Fractional CO2 laser and adjunctive therapies in skin of color melasma patients.

Background: Ablative lasers have long been considered an unfavorable option for melasma in patients with skin of color and continue to be underutilized. Objective: To evaluate the safety and outcomes of ablative fractional CO2 lasers on refractory melasma in patients with skin of color. Methods: A retrospective chart review of 12 patients from a single-center dermatology clinic. The study included refractory melasma patients receiving ablative fractional CO2 laser therapy alone or with laser toning and/or tranexamic acid (TXA). A validated modified Melasma Area and Severity Index (mMASI) scoring scale was used to assess disease severity at baseline and approximately 1 month after each treatment session. Results: Among the 12 patients, 41.7% patients showed >50% reduction in mMASI scores with 33.3% of patients showing statistical significance (P < .05). The CO2 laser therapy with the TXA cohort showed the largest decrease in the mean mMASI scores and the CO2 laser with laser toning showed the lowest decrease in scores. Patients who started on oral TXA earlier, after their initial ablative laser session, showed better clinical improvement. Limitations: Retrospective study design with short follow-up period and a small sample size. Conclusion: Ablative CO2 laser treatment may be a reasonable option for refractory melasma in patients with skin of color, though future research is needed.

"COVID toes": A true viral phenomenon or a diagnosis without a leg to stand on?

"COVID toes" is the colloquial name of chilblain-like lesions thought to be a sequela of COVID-19 infection. Over two years and approximately 300 publications later, this association remains controversial. Here, we summarize key clinical, serological, biological, histological, and immunological evidence that supports and rejects this relationship and discuss alternate theories underlying the pathogenesis of chilblain-like lesions.

Apremilast in the Treatment of Plaque Psoriasis: Differential Use in Psoriasis.

Small molecule medications like apremilast are emerging as promising options for patients with psoriasis and other inflammatory conditions. Apremilast was approved by the Food and Drug Administration in 2014 for the management of both psoriasis and psoriatic arthritis. Apremilast inhibits phosphodiesterase-4, which increases the intracellular levels of cyclic AMP, thereby reducing inflammatory cytokine production. This review aims to discuss the published evidence and evaluate the differential use of apremilast in plaque psoriasis of the body and scalp, nail psoriasis, and palmoplantar psoriasis. In clinical trials, apremilast effectively reduced the severity of different dermatological manifestations of psoriasis and improved patients' quality of life. It has an acceptable safety profile and is generally well-tolerated. Oral medications like apremilast offer an alternative route of administration which can be more convenient and appropriate for some patients. Additionally, pharmacoeconomic analyses of available anti-psoriatic systemic agents favor apremilast as a cost-effective therapeutic option.

Evaluating calcipotriene 0.005% foam for the treatment of plaque psoriasis of the scalp and body in patients aged 12 years and older.

Introduction: Topical corticosteroids are the mainstay of treatment for mild-to-moderate psoriasis in adult and adolescent patients but there can be many adverse events associated with long-term corticosteroid use. Corticosteroid-sparing alternatives include Vitamin D3 analogs, such as calcipotriene (also known as calcipotriol), which have long been used as monotherapy or combination therapy with other topical agents to treat psoriasis. Calcipotriene's mechanism of action is not fully understood but it is believed to be effective due to its anti-proliferative and anti-inflammatory properties.Areas covered: Herein, the authors review the safety and efficacy of calcipotriene 0.005% aerosol foam, as well as factors affecting patient adherence to topical therapies. The authors offer an expert opinion and future perspectives on the use of calcipotriene foam as monotherapy compared with other topical pharmacotherapies.Expert opinion: Calcipotriene 0.005% foam is a safe and effective topical treatment when used to treat plaque psoriasis in patients aged 12 years and older. Despite its safety and efficacy, it remains largely utilized as a second-line agent due to its slow clinical improvement. Slow onset of action can result in poor patient adherence.