A newsletter that delivers the latest in dermatology research directly to you.
seventy-Sixth issue
January 8, 2025
Outcomes of importance to patients living with cutaneous chronic graft-vs-host disease
JAMA Dermatology
JAMA Dermatology
Leveling up from symptoms to solutions—brains expanding, care improving
Cutaneous chronic graft-versus-host disease (GVHD) is a severe complication of allogeneic hematopoietic cell transplantation and is associated with substantial morbidity and mortality. Despite its impact, the health-related quality-of-life (HRQOL) domains that are most important to patients are poorly understood. This concept elicitation study of 31 adults with cutaneous chronic GVHD aimed to define HRQOL from the patient's perspective.
What did they find?
Main Takeaway: Cutaneous chronic GVHD profoundly impairs HRQOL by causing skin changes, affecting social and physical functioning, and negatively impacting psychological well-being. This study highlights a direct link between cutaneous chronic GVHD and various HRQOL domains while also identifying themes not captured in current GVHD- and dermatology-specific patient-reported outcome tools.
Cutaneous chronic graft-versus-host disease (GVHD) is a severe complication of allogeneic hematopoietic cell transplantation and is associated with substantial morbidity and mortality. Despite its impact, the health-related quality-of-life (HRQOL) domains that are most important to patients are poorly understood. This concept elicitation study of 31 adults with cutaneous chronic GVHD aimed to define HRQOL from the patient's perspective.
What did they find?
- Five key HRQOL domains were identified:
- Skin changes and symptoms: Most frequent symptoms included dry skin (65%), tight skin (61%), itch (48%), and discoloration (45%).
- Social functioning: All participants reported social impairments.
- Psychological and emotional functioning: Frustration (Smith S score, 0.32) and worry or concern (Smith S score, 0.12) were most prominent.
- Physical functioning: Discomfort (Smith S score, 0.20) was a common symptom.
- General health perceptions: Perceptions were influenced by individual factors such as disease location, comparison to cancer, and disease duration.
- Skin changes and symptoms: Most frequent symptoms included dry skin (65%), tight skin (61%), itch (48%), and discoloration (45%).
Main Takeaway: Cutaneous chronic GVHD profoundly impairs HRQOL by causing skin changes, affecting social and physical functioning, and negatively impacting psychological well-being. This study highlights a direct link between cutaneous chronic GVHD and various HRQOL domains while also identifying themes not captured in current GVHD- and dermatology-specific patient-reported outcome tools.
Risk of fungal infection in patients with psoriasis receiving biologics
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Biologics: clearing skin in patients with psoriasis but letting fungi crash the party!
Psoriasis, a chronic inflammatory dermatosis, can be managed with topical, oral, and injectable medications. Biologics, injectable, immune-modulating monoclonal antibodies, are highly effective; however, their mechanism may induce immunosuppression. IL-17 inhibitors have been linked to an increased risk of superficial fungal infections, possibly due to their role in preventing such infections. With newer biologics now targeting alternative cytokines, this retrospective single-center cohort study of 592 cases in 297 psoriasis patients (ages 15+) investigated fungal infection complications associated with various biologic treatments.
What did they find?
Main Takeaway: Biologic IL-17 inhibitors used in psoriasis patients are associated with an increased risk of fungal infections compared to IL-12/23 p40 inhibitors, particularly in older patients and those with diabetes.
Psoriasis, a chronic inflammatory dermatosis, can be managed with topical, oral, and injectable medications. Biologics, injectable, immune-modulating monoclonal antibodies, are highly effective; however, their mechanism may induce immunosuppression. IL-17 inhibitors have been linked to an increased risk of superficial fungal infections, possibly due to their role in preventing such infections. With newer biologics now targeting alternative cytokines, this retrospective single-center cohort study of 592 cases in 297 psoriasis patients (ages 15+) investigated fungal infection complications associated with various biologic treatments.
What did they find?
- 73 cases (12.3%) of 106 total fungal infections were observed, including dermatophytosis (77.6%), candidiasis (20.8%), Malassezia infections (4.7%), and other rare fungal infections (1.9%) such as pneumocystis pneumonia and cryptococcal pneumonia.
- Fungal infections were most frequently observed in patients (54 cases among 82 patients) treated with an IL-17 inhibitor (OR: 3.08, P=0.017) when compared to IL-12/23 p40 inhibitors.
