Improving Systemic Therapy Selection for Inflammatory Skin Diseases: A Clinical Need Survey

Generalized pustular psoriasis (GPP) is a chronic, rare, and potentially life-threatening disease. There is limited understanding of patient characteristics in GPP and their correlation with disease progression or healthcare resource utilization. Our review aims to examine real-world evidence on these characteristics and the associated disease burden as related to economic and quality of life factors. Results showed that most patients with GPP experienced flares once a year, lasting from 2 weeks to 3 months, with > 80% of patients having residual disease post-flare, with/without treatment, indicating the long-term nature of GPP. The impact of GPP on patients’ daily activities was significant, even in the absence of a flare. GPP adversely affected mental health, and anxiety and depression were reported regularly. Patients with GPP had more comorbidities, were prescribed more medication, and had more inpatient and …

SKIN The Journal of Cutaneous Medicine

Methods• Robust gene expression is obtained from lesional PSO, AD, and MF samples collected by non-invasive skin scraping.

Food allergy in atopic dermatitis is mediated by complex immune interactions between genetics, diet, environment, and the microbiome. When contact between inflamed skin and food antigens occurs, contact hypersensitivity can develop. Consequently, systemic contact dermatitis (SCD) can occur after ingestion of allergenic foods or food additives in the setting of a Th2 response with CLA-positive T cells, triggering dermatitis where skin resident memory lymphocytes reside. This phenomenon explains food-triggered dermatitis. Atopy patch tests (APTs) detect sensitization to food proteins responsible for SCD, which in turn can be confirmed by oral food challenge with delayed interpretation. We summarize the literature on using APTs to identify foods for oral challenge with dermatitis as an outcome. In dermatitis patients at risk for Th2 skewing based on a history of childhood-onset flexural dermatitis, shared decision …

MethodsWe systematically identified randomized controlled trials addressing systemic treatments for AD from inception to July 8, 2023 from MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and adverse events. We used GRADE to rate the certainty of the evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 154 trials enrolling 29,831 patients (pediatrics and adults) and evaluated 78 unique interventions over a median 13 weeks (range 1–52). High-dose upadacitinib was among the most effective in improving multiple patient-important outcomes, but among the most harmful. High-dose abrocitinib and low-dose upadacitinib were of intermediate …

Topical corticosteroids (TCSs) are the most widely used treatment for atopic dermatitis (AD), but they can have adverse effects such as skin atrophy, telangiectasias, and hypopigmentation, especially with prolonged use of higher potency steroids. Many patients also have a fear of using TCSs, known as “corticophobia.” With the development of biologics and Janus kinase inhibitors, a nonsteroidal approach to the treatment of AD may be possible and may be preferred by certain patients. Given what is known about these nonsteroidal therapies, we propose a structured treatment ladder and action plan that can guide clinicians and patients on the use of these therapies for the treatment of AD. The ladder divides nonsteroidal medication classes into treatments for exacerbation versus maintenance therapies in an escalating order of increasing potential for adverse effects, both real and perceived. This treatment …

Atopic dermatitis (AD) has a complex pathogenesis that leads to the characteristic itchy, eczematous skin findings. Treatment of AD is aimed at alleviating symptoms, preventing exacerbations and infections, and minimizing long-term risks. Treatment depends on the extent and severity of the AD but almost always includes topical therapies as a first line and often in addition to other treatments. These topicals include a variety of moisturizers and non-pharmacologic preparations, steroids, crisaborole, and calcineurin inhibitors, as well as a topical Janus kinase (JAK) inhibitor. Each has strengths and weaknesses in terms of efficacy, accessibility, and safety/tolerability. Given the heterogeneity of AD, it is important to be able to call upon a variety of topical therapies to meet individual needs.

Clinics in Dermatology

ConclusionsAI-powered language models perform adequately on dermatology CME questions but do not consistently achieve the passing score required to receive credit. AI developers may wish to target procedural questions to push AI's performance into the passing range. AI is still a valuable resource for CME. Limitations of this study include a relatively small number of questions (N= 100) and categories of questions (N= 10). The external validity of ChatGPT and Claude's performance may vary considering the number of questions asked.

