Tralokinumab plus topical corticosteroids for the treatment of moderate-to-severe atopic dermatitis: results from the double-blind, randomized, multicentre, placebo-controlled phase III ECZTRA 3 trial.

BACKGROUND: Tralokinumab is a fully human monoclonal antibody that specifically neutralizes interleukin-13, a key driver of atopic dermatitis (AD). OBJECTIVES: To evaluate the efficacy and safety of tralokinumab in combination with topical corticosteroids (TCS) in patients with moderate-to-severe AD who were candidates for systemic therapy. METHODS: This was a double-blind, placebo plus TCS controlled phase III trial. Patients were randomized 2 : 1 to subcutaneous tralokinumab 300 mg or placebo every 2 weeks (Q2W) with TCS as needed over 16 weeks. Patients who achieved an Investigator's Global Assessment (IGA) score of 0/1 and/or 75% improvement in Eczema Area and Severity Index (EASI 75) at week 16 with tralokinumab were rerandomized 1 : 1 to tralokinumab Q2W or every 4 weeks (Q4W), with TCS as needed, for another 16 weeks. RESULTS: At week 16, more patients treated with tralokinumab than with placebo achieved IGA 0/1: 38·9% vs. 26·2% [difference (95% confidence interval): 12·4% (2·9-21·9); P = 0·015] and EASI 75: 56·0% vs. 35·7% [20·2% (9·8-30·6); P < 0·001]. Of the patients who were tralokinumab responders at week 16, 89·6% and 92·5% of those treated with tralokinumab Q2W and 77·6% and 90·8% treated with tralokinumab Q4W maintained an IGA 0/1 and EASI 75 response at week 32, respectively. Among patients who did not achieve IGA 0/1 and EASI 75 with tralokinumab Q2W at 16 weeks, 30·5% and 55·8% achieved these endpoints, respectively, at week 32. The overall incidence of adverse events was similar across treatment groups. CONCLUSIONS: Tralokinumab 300 mg in combination with TCS as needed was effective and well tolerated in patients with moderate-to-severe AD.

Itch: an under-recognized problem in psoriasis.

Psoriasis has historically been considered a nonpruritic dermatosis, in contrast with atopic dermatitis. Thus, itch has often been underappreciated and overlooked in psoriasis. However, increasing evidence over the past decade has shown that itch can be one of the most prevalent and burdensome symptoms associated with psoriasis, affecting almost every patient to some degree. Itch can involve the entire body, although it predominantly affects the legs, hands, back, body and especially the scalp. Uncontrolled itch can significantly impact all aspects of the well-being and quality of life of the patient. While there has been some progress in trying to better understand the pathophysiology of itch in psoriasis, more research effort and interest are needed. This under-recognition of itch in psoriasis is clearly reflected in the dearth of treatment options targeting itch despite significant advancement in treating the lesions themselves. Recently, however, clinical studies have begun to include itch as a study outcome. The resulting data have demonstrated concomitant antipruritic benefits and improved Psoriasis Area and Severity Index (PASI) scores with mainstay treatments for psoriasis, such as topical corticosteroids and vitamin D analogs, phototherapies, and various systemics and biologics. This article takes a closer look at this debilitating symptom, reviewing the available epidemiology data for psoriatic itch, presenting the current understanding of psoriatic itch pathophysiology and highlighting important clinical data for various treatment options for itch. Practical considerations for increasing the recognition of itch as well as improving its management in psoriasis are also provided.

Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI.

Ethnic skin or 'skin of colour', which is characterized by increased epidermal melanin, labile melanocytes and reactive fibroblast responses, poses special challenges for the use of laser and light-based therapies. These therapies are associated with a greater risk of dyspigmentation and scarring in ethnic skin and therefore require careful selection of device and treatment parameters to minimize complications. Whereas early-generation lasers for hair removal and resurfacing were generally contraindicated for individuals with Fitzpatrick skin phototypes (SPT) IV-VI, advances in the past decade have given rise to a range of devices that can be safely used in ethnic skin. Longer wavelength lasers such as the 810 and 1064 nm Nd:YAG; intense pulsed light and monochromatic excimer light (308 nm); fractional lasers; and radiofrequency devices have all been used safely for hair removal, pigmentary abnormalities, resurfacing and skin tightening in ethnic skin, respectively. Notwithstanding these advances, nuances in the laser or light treatment of darker skin types remain and must be considered to ensure safe therapeutic outcomes. The vast majority of published data pertaining to lasers and light treatments in nonwhite skin involve patients of East Asian ethnicity (e.g. Korean, Japanese, Chinese, Thai). By contrast, there is a paucity of studies involving individuals of African ancestry or those with SPT V or VI. This article will review laser and light-based modalities that are considered safe and effective for individuals with richly pigmented skin.

Cosmetic procedures in skin of color.

An increasing proportion of patients undergoing aesthetic procedures are individuals with skin of color (Fitzpatrick skin types IV-VI). Racial or ethnic differences exist in perceptions of beauty, the prevalence of specific cosmetic concerns, as well as optimal approaches to treatment. Most important, is the need to avoid treatment-associated pigmentary alterations and keloid scarring, of which there is a greater risk in patients with skin of color. Here we review leading esthetic concerns in the darker skinned patient and discuss approaches to treatment.

Reassessment of the suction blister model of wound healing: introduction of a new higher pressure device.

BACKGROUND: Negative pressure suction blisters have been used as a reproducible and minimally invasive in vivo model of wound healing in human subjects. Despite advantages over other available methods, this technology has not been employed widely in wound healing research. OBJECTIVE: To evaluate the efficacy of a higher pressure suction blister system as an in vivo human model for wound healing and to demonstrate the superiority of this method over previously used suction blister models of wound healing. METHODS: Four 5-mm-diameter suction blisters were induced on the medial upper arm of 18 healthy men and women using a negative pressure of 508 mmHg. Blister roofs were removed, exposing the underlying dermis. The time required for blister formation, the uniformity of wounds, and the degree of patient tolerance were assessed. The ability to monitor clinical re-epithelialization over 7 days was also evaluated by a team of investigators. RESULTS: Four partial-thickness wounds were produced on each subject in 25-45 min. Wound diameter and morphology were uniform in all subjects. Volunteers tolerated the procedure without complaints of pain or discomfort. Progressive, re-epithelialization was observed daily starting 24 h post-wounding. CONCLUSIONS: This higher pressure suction blister system is an effective model for wound healing. Compared to reported methods, it is a better tolerated, more reliable, and more efficient approach to studying in vivo wound repair in human subjects. It is especially well suited for screening the wound healing potential of new pharmacologic agents.