- No increased risk of fungal infections in patients treated with IL-23 p19 (P=0.934) or TNF-alpha inhibitors (P=0.267) when compared to IL-12/23 p40 inhibitors.
- Independent risk factors for fungal infection included older age at the start of biologic (OR: 1.04, P<0.001) and diabetes mellitus (OR: 2.40, P=0.013).
Main Takeaway: Biologic IL-17 inhibitors used in psoriasis patients are associated with an increased risk of fungal infections compared to IL-12/23 p40 inhibitors, particularly in older patients and those with diabetes.
Tralokinumab therapy effect on cutaneous transcriptome profiles
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Flipping the tran(script)ome with tralokinumab!
Atopic dermatitis (AD) is a chronic inflammatory skin disorder marked by persistent itch and eczematous lesions. Its pathogenesis involves a combination of epidermal barrier dysfunction and heightened immune activity. Tralokinumab, a monoclonal antibody targeting interleukin-13 (IL-13), a cytokine implicated in the pathophysiology of AD, is under investigation for its therapeutic potential. This study employed RNA sequencing to assess the effects of tralokinumab monotherapy on the cutaneous transcriptome in patients with AD, providing insights into its molecular impact.
What did they find?
Main Takeaway: Tralokinumab, an AD therapy targeting IL-13, shifts the lesional AD transcriptomic profile toward a non-lesional profile. Improvements in gene expression were evident within the first two weeks of therapy; however, persistent dysregulation after 16 weeks emphasizes the need for long-term treatment.
Atopic dermatitis (AD) is a chronic inflammatory skin disorder marked by persistent itch and eczematous lesions. Its pathogenesis involves a combination of epidermal barrier dysfunction and heightened immune activity. Tralokinumab, a monoclonal antibody targeting interleukin-13 (IL-13), a cytokine implicated in the pathophysiology of AD, is under investigation for its therapeutic potential. This study employed RNA sequencing to assess the effects of tralokinumab monotherapy on the cutaneous transcriptome in patients with AD, providing insights into its molecular impact.
What did they find?
- At baseline, 2,847 genes showed differential expression in lesional AD skin compared to healthy control skin (P<0.05).
- 216 and 457 genes had differential expression in lesional AD skin at week 2 and week 16 of tralokinumab treatment, respectively, compared to the lesional AD skin at baseline (P<0.05).
- There was a reduction in differentially expressed genes in lesional AD skin at baseline, week 2, and week 16 of Tralokinumab treatment compared to the non-lesional AD skin.
- After 16 weeks of therapy, 751 genes remained dysregulated in lesional AD skin compared to healthy control skin.
Main Takeaway: Tralokinumab, an AD therapy targeting IL-13, shifts the lesional AD transcriptomic profile toward a non-lesional profile. Improvements in gene expression were evident within the first two weeks of therapy; however, persistent dysregulation after 16 weeks emphasizes the need for long-term treatment.
Comparison of digital pathology and light microscopy among dermatology residents: A reappraisal following practice changes
Dermatopathology
Dermatopathology
Is digital really pivotal?
Digital pathology is cutting-edge technology that creates whole slide images of tissue samples and is gaining popularity in medical education. While the diagnostic ability of digital pathology is comparable to traditional light microscopy, there is a concern about the loss of microscope proficiency among trainees. In this single-center study, researchers aimed to evaluate resident competency with digital pathology versus light microscopy and survey their preferences. Dermatology residents (n=21) from three post-graduate years (PGY) were assessed on their ability to diagnose dermatologic conditions with classic histopathologic findings using digital pathology (n=32) and light microscopy (n=32).
What did they find?
Main Takeaway: Digital pathology not only yielded higher diagnostic accuracy but was also the preferred modality among residents. However, the study highlights a concerning decline in light microscopy competency among trainees without prior experience, underscoring the need for balanced training to preserve essential microscopy skills.
Digital pathology is cutting-edge technology that creates whole slide images of tissue samples and is gaining popularity in medical education. While the diagnostic ability of digital pathology is comparable to traditional light microscopy, there is a concern about the loss of microscope proficiency among trainees. In this single-center study, researchers aimed to evaluate resident competency with digital pathology versus light microscopy and survey their preferences. Dermatology residents (n=21) from three post-graduate years (PGY) were assessed on their ability to diagnose dermatologic conditions with classic histopathologic findings using digital pathology (n=32) and light microscopy (n=32).