SKIN The Journal of Cutaneous Medicine

Purpose: Three clinicopathologic-based risk assessment systems (Brigham and Women’s Hospital (BWH) staging, American Joint Committee on Cancer 8 th Edition (AJCC8) staging or National Comprehensive Cancer Network (NCCN)) are used to guide treatment pathway decisions, including nodal assessment and adjuvant radiation therapy. Each of these systems suffers from accuracy limitations. The 40-GEP test was developed to use tumor biology to predict regional/distant metastasis and has previously been validated as an independent risk stratification test for cSCC patients who are diagnosed with one or more clinicopathologic risk factors. The purpose of this study was to evaluate the performance of the 40-GEP test in the prognostication of metastasis when results are used in the context of each of the clinicopathologic risk assessment system.Study: Under an IRB-approved protocol, centralized pathology review, and sample analysis were performed in a CAP-accredited, CLIA-certified laboratory using formalin-fixed paraffin-embedded archival primary SCC tumor specimens with one or more risk factors (n= 897). Verified clinicopathologic information and outcomes data were collected from 58 contributing centers. Three-year risk stratification for regional and distant metastasis was assessed using Kaplan-Meier analysis for metastasis-free survival (MFS) for Class 1 (low risk), Class 2A (moderate risk), and Class 2B (high risk) groups. Nested Cox regression models and accuracy metrics were used to compare risk prediction of clinicopathologic risk assessment vs. clinicopathologic risk assessment in combination with 40-GEP.Results: The …

SKIN The Journal of Cutaneous Medicine

Introduction: Sonidegib, a Hedgehog (HH) pathway inhibitor, is approved for the treatment of locally advanced basal cell carcinoma (laBCC) not amenable to curative surgery or radiation. The pivotal 42-month BOLT (NCT01327053) study demonstrated sustained efficacy and manageable safety of sonidegib. Prior analyses at 18 months demonstrated clinical benefit persisting beyond sonidegib discontinuation. Pharmacokinetic modeling suggests HH pathway inhibition can be maintained following discontinuation. This analysis presents the efficacy of sonidegib 200 mg daily in patients with laBCC who discontinued treatment without disease progression (PD) at 42 months (end of study).Methods: BOLT was a randomized, double-blind, placebo-controlled, Phase 2 study. Objective response rates (ORRs; complete response+ partial response), duration of response (DOR), and progression-free survival (PFS) were assessed by central and investigator review per modified response evaluation criteria in solid tumors (mRECIST). Adverse events (AEs) were also assessed.Results: Of the 66 patients with laBCC randomized to sonidegib 200 mg daily, 37 discontinued treatment without PD. The ORRs for these patients per central (57%[n= 20]) and investigator (73%[n= 27]) review were similar to the overall patient population (61%[n= 40] and 71%[n= 47] per central and investigator review, respectively). For patients who discontinued treatment, the median (95% confidence interval [CI]) DOR per central and investigator review was not estimable (NE) and 20.2 months (12.0, NE), respectively. The median PFS (95% CI) per central and investigator review …

