand measurements (P = .008) and the laser device and hand measurements (P = .006) were found. CONCLUSION: Measurements of the 3D device appear analogous to laser devices, making it an alternative tool for clinicians interested in monitoring wound progression. Because the 3D device has the capacity to examine wound volume, prospective comparative trials should be used to examine the accuracy and precision of the device to measure volume.

Development of Drug-Induced Inverse Psoriasis in a Patient with Crohn's Disease.

Crohn's disease is difficult to manage and often requires multiple medications. While these drugs vastly improve quality of life, physicians must monitor for adverse events. We report a case of a flare of inverse psoriasis after 15 months of treatment with ustekinumab. This is the third reported case of a flare of drug-induced psoriasis with ustekinumab, and it is the first reported case with an inverse presentation; however, the clinical picture is confounded by concomitant use of hydroxychloroquine. Inverse psoriasis is a rare variant of drug-induced psoriasis of which physicians must be cognizant while treating patients with Crohn's disease.

Healing Chronic Wounds: Current Challenges and Potential Solutions.

PURPOSE OF REVIEW: The purpose of this review is to raise awareness, examine the challenges faced by wound care researchers and explore opportunities for potential improvements. RECENT FINDINGS: Chronic wounds are associated with significant morbidity and mortality, and they represent a major medical and financial burden. Despite this, no new therapy has received FDA efficacy approval for the treatment of chronic wounds since 1997. Previous preclinical studies using animal models did not translate to human wounds due to inherent limitations of experimental models, variability in assessment methods and overall experimental design. Clinical trials continued to be challenged by the balance of the inclusion and exclusion criteria, the high cost and time expenditure of the trials, and the constraint of a single FDA-acceptable outcome of complete wound closure. SUMMARY: Wound research faces multiple challenges in both pre-clinical and clinical research that slowed progress and development of efficacious therapies. Solutions to such challenges will provide new opportunities for improved study design in the future.

A Review on Imiquimod Therapy and Discussion on Optimal Management of Basal Cell Carcinomas.

Basal cell carcinoma (BCC) is the most common type of skin cancer with an increasing incidence. However, it is still poorly researched compared to many other human diseases. Today, cutaneous neoplasms are a frequent, major problem faced by medical professionals. BCC tumors can cause extensive cosmetic distress as well as disfigurement to patients especially when on the face. Treatment options include surgery, systemic agents, and topical agents. Over the past few decades more studies have been performed to evaluate the utility of topical imiquimod therapy for treatment of BCC. Imiquimod is a toll-like receptor that modifies the immune response via the up-regulation of cytokines and has the capacity to improve a person's immune response. Multiple clinical studies have demonstrated the ability of topical imiquimod to diminish or even eradicate basal cell carcinoma. Given this variety of treatment options and the need for noninvasive options, this review is focused on summarizing the existing information available on the use of imiquimod for BCC and comparing it to other treatment modalities. While excision is the first line treatment and often has greater success with regards to clearance, imiquimod has been shown to be an efficacious treatment modality for BCC. Imiquimod therapy has been shown to be a less invasive and cheaper option than many other treatment modalities. It may be used as either monotherapy or in combination with other treatments, though occlusion has not been shown to be helpful. Several dosing regimens have been studied in the literature. Dosing should take into account factors such as the type of BCC, location, and physician/patient comfort with the regimen. Variability in response to treatment with imiquimod amongst studies suggests that response to treatment may depend on location of lesion, thus more research must be done in this area.

Alopecia Areata: Review of Epidemiology, Clinical Features, Pathogenesis, and New Treatment Options.

Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. It typically presents with sharply demarcated round patches of hair loss and may present at any age. In this article, we review the epidemiology, clinical features, pathogenesis, and new treatment options of AA, with a focus on the immunologic mechanism underlying the treatment. While traditional treatment options such as corticosteroids are moderately effective, a better understanding of the disease pathogenesis may lead to the development of new treatments that are more directed and effective against AA. Sources were gathered from PubMed, Embase, and the Cochrane database using the keywords: alopecia, alopecia areata, hair loss, trichoscopy, treatments, pathogenesis, and epidemiology.

Evaluation of Donor Site Pain After Fractional Autologous Full-Thickness Skin Grafting.

Background: Despite the development of numerous wound treatment alternatives, 25% to 50% of leg ulcers and >30% of foot ulcers are not fully healed after 6 months of treatment. Autologous skin grafting is a time-tested therapy for these wounds; however, the creation of a new wound in the donor area yields a considerable limitation to this procedure. Innovation: Fractional autologous full-thickness skin grafting (FFTSG) is a technique wherein multiple small full-thickness skin grafts (FTSGs) are harvested with possibly minor donor-site comorbidities. The first device used to harvest FFTSG (ART™ system, Medline, Northfield, IL) is a device capable of harvesting >300 small FTSGs and transferring them to a target wound. Objective: To better evaluate patients' clinical experience, we sought to evaluate pain at the donor site associated with this procedure. Approach: Pain was assessed with numeric visual analog pain scales at days 1, 2, 4, and 7. Nine subjects underwent this procedure with only six of them reporting any level of pain on day 1, and none disclosing pain after day 2. Conclusion: In this study, we evidenced that this device manages to harvest FTSGs with minimal associated pain. Future research will need to evaluate other aspects of the procedure as well as long-term outcomes at the donor and recipient areas.