Rapid resolution of non-segmental vitiligo in a patient treated with abrocitinib: A case report.

Vitiligo is a common, autoimmune, depigmenting disorder of the skin. Janus Kinase inhibitors have emerged as promising topical and oral therapeutic options for vitiligo. There have been no reports of vitiligo being treated with oral Abrocitinib, a selective Janus Kinase 1 inhibitor approved for the treatment of moderate to severe atopic dermatitis. Here, we present a 61-year-old male with acrofacial vitiligo who had repigmentation plateau with twice daily tacrolimus 0.1% ointment, oral ginkgo biloba, and oral minipulse prednisone × 4 months; however, they had significant improvement after taking abrocitinib 100 mg per day for 2 months. He was able to transition topical tacrolimus twice weekly monotherapy for maintenance. This report shows that oral Janus Kinase inhibitors may be a useful option for the treatment of recalcitrant vitiligo. Results of ongoing randomized control trials are needed to determine the durability and safety of oral Janus Kinase inhibitors long-term.

Treatment of coronavirus disease 2019-associated mucositis in adolescents: A case report and brief literature review.

Reactive Infectious Mucocutaneous Eruption is an acute mucocutaneous inflammation secondary to an infection with minimal to absent cutaneous features that has recently been linked to the Severe Acute Respiratory Syndrome Coronavirus-19 (SARS-CoV-19 virus). Unfortunately, the relative rarity of case reports of Reactive Infectious Mucocutaneous Eruption in paediatric populations has led to fewer known successful treatment options with the current mainstay being systemic immunosuppression (e.g. corticosteroids, cyclosporine and etanercept). In this case report, we discuss a case of an adolescent patient with (polymerase chain reaction) PCR+ coronavirus disease 2019 infection and an oral eruption without cutaneous symptoms. He was treated successfully using a single dose of dexamethasone and supportive care through amorphous hydrogel (Intrasite gel), thus providing a safe, cheap and effective treatment option in mild coronavirus disease 2019-associated Reactive Infectious Mucocutaneous Eruption in paediatric patients. We also discuss the current findings, diagnostic terms and treatment options of mucosal manifestations of coronavirus disease 2019 in children.

Lab-Based Culprit Drug Identification Methods for Cutaneous Drug Eruptions: A Scoping Review.

BACKGROUND: Identification of culprit drugs when managing cutaneous drug eruptions is essential. Causality assessment methods (CAMs) have been proposed, including lab-based techniques. However, no consensus guidelines exist. OBJECTIVES: To identify and map the functionality and feasibility of lab-based CAMs. METHODS: A scoping review was conducted to identify culprit drug identification methods. Publications on lab-based methods were analyzed. Medline, Embase, and Cochrane Central Register of Controlled Trials databases were searched. RESULTS: Twenty-five publications met inclusion criteria. Nine lab-based CAMs were studied, including lymphocyte transformation test, cytokine measurement (ELISpot, ELISA, beads array assay), modified IFN-É£ ELISpot, CellScan, histamine release, granzyme B-ELISpot, intracellular granulysin, lymphocyte toxicity assay, and HLA allele genotyping. Diagnostic accuracy was reported for 8/9 methods. Clinical assessment and operational algorithms were commonly used as validation benchmarks. Lab-based methods were assessed at different phases of a drug eruption including in the acute (18.1%), recovery (27.3%), acute and recovery (27.3%), or an unspecified phase (27.3%). Lymphocyte transformation test (specificity 30% to 100%, sensitivity 27% to 73%) and cytokine measurement (specificity 76% to 100%, sensitivity 20% to 84%) were the most common methods studied. CONCLUSIONS: Lab-based CAMs can be low-risk, effective, and complementary of clinical methods. High-quality studies are needed to adequately develop and validate these tools for clinical practice.

Methods for Identifying Culprit Drugs in Cutaneous Drug Eruptions: A Scoping Review.

BACKGROUND: Cutaneous drug eruptions are a significant source of morbidity, mortality, and cost to the healthcare system. Identifying the culprit drug is essential; however, despite numerous methods being published, there are no consensus guidelines. OBJECTIVES: Conduct a scoping review to identify all published methods of culprit drug identification for cutaneous drug eruptions, compare the methods, and generate hypotheses for future causality assessment studies. ELIGIBILITY CRITERIA: Peer-reviewed publications involving culprit drug identification methods. SOURCES OF EVIDENCE: Medline, Embase, and Cochrane Central Register of Controlled Trials. CHARTING METHODS: Registered PRISMA-ScR format protocol on Open Science Forum. RESULTS: In total, 109 studies and 26 reviews were included comprising 656,635 adverse drug events, most of which were cutaneous. There were 54 methods of culprit drug identification published, categorized as algorithms, probabilistic approaches, and expert judgment. Algorithms had higher sensitivity and positive predictive value, but lower specificity and negative predictive value. Probabilistic approaches had lower sensitivity and positive predictive value, but higher specificity and negative predictive value. Expert judgment was subjective, less reproducible, but the most frequently used to validate other methods. Studies suggest that greater accuracy may be achieved by specifically assessing cutaneous drug eruptions and using combinations of causality assessment categories. CONCLUSIONS: Culprit drug identification for adverse drug reactions remains a challenge. Many methods have been published, but there are no consensus guidelines. Using causality assessment methods specifically for cutaneous drug eruptions and combining aspects of the different causality assessment categories may improve efficacy. Further studies are needed to validate this hypothesis.

3D printing in critical care: a narrative review.

BACKGROUND: 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. OBJECTIVE: This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. METHODS: A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. RESULTS: Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. CONCLUSION: The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.