SKIN The Journal of Cutaneous Medicine

Introduction: Tralokinumab, an IL-13 targeted biologic approved in the United States (US) for adult patients with moderate-to-severe atopic dermatitis (AD), improved patient-reported outcomes (PROs) in clinical trials and after 4 weeks of use in the real-world setting. This 6-month interim analysis evaluated the real-world impact of tralokinumab on PROs in adult patients.Methods: This is an interim analysis of an ongoing 52-week patient survey study enrolling US AD patients from the Adbry TM Advocate TM Program. Patients completed the baseline survey close to tralokinumab initiation. Data on demographics and PROs including weekly itch numeric rating scale (NRS), eczema-related weekly sleep NRS, Dermatology Life Quality Index (DLQI), and Treatment Satisfaction Questionnaire for Medication (TSQM-9) were collected. Percent and absolute changes from baseline to 6 months of treatment were calculated. Outcomes are stratified by previous dupilumab use. The percentage of patients experiencing minimal clinically important difference (MCID) was also calculated for itch NRS (3-point reduction) and DLQI (4-point reduction).Results: As of May 2023, 102 patients completed baseline, 1-month, and 6-month surveys. Of these, 59.8% were female, mean age was 44.2 years (SD= 15.7), 82.4% were white, and 85.3% had private insurance. 84.3% were previously treated with topical corticosteroids (TCS) and 52.9% were dupilumab-experienced patients. Over 6 months, there was an improvement in the mean sleep interference NRS (40%), average weekly itch NRS (39%), worst weekly itch NRS (33%), PO-SCORAD (37%), and DLQI (52%). There …

MethodsWe systematically identified randomized controlled trials addressing topical treatments for AD from MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT to July 8, 2023. We excluded split-body trials. We performed Bayesian random-effects network meta-analyses on AD severity, itch severity, sleep disturbance, AD-related quality of life, AD exacerbations, and harms. We used GRADE to rate certainty of evidence. A multidisciplinary panel including patient partners determined thresholds for patient-important benefits and harms.ResultsWe analyzed 235 trials enrolling 46,315 patients (pediatrics and adults) and evaluated 69 unique interventions over a median 4 weeks for induction and 16 weeks for maintenance (overall range 1–156). To gain AD control, pimecrolimus improved the most outcomes, while tacrolimus, moderatepotency corticosteroids, delgocitinib, and ruxolitinib had …

British Journal of Dermatology

Introduction/Background Atopic dermatitis (AD) is a chronic disease affecting children and adults and requires long-term treatment. Moderate-to-severe AD causes itching, which considerably impacts sleep. Interleukin (IL)-13 is the key cytokine in the skin of patients with AD. Lebrikizumab (LEB) is a novel monoclonal antibody that binds with high affinity and slow off-rate to IL-13, thereby blocking the downstream effects of IL-13 with high potency. LEB has demonstrated efficacy and maintained improvement in measures of itch and sleep over 52 weeks in previous phase 3 trials. ADhere (NCT04250337) was a 16-week, randomized, double-blinded, placebo-controlled, phase 3 clinical trial, where patients were treated with LEB and topical corticosteroids (TCS) vs placebo and TCS. LEB responders from ADhere at week 16 were defined as having Investigator’s Global Assessment response of 0 or 1 or …

Clinical and Experimental Dermatology

We elaborate on our previously published article by asking ChatGPT to create images for each of the diagnoses previously asked in our article. We assess ChatGPT's internal validity by calculating the accuracy of ChatGPT's responses provided to its own images.

BackgroundAtopic dermatitis (AD) typically starts in infancy and early childhood. The chronic skin disorder is associated with recurrent flares, pruritus, and genetic predisposition. Daily use of moisturizers that contain lipids, such as ceramides, reduces the rate of AD flares and the need for topical steroid treatment. We aimed to provide insights on AD attenuation to tailor AD prescription therapy, skin care, and maintenance treatment to improve pediatric patients with AD and families.MethodsA panel of 6 pediatric dermatologists and dermatologists who treat neonates, infants, and children developed a consensus paper on AD attenuation for pediatric patients. The modified Delphi process comprised a face-to-face panel meeting and online follow-up to discuss the systematic literature search results and draw from clinical experience and opinion of the panel to adopt and agree on 5 statements. Results: Understanding the functional properties of newborn and infant skin, discussing skincare product use with parents, and recommending tailored prescription and skincare routines can improve newborn, infant, and children’s skin health. Studies on the prophylactic application of moisturizers initiated in early infancy suggest moisturizers may delay rather than prevent AD, especially in high-risk populations and when used continuously. Increasingly there is evidence that moisturizer application reduces the severity of AD and extends the time to flares, which may help attenuate the atopic march. The protective effect of skin care for AD has been observed in studies where its daily use is ongoing; these beneficial effects may be lost in less than 1year after …

