Ixekizumab in the treatment of moderate-to-severe plaque psoriasis: Patient adherence, satisfaction, and preferences.

Ixekizumab is a humanized monoclonal antibody that exhibits its immunomodulatory effects by binding to interleukin 17A (IL-17A), a proinflammatory cytokine. It was approved for the treatment of plaque psoriasis by the Food and Drug Administration in 2016. Ixekizumab has demonstrated superiority in clinical trials against etanercept, with no significant difference in the side effect profile. The chronicity of psoriasis requires continual treatment to achieve disease clearance. Many factors may affect adherence to treatment including patient satisfaction, patient preferences, medication cost, and medication side effects. Limited data on patient adherence, satisfaction, and preference exists in formal literature. Often, surrogate measures must be used to extrapolate information regarding these measures. In this narrative review, we describe patient adherence, satisfaction, and preferences via both direct and surrogate measures as they relate to ixekizumab treatment for moderate-to-severe plaque psoriasis.

Review of 3 Comprehensive Anki Flash Card Decks for Dermatology Residents.

Anki is a web-based application where users may develop, share, and use flashcard decks of a variety of topics including dermatology. There is a wide breadth of information dermatology residents are required to learn during residency training. Flashcards may be useful tools for dermatology residents to master large amounts of information.

The Evidence Behind Topical Hair Loss Remedies on TikTok.

With the rise of social media influence and ease of accessibility of information, patients often encounter and implement hair loss advice from sources other than medical professionals. Many of these recommendations include herbs and other natural extracts (ie, rosemary oil, rice water, onion juice, garlic gel) as treatments. This review aims to investigate the evidence-based research behind these claims.

Erythema multiforme after treatment with sorafenib.

Sorafenib, an oral chemotherapeutic agent used in the treatment of solid tumors, is associated with a variety of adverse cutaneous drug reactions in up to 90% of patients. Infrequently, delayed-type hypersensitivity reactions such as erythema multiforme occur. This case describes a child treated with sorafenib for a retrosternal desmoid tumor who developed widespread erythema multiforme across his extremities, trunk, face, and mucosal membranes.

A perianal subcutaneous metastasis as the presenting sign for lung cancer.

Metastases to soft tissues are rarely reported in the initial presentation and diagnosis of lung cancer. We report a case of a 77-year-old white man who presented with a 9-day history of a painful, rapidly growing mass on his left buttock in the gluteal cleft. The deep dermal location of the neoplasm and the lack of epidermal involvement led to suspicion of a metastatic carcinoma. Imaging showed a lung lesion suspected to be a primary malignancy with distant liver and gastric fundus metastases. Lung pathology showed primarily adenocarcinoma with squamous differentiation, whereas the skin biopsy showed poorly differentiated squamous cell carcinoma. Clinically, we concluded the skin carcinoma was a metastasis of a primary lung adenocarcinoma with squamous differentiation. This case highlights the importance of appropriate preventative screening.

Embolization of a hemorrhaging abdominal plexiform neurofibroma.

In rare instances, neurofibromas may spontaneously bleed. In this case, a 21-year-old woman with a known cutaneous neurofibroma presented with a rapidly enlarging right abdominal wall mass. After embolization of a focal pseudoaneurysm and the right internal mammary artery, her hemoglobin continued to decline. The right internal mammary artery and inferior epigastric artery were then embolized. The patient eventually underwent mass resection, hematoma evacuation, and flap reconstruction. Final surgical pathology confirmed the expected diagnosis of plexiform neurofibroma. The Schwann cells of plexiform neurofibromas, present in approximately 50% of patients with neurofibromatosis-1, have invasive and angiogenic properties, often resulting in hemorrhage.

A Real-World Evaluation of the Long-Term Safety and Efficacy of Infliximab in the Treatment Moderate-to-Severe Psoriasis.

INTRODUCTION: Psoriasis is a chronic immune-mediated inflammatory skin disease that occurs in 2.5-3.5% of the general population. Infliximab (INF), a TNF-α inhibitor biologic agent, is a long-standing efficacious treatment for psoriasis; however, not all patients sustain a long-term response (LTR) because of a number of factors including antibody production. There is a paucity of studies assessing infliximab efficacy over a period ≥ 5 years. METHODS: A retrospective cohort chart review of our clinic patients who had undergone ≥ 5 years of treatment with infliximab for chronic plaque psoriasis was performed. The following variables were recorded and analyzed with the Fisher exact test: age, sex, body mass index ([BMI]; normal weight [NW], overweight [OW], obese [OB]), changes in infliximab strength (dose or frequency), concomitant systemic therapy, and side effects. Clinical improvement was assessed by comparing the total body surface area (tBSA) affected by psoriasis before and after treatment. RESULTS: There was a significant difference in likelihood of achieving LTR between the NW, OW and OB groups (p = 0.044). Non-normal-weight patients (OW + OB) were significantly more likely to achieve and sustain LTR than NW patients (OR 9.07, p = 0.020). There were no other significant associations for the other evaluated variables. LIMITATIONS: Patients who began treatment with infliximab before 2009 (prior to the use of the clinic's electronic medical record) were excluded. The Psoriasis Area and Severity Index (PASI) was not available for this study. CONCLUSION: Surprisingly, patients who are overweight or obese are more likely to obtain long-term clinical benefit in their psoriasis symptoms with infliximab therapy than patients who are normal weight.

Comparison of melanoma incidence in metropolitan areas versus nonmetropolitan areas in the state of Texas stratified by poverty classification.

Numerous risk factors for the development of melanoma have been identified; however, there is conflicting research on whether residence in nonmetropolitan areas, with a population <49,999 people, is associated with an increased cancer risk. This retrospective study aimed to identify the correlation of nonmetropolitan residence in Texas and the incidence of melanoma, while also stratifying the results by poverty level. Data were obtained from the Texas Department of State Health Services' Texas Cancer Registry. The incidence of melanoma in Texas from 1996 to 2015 in nonmetropolitan and metropolitan counties was calculated and stratified by poverty classification. Overall, the incidence of melanoma was 51,431 out of 22,140,398 (0.23%) in metropolitan areas and 9685 out of 3,005,163 (0.32%) in nonmetropolitan areas. Thus, the proportion of residents with melanoma in nonmetropolitan areas was 1.39 times that in metropolitan areas, which translates to an ∼39% increase in likelihood to develop melanoma. When these data were stratified by poverty, 57% of the cases of melanoma among those living in nonmetropolitan counties were in areas with a poverty rate of 10% to <20%; conversely, only 2% of the cases were among those living in nonmetropolitan counties with a poverty rate of 0% to 5%.