Treatments on the horizon for locally advanced basal cell carcinoma.

Basal cell carcinoma (BCC) is one of the most common human cancers. Most cases of BCC are amenable to surgical and topical treatments with excellent prognosis if diagnosed timely and managed appropriately. However, in a small percentage of cases, it could be locally advanced BBC (laBCC) and not amenable to surgery or radiation, including recurrent, large tumors or tumors that invade deeper tissue. Hedgehog inhibitors (vismodegib and sonidegib) are approved as the first-line treatment of laBCC. PD-1 inhibitor immunotherapy (cemiplimab) is indicated for cases that progressed on or could not tolerate hedgehog inhibitors or when hedgehog inhibitors are contraindicated. Given the modest response and bothersome side effects of some of the agents above, there are reports of novel treatments, and clinical trials are currently evaluating multiple agents.

Prolonged Antipruritic Effect of Botulinum Toxin Type A on Cowhage-induced Itch: A Randomized, Single-blind, Placebo-controlled Trial.

Botulinum toxin type A (Botox) is thought to have antipruritic effects through inhibition of pruritic factors, including acetylcholine, substance P, and glutamate. The aim of this randomized, single-blind, placebo-controlled trial was to test the effect of botulinum toxin type A on cowhage, a non-histaminergic model for chronic itch. Botulinum toxin type A was injected into the arm of 35 healthy subjects, with a saline control injected into the contralateral arm. Thermal sensory parameters (warmth and heat thresholds and heat pain intensity) and itch intensity after cowhage application were examined on test areas. Botulinum toxin type A reduced itch intensity, overall perceived itch (area under the curve (AUC); percentage change from baseline), and peak itch intensity compared with the control at 1 week, 1 month, and 3 months. Botulinum toxin type A had no effect on thermal thresholds or heat pain intensity. In conclusion, botulinum toxin type A reduced cowhage itch for at least 3 months, which suggests that botulinum toxin type A is a potential long-lasting treatment for localized, non-histaminergic itch.

Cutaneous Oncology in the Immunosuppressed.

Patients with immunosuppressive conditions experience an increased frequency and severity of cutaneous malignancies. This article highlights management of keratinocyte carcinoma, melanoma, Merkel cell carcinoma, and Kaposi sarcoma in the setting of lymphoproliferative disorders, acquired immunodeficiencies, and organ transplantation. Advances in the safety of organ transplant recipient immunosuppression, early identification of risk factors, and new targeted therapies are improving skin cancer outcomes in immunocompromised populations.

Postoperative Candida Infection following Complex Periocular Reconstruction.

Postoperative candida infection is a rarely reported complication in cutaneous surgery, although it may develop more often in particular clinical settings. We present a 59-year-old woman with a well-controlled human immunodeficiency virus infection. She developed a bright red eruption with satellite pustules 2 weeks after excision of recurrent lentigo maligna melanoma of the left lower eyelid and periocular region. Due to defect size and complexity of the reconstruction (glabellar transposition flap, Hughes flap, composite graft from upper contralateral eyelid, and full-thickness skin graft from ipsilateral retroauricular region), she was placed on prophylactic oral amoxicillin-clavulanic acid and topical bacitracin and polymyxin. Immediate postoperative course was unremarkable, and sutures were removed after 7 days. Three days later, she developed bright red erythema and pustules within the surgical site and complained of burning. Empirically she was switched to topical gentamicin and oral ciprofloxacin, and later to linezolid, due to inadequate response. Wound culture grew Candida albicans sensitive to fluconazole and voriconazole. After oral fluconazole and topical clotrimazole initiation, the patient rapidly improved. The graft remained viable and apart from small partial dehiscence on the cheek, the healing was unremarkable. Apart from the case presentation, we also discuss different factors associated with postoperative candida infection, including immunocompromised status, surgical procedure location, and postoperative antibiotic use. Early recognition and treatment of postoperative candida infections are crucial to prevent delayed healing and associated morbidity.

Dermatitis artefacta.

Dermatitis artefacta, also known as factitial dermatitis, is a condition whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role. It is particularly common in women and in those with an underlying psychiatric diagnosis or external stress. The diagnosis is one of exclusion, and it is often difficult to confirm, with patients rarely admitting their role in the creation of their lesions. Treatment can be challenging, and management should adopt a multidisciplinary team approach composed of dermatologists and mental health professionals. We present a literature review of dermatitis artefacta, highlighted by a case report of a patient with bilateral ulcerations to the legs, which after thorough investigation represented dermatitis artefacta.

Psychiatric disorders and pruritus.