The Journal of Clinical and Aesthetic Dermatology

ObjectiveAdjuvant radiation therapy (ART) is often recommended for high-risk cSCC patients but carries significant costs and risks. This study aims to determine if utilizing the 40-GEP test to guide ART can reduce healthcare costs in cSCC management.MethodsMedical claims data with new diagnoses of cSCC for the 12 months ending June 2022 in the Medicare (≥ 65 years) population (source: IQVIA claims database) were obtained and normalized to the general population for missingness. CPT codes associated with radiation therapy within one-year post diagnosis were used to establish adjuvant RT use (defined as ‘ART’). Average weighted direct costs for four major ART modalities were calculated from published studies and (IQVIA). Sensitivity analysis was used to assess the financial impact of ART treatment using varying distributions of 40-GEP Class results.ResultsNormalized medical claims data identified …

SKIN The Journal of Cutaneous Medicine

Introduction-The development of metastases has a profound impact on cSCC patient survival. Lower-stage tumors are those that lack factors that portend higher risk for disease progression and therefore not typically considered for increased surveillance or treatment. However, up to one-third of all metastatic events have been reported for patients originally staged as T1. The 40-GEP test is validated to accurately classify risk for regional and/or distant metastasis in patients with primary cSCC with at least one high-risk factor. The current study investigated whether the 40-GEP test could independently improve identification of lower-staged tumors at increased risk of metastasis.Methods-In an IRB-approved, retrospective, multi-center study, primary tumor tissue and associated clinical data from patients with cSCC and one or more clinicopathologic risk factors (n= 897) were collected. Within this overall cohort, lower Brigham and Women’s Hospital (BWH) T-staged samples (n= 444 T1 and n= 335 T2a) were evaluated by Kaplan-Meier survival analysis to determine metastasis-free survival (MFS) according to 40-GEP risk class (Class 1-low metastatic risk; Class 2A-higher risk; Class 2B-highest risk).Results-There was a total of 118 metastatic events in the overall cohort, of which 25%(29/118) and 38%(45/118) occurred in BWH T1 and T2a, respectively. BWH T1 tumors had an overall event rate of 6.5%(29/444), with T1/Class 2B tumors having a 5.1-fold increased event rate of 33.3%. BWH T2a tumors had an overall event rate of 13.4%(45/335), with T2a/Class 2B tumors having a 2.7-fold increased event rate of 36.4%. Stratification by the 40-GEP test …

British Journal of Dermatology

IntroductionIntegrated safety data for lebrikizumab (LEB) treatment in moderate-to-severe atopic dermatitis (AD) has been previously published. Conjunctivitis and keratitis were identified as adverse events (AEs) of special interest in the AD program. Objectives Further characterize patient-reported conjunctivitis and keratitis AEs in LEB clinical trials for AD. Methods Data from adult and adolescent patients were analyzed in 2 groups: a) LEB 250mg every 2 weeks (LEBQ2W, N=783) vs placebo (PBO, N=404), weeks 0-16 (PC 0-16wk) from 4 clinical trials (ADvocate1, ADvocate2, ADhere, Phase 2b study); and b) patients who received at least one dose of LEB (ALL-LEB, N=1720) from 8 clinical trials (ADvocate1, ADvocate2, ADhere, ADore, ADjoin (ongoing), ARBAN, TREBLE, Phase 2b study). Conjunctivitis and keratitis refer to cluster definitions defined by …

Journal of Integrative Dermatology

The use of complementary and alternative approaches in rosacea, a common, yet poorly understood chronic facial condition with an unknown etiology, has continued to grow. Recent studies have implicated oxidative stress in the pathophysiology of rosacea. As a result, there has been increasing interest in evaluating the effects of using naturally occurring antioxidants as therapeutic agents for managing rosacea. We discuss therapeutic applications of grape seed extract (GSE), vitamin C, azelaic acid, and zinc which have been studied for effects on reducing rosacea.

SKIN The Journal of Cutaneous Medicine

Introduction: The decision to initiate systemic therapy (ST) in patients with atopic dermatitis (AD) is complex, with no criteria that are globally agreed upon. To aid dermatology providers in this decision-making, the “When to Start Systemic Therapy Checklist” was developed. The checklist comprises three components:(A) clinical severity,(B) subjective burden, and (C) lack of treatment response, each with several criteria. Systemic therapy is indicated when at least one criterion in each component is fulfilled. To corroborate the validity of this checklist, we evaluated the agreement between the decision to initiate ST using the checklist, against the reference, CorEvitas AD Registry patients prescribed a ST.Methods: Adults with moderate-to-severe AD from the prospective, longitudinal CorEvitas AD registry were included in this descriptive analysis (July 2020–August 2023). Patients were included if they were initiating ST at enrollment (ST group) or not initiating ST at enrollment (non-ST group) but had vIGA-AD®≥ 3 and Eczema Area Severity Index≥ 12. The checklist criteria were compared against registry outcome measures; when a criterion did not match a measure, either a proxy measure was selected or that part of the questionnaire was excluded. Overall percentage agreement (accord between checklist criteria and ST initiation status [reference standard]) with corresponding 95% confidence intervals (CIs) was calculated.Results: In the ST group (n= 1488), 97.0% of patients met at least one criterion from section A, 94.1% from section B, and 92.1% for either section A or B. In the non-ST group (n= 208), 100% of patients met at least one criterion …

JAAD international

Acknowledgements: We are extremely grateful to all the families who took part in this study, the 30 midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, 31 computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, 32 receptionists and nurses. 3334 Conflicts of Interest: KA is a consultant to Target RWE and receives research grants to her institution from 35 Pfizer. SML is an investigator on the European Union Horizon 2020-funded BIOMAP Consortium 36 (http://www. biomap-imi. eu/) but is not in receipt of industry funding. 37 38

JAAD International

Patient Consent: Consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and included at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available.

JAAD international

To the Editor: Humanities-based medical ed-ucation has demonstrated improved communication, observational skills, and pattern recognition 1, 2; however, graduate medical education often does not include humanities curricula. 3 Because of emphasis on visual diagnoses and close patient interactions, dermatology training particularly may benefit from humanities education. Although there have been previous humanities curricula that use fine arts to focus on improving visual diagnostic skills among medical students, 4 a humanities-inspired graduate medical education curriculum in dermatology has yet to be described in the literature. Consequently, we aimed to implement a novel dermatology-oriented humanities pilot course to determine if these principles would be considered a valuable addition to the currently available curriculum.

JAAD international

Manuscript word count: 500 30 References: 5 31 Tables: 1 32 Figures: 1 33 Supplemental Material: Figure 1 (https://data. mendeley. com/datasets/z874fnhxhp/1) 34 Supplemental Material: Figure 2 (https://data. mendeley. com/datasets/yc43f292wx/1) 35 36

JAAD International

BackgroundChronic pruritus (CP) is a poorly characterized condition associated with intense pruritus without a primary skin eruption. This condition tends to emerge more commonly in older adults, and there is limited research on triggering factors.ObjectiveTo explore the clinical characteristics and pathophysiology of chronic pruritus following exposure to an immune stimulus.MethodsClinical characteristics and plasma samples were collected from 15 patients who developed CP following an immune stimulus such as checkpoint inhibitors or vaccination. A multiplex panel was used to analyze plasma cytokine concentrations within these patients.ResultsMost immunotherapy-treated patients experienced CP during treatment or after 21 to 60 days of receiving treatment, while vaccine-stimulated patients developed pruritus within a week of vaccination. Plasma cytokine analysis revealed elevated levels of twelve …