The skin and psyche are intimately related with various skin diseases caused by or resulting in psychiatric disturbances. Pruritus is a commonly reported symptom in psychiatric patients, and likewise psychiatric co-morbidities, including anxiety and depression, are frequently seen in chronic pruritus patients. Primary psychodermatologic conditions, such as somatic symptom disorder, dermatitis artefacta, obsessive-compulsive and related disorders (excoriation disorder and prurigo nodularis), delusional infestation, and substance use disorder, can all induce significant pruritus in patients, severely affecting their quality of life. Such entities can be challenging to manage, and therefore a greater understanding of the underlying psychopathology and evaluation of associated psychosocial factors is necessary. In addition to proper skin hygiene and first-line pharmacotherapies such as selective serotonin reuptake inhibitors, noradrenergic and selective serotonin antidepressants, antiepileptics, and antipsychotics (for delusional and psychotic disorders), patients with psychopruritic disorders should be offered psychotherapy to maximize the therapeutic efficacy.

Muddy conditions reduce hygiene and lying time in dairy cattle and increase time spent on concrete.

Dairy cattle spend less time lying and show signs of increased stress when housed in rainy and windy conditions, but no work has separated the effects of exposure to inclement weather from muddy conditions underfoot. Our objective was to evaluate the effects of muddy conditions alone on lying behavior, hygiene, and physiological responses. We housed pairs of pregnant, nonlactating dairy cattle (n = 12; 6 primigravid heifers, 6 multiparous cows) in enclosed pens with dirt floors and a concrete feed apron. Cattle were exposed to 3 levels of soil moisture: 90 (dry), 74 (muddy), or 67% (very muddy) dry matter for 5 d each in a replicated 3 × 3 Latin square design. Lying time was measured on all days with data loggers, and lying locations and postures were recorded on the final day of each treatment. Before and after each treatment, blood samples were collected, and the percentage of dirty surface area was measured on the udder, hind leg, and side of each animal. Cattle spent less time lying down in muddier conditions, especially in the first 24 h of exposure, when cows and heifers spent only 3.2 and 5.8 h, respectively, lying down in the muddiest treatment compared with 12.5 and 12.7 h on dry soil. When the soil was dry, cattle never chose to lie down on concrete, but in muddier conditions they spent a greater proportion of their lying time on concrete (mean ± SE: 56 ± 14 and 10 ± 8% in the very muddy and muddy treatments, respectively). The shift in lying location was more marked for heifers, and all 6 spent ≥87% of their lying time on concrete in the muddiest treatment. When cattle chose to lie down on wetter soil, they limited the surface area exposed to their surroundings by tucking their legs beneath their bodies (mean ± SE: 30 ± 11, 15 ± 4, and 5 ± 2% of lying observations in the very muddy, muddy, and dry treatments, respectively). Despite cattle spending less time on wetter soil, all 3 measured body parts became dirtier in muddier conditions (1.4-, 1.6-, and 1.8-fold more on the leg, udder, and side, respectively, in the muddiest compared with the driest treatment). In addition, higher soil moisture levels resulted in greater reductions in white blood cell counts relative to baseline levels (-0.95, -0.43, and 0.34 × 109/L relative to baseline levels in the very muddy, muddy, and dry treatments). Muddy conditions, even in the absence of wind or rain, are aversive for cattle and have negative implications for their welfare.

The prevalence and characteristics of chronic ocular itch: a cross-sectional survey.

INTRODUCTION: In this cross-sectional study, we aimed to determine the prevalence and characteristics of chronic ocular itch in an outpatient ophthalmology and optometry clinic. METHODS: Four hundred patients from an outpatient ophthalmology and optometry clinic were enrolled. The presence and characteristics of chronic ocular itch were assessed by a questionnaire. Data regarding ophthalmologic, dermatologic, and systemic conditions as well as current medications were extracted from medical records. RESULTS: Chronic ocular itch was present in 118 (29.5%) of 400 participants. Chronic ocular pruritus was significantly more prevalent in females [P=0.015; odds ratio (OR)=1.8; 95% confidence interval (CI), 1.1-2.8] and was significantly associated with the presence of allergic conjunctivitis [51.8% (n=45); P<0.001; OR=5.0; 95% CI, 3.0-8.3], dry eye syndrome [40.1% (75); P<0.001; OR=2.6; 95% CI, 1.7-4.1], blepharitis [43.8% (n=21); P=0.021; OR=2.0; 95% CI, 1.1-3.8], and atopic dermatitis [50.0% (n=10); P=0.023; OR=2.6; 95% CI, 1.1-5.8]. Chronic ocular itch was not significantly associated with systemic conditions, or the use of prescribed ophthalmologic medications. DISCUSSION: Chronic ocular itch is common and may be related to ophthalmologic or dermatologic pathologies. The present findings highlight the importance of identifying and managing this uncomfortable symptom that may negatively impact the quality of life and sleep of affected patients.