JAAD International

BackgroundEmpirical decisions to select therapies for psoriasis (PSO) and atopic dermatitis (AD) can lead to delays in disease control and increased healthcare costs. However, routine molecular testing for AD and PSO are lacking.ObjectiveTo examine 1) how clinicians choose systemic therapies for patients with PSO and AD without molecular testing and 2) to determine how often the current approach leads to patients switching medications.MethodsA 20-question survey designed to assess clinician strategies for systemic treatment of AD and PSO was made available to attendees of a national dermatology conference in 2022.ResultsClinicians participating in the survey (265/414, 64% response rate) ranked “reported efficacy” as the most important factor governing treatment choice (P<.001). However, 62% (165/265) of clinicians estimated that two or more systemic medications were typically required to achieve …

JAAD international

BackgroundModern radiotherapy is associated with dermatitis (RD) in approximately one-third of patients treated for breast cancer. There is currently no standard for treating RD.ObjectiveThe objective of this study was to determine whether LUT014, a topical BRAF inhibitor which paradoxically activates mitogen-activated protein kinase, can safely improve RD.MethodsA phase I/II study was designed to first follow a small cohort of women with grade 2 RD regarding toxicity and response. Then, 20 patients were randomized to compare LUT014 to “vehicle” relative to safety and response (measured with common terminology criteria for adverse events, Dermatology Life Quality Index).ResultsNo substantial toxicity (eg, 0 serious adverse event) was associated with LUT014. All 8 women receiving LUT014 achieved treatment success (5-point Dermatology Life Quality Index reduction at day 14) compared to 73% (8/11) on …

JAAD International

BackgroundAlthough anti-Program-Death-1 (PD-1) is a standard adjuvant therapy for patients with resected melanoma. We hypothesize that there are discrepancies of survival, recurrence pattern and toxicity to adjuvant PD-1 between different ethnicities and melanoma subtypes.Objective/methodsWe performed a multicenter cohort study incorporating 6 independent institutions in Australia, China, Japan, and US. The primary outcomes were RFS and OS. Secondary outcomes were disease recurrence patterns and toxicities.ResultsIn total 534 patients were included. East-Asian/Hispanic/African had significantly poorer RFS/OS. Non-acral-cutaneous/unknown primary (NAC/UP) had the best RFS/OS, followed by acral; mucosal the poorest. Within the NAC/UP subtypes, East-Asian/Hispanic/African had significantly poorer RFS/OS than Caucasian. In the multivariate analysis incorporating ethnicity/melanoma-subtype …

JAAD international

Five patients had a methotrexate dose adjustment or initiation in the first month prior to presentation. Six patients were not taking methotrexate and folic acid as prescribed. In one such case, the patient’s dermatologist had discontinued the prescription, but the patient’s primary care physician had continued to refill. Two patients had recent prescriptions for ciprofloxacin. Two patients had recent hospital visits for dehydration. Two patients were using methotrexate in the context of decreased renal function. One patient had previous hospitalizations suspicious for undiagnosed chronic methotrexate toxicity. Ten patients presented with any erosion or ulceration. Seven patients presented with cutaneous erosion or ulceration, and 9 patients presented with mucosal involvement. At time of presentation, 8 patients were pancytopenic, 7 patients had renal function abnormality, and 4 patients had liver function abnormality. All …

JAAD International

To the Editor: Basal cell carcinoma (BCC) is the most common skin cancer worldwide; up to 30% are the superficial subtype (sBCC), representing a substantial tumor burden. 1 It has been reported that curettage followed by daily topical application of imiquimod 5% cream for 6 weeks for a group of patients with either superficial or nodular BCC had no observed recurrences, though follow up was limited to only 12 months. 2, 3 We have found this treatment effective, and desired to determine the long-term recurrence rates for the sBCC subtype in a group of patients large enough to stratify outcomes by tumor location and average length of treatment required to reach a typical clinical response to imiquimod cream in this setting.This retrospective evaluation of patients with sBCC treated by curettage followed by topical imiquimod 5% cream (C&I), included all immunocompetent patients with a primary sBCC treated in our …

JAAD international

BackgroundSkin cancer is the most common form of cancer worldwide. As artificial intelligence (AI) expands its scope within dermatology, leveraging technology may aid skin cancer detection.ObjectiveTo assess the safety and effectiveness of an elastic-scattering spectroscopy (ESS) device in evaluating lesions suggestive of skin cancer.MethodsThis prospective, multicenter clinical validation study was conducted at 4 US investigational sites. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were clinically assessed by expert dermatologists and evaluated by a device using AI algorithms comparing current ESS lesion readings with training data sets. Statistical analyses included sensitivity, specificity, AUROC, negative predictive value (NPV), and positive predictive value (PPV).ResultsOverall device sensitivity was 97.04%, with subgroup sensitivity of 96.67% for melanoma, 97.22 …

JAAD International

BackgroundPhase 3 PRIME/PRIME2 trials independently demonstrated efficacy and an acceptable safety profile of dupilumab adults with moderate-to-severe prurigo nodularis.ObjectiveTo obtain a more precise estimate of onset and magnitude of treatment effect using PRIME/PRIME2 pooled data.MethodsIn PRIME/PRIME2, patients were randomized to dupilumab or placebo for 24 weeks. Pooled analysis assessed proportion of patients achieving clinically meaningful improvement in itch, clear/almost-clear skin, or both, at weeks 12 and 24, overall and by demographic subgroups, and changes from baseline to week 24 in symptoms, signs, and quality of life.ResultsPatients receiving dupilumab (n = 153) vs placebo (n = 158) experienced significant improvements in all tested endpoints. At week 24, 90 (58.8%) dupilumab-treated vs 30 (19.0%) placebo-treated patients achieved clinically meaningful improvement in …

JAAD international

BackgroundThe elastic scattering spectroscopy (ESS) device (DermaSensor Inc., Miami, FL) is a noninvasive, painless, adjunctive tool for skin cancer detection.ObjectivesTo investigate the performance of the ESS device in the detection of melanoma.MethodsA prospective, investigator-blinded, multicenter study was conducted at 8 United States (US) and 2 Australian sites. All eligible skin lesions were clinically concerning for melanoma, examined with the ESS device, subsequently biopsied according to dermatologists’ standard of care, and evaluated with histopathology. A total of 311 participants with 440 lesions were enrolled, including 44 melanomas (63.6% in situ and 36.4% invasive) and 44 severely dysplastic nevi.ResultsThe observed sensitivity of the ESS device for melanoma detection was 95.5% (95% CI, 84.5% to 98.8%, 42 of 44 melanomas), and the observed specificity was 32.5% (95% CI, 27.2% to …

JAAD international

BackgroundSkin cancer is the most common form of cancer worldwide. As artificial intelligence (AI) expands its scope within dermatology, leveraging technology may aid skin cancer detection.ObjectiveTo assess the safety and effectiveness of an elastic-scattering spectroscopy (ESS) device in evaluating lesions suggestive of skin cancer.MethodsThis prospective, multicenter clinical validation study was conducted at 4 US investigational sites. Patients with skin lesions suggestive of melanoma and nonmelanoma skin cancers were clinically assessed by expert dermatologists and evaluated by a device using AI algorithms comparing current ESS lesion readings with training data sets. Statistical analyses included sensitivity, specificity, AUROC, negative predictive value (NPV), and positive predictive value (PPV).ResultsOverall device sensitivity was 97.04%, with subgroup sensitivity of 96.67% for melanoma, 97.22 …

JAAD international

To the Editor: Humanities-based medical ed-ucation has demonstrated improved communication, observational skills, and pattern recognition 1, 2; however, graduate medical education often does not include humanities curricula. 3 Because of emphasis on visual diagnoses and close patient interactions, dermatology training particularly may benefit from humanities education. Although there have been previous humanities curricula that use fine arts to focus on improving visual diagnostic skills among medical students, 4 a humanities-inspired graduate medical education curriculum in dermatology has yet to be described in the literature. Consequently, we aimed to implement a novel dermatology-oriented humanities pilot course to determine if these principles would be considered a valuable addition to the currently available curriculum.

JAAD international

To the Editor: We read with interest the recent letter by Trepanowski et al, 1 ‘‘Social media dermatologic advice: Dermatology without dermatologists.’’The authors address how social media recommendations may not match recommendations by the American Academy of Dermatology. The public is increasingly turning to social media for dermatologic health information; eg, TikTok enables users to share video content, including about health conditions such as acne. 2 Although this platform expands connectivity, it may also spread health misinformation.Historically, isotretinoin has been associated with negative mental health side effects. The most reported such effects are depression and suicidal ideation. 3 However, recent work suggests that psychiatric disturbances associated with isotretinoin may be less common than previously believed. A recent global population-based retrospective cohort study of [75,000 …

JAAD international

To the Editor: Skin and soft tissue infections (SSTIs) are common complications of systemic cancer therapy. 1, 2 Immunosuppression from malignancy or oncologic treatment may also predispose patients to SSTIs. 1, 3, 4 Studies investigating infections associated with various types of medical oncologic therapy are lacking.We aimed to characterize systemic cancer therapy-related SSTIs in the outpatient and inpatient consultative services by means of a retrospective chart review of the Yale New Haven Health electronic medical record from 2016 to 2022. Patients actively treated with cytotoxic chemotherapy, targeted therapy, and/or immunotherapy were included. Infections were identified by search of electronic medical record using keywords “infection,”“cellulitis,”“abscess,”“bacterial,”“fungal,”“viral,”“parasitic,” and related terms and confirmed by manual review of dermatology notes.

JAAD International

BACKGROUNDHidradenitis supprativa (HS) is a chronic inflammatory skin disease that can respond to treatment with laser hair removal.OBJECTIVETo assess alexandrite laser hair removal laser as a treatment for hidradenitis suppurativa as measured by the HS Clinical Response (HiSCR).MATERIALS AND METHODSWe conducted a prospective, randomized, controlled study in adult patients with HS. Participants underwent a series of 4 monthly laser treatments to one side of the body, with the contralateral side serving as a control. The primary outcome was HiSCR response at week 24, 8 weeks after the final laser treatment.RESULTSThe percent improvement across treated sites after 4 treatments was 72.73% axillary, 70% inguinal, and 100% inframammary. Across all body regions, HiSCR response was significantly higher for the sites treated with the alexandrite laser compared to the contralateral controls: 75 …

JAAD International

BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rarely described in the pregnant population, and knowledge of their impact on the mother/fetus is limited.ObjectiveTo describe SJS/TEN in pregnant women and to investigate the risk factors for developing SJS/TEN in pregnancy.MethodsWe utilized hospitalization data from the 2009-2020 National Inpatient Sample. Pregnancy hospitalizations and SJS/TEN involvement were identified by ICD-9/10 codes and analyzed by chi-square and logistic regression.ResultsWe identified 650 pregnancies complicated by SJS/TEN requiring hospitalization. The median age was 28 years, and most were non-Hispanic White (55.2%). There were ≤10 cases associated with mortality. Most SJS/TEN cases (73.9%) occurred during the third trimester. HIV infection (OR=9.49; p=0.030), herpes simplex virus infection (OR=2.49; p=0.021 …

JAAD International

BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rarely described in the pregnant population, and knowledge of their impact on the mother/fetus is limited.ObjectiveTo describe SJS/TEN in pregnant women and to investigate the risk factors for developing SJS/TEN in pregnancy.MethodsWe utilized hospitalization data from the 2009-2020 National Inpatient Sample. Pregnancy hospitalizations and SJS/TEN involvement were identified by ICD-9/10 codes and analyzed by chi-square and logistic regression.ResultsWe identified 650 pregnancies complicated by SJS/TEN requiring hospitalization. The median age was 28 years, and most were non-Hispanic White (55.2%). There were ≤10 cases associated with mortality. Most SJS/TEN cases (73.9%) occurred during the third trimester. HIV infection (OR=9.49; p=0.030), herpes simplex virus infection (OR=2.49; p=0.021 …