What did they find?
- Diagnostic accuracy was higher using digital pathology, with a mean score of 22/32 for digital slides versus 18/32 for glass slides (P<0.001).
- Residents with light microscopy experience scored higher on light microscopy with an average score of 19/32 compared to 10/32 for residents without experience (P=0.039).
- The PGY4 class scored lower than PGY3 on light microscopy, likely due to remote training during their first year.
- 18 of 21 residents preferred digital pathology, 2 had no preference, and 1 preferred light microscopy.
Main Takeaway: Digital pathology not only yielded higher diagnostic accuracy but was also the preferred modality among residents. However, the study highlights a concerning decline in light microscopy competency among trainees without prior experience, underscoring the need for balanced training to preserve essential microscopy skills.
Can ultrasound mapping reduce recurrence in Hidradenitis suppurativa surgery?
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
What if a deeper look could mean fewer relapses?
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often requiring surgery, with common recurrence. To improve surgical outcomes, a team investigated the impact of preoperative ultra-high-frequency ultrasound (UHFUS) mapping. This retrospective study enrolled 40 HS patients undergoing wide excision with UHFUS-guided lesion mapping, followed by secondary intention healing. Lesion boundaries were identified using 48-MHz and 70-MHz probes, and patients were monitored for 22 months post-surgery.
What did they find?
Main Takeaway: Preoperative UHFUS mapping may enhance surgical precision, reduce recurrence rates, and accelerate healing in HS management.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often requiring surgery, with common recurrence. To improve surgical outcomes, a team investigated the impact of preoperative ultra-high-frequency ultrasound (UHFUS) mapping. This retrospective study enrolled 40 HS patients undergoing wide excision with UHFUS-guided lesion mapping, followed by secondary intention healing. Lesion boundaries were identified using 48-MHz and 70-MHz probes, and patients were monitored for 22 months post-surgery.
What did they find?
- Only 10% experienced relapse, achieving a 90% total remission rate.
- Visual Analog Scale (VAS) scores dropped significantly from 5.1 at baseline to 1 after 4 weeks, signaling pain reduction.
- Wound size decreased from 31.97 cm² to 7.8 cm² within 4 weeks, with a mean healing time of 41.8 days.
- Dual-probe UHFUS improved surgical precision by identifying tunnels and subclinical lesions.
Main Takeaway: Preoperative UHFUS mapping may enhance surgical precision, reduce recurrence rates, and accelerate healing in HS management.
Equisetum arvense and soybean extract cream can safely reduce forehead wrinkles
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
New year, new me, with less wrinkles, that is!
Equisetum arvense (horsetail) has been shown to reduce reactive oxygen species and inhibit the breakdown of hyaluronic acid, while soybean extract is recognized for its potent antioxidant properties. A recent prospective pilot study evaluated the safety and efficacy of an anti-wrinkle cream combining these two compounds. Fifteen participants applied the cream daily to their foreheads for 8 weeks, with wrinkle severity assessed using the Fitzpatrick Wrinkle Grading Scale (FWS) and standardized photographs. Safety was closely monitored to assess tolerability and identify any potential adverse effects.
What did they find?
Equisetum arvense (horsetail) has been shown to reduce reactive oxygen species and inhibit the breakdown of hyaluronic acid, while soybean extract is recognized for its potent antioxidant properties. A recent prospective pilot study evaluated the safety and efficacy of an anti-wrinkle cream combining these two compounds. Fifteen participants applied the cream daily to their foreheads for 8 weeks, with wrinkle severity assessed using the Fitzpatrick Wrinkle Grading Scale (FWS) and standardized photographs. Safety was closely monitored to assess tolerability and identify any potential adverse effects.
What did they find?
- FWS scores reduced from baseline (8.7 ± 1.3) to post-treatment (6.1 ± 1.8 [P < 0.005]).
- 93.4% of participants reported a “fair” or “good” improvement in their forehead wrinkles, while only 6.6% reported no change.
- A small proportion of participants reported adverse effects, with 13.3% experiencing irritation and 20% reporting itch at the application sites.
- No color, odor, or pH changes were seen during accelerated stability testing, and the texture remained consistent.
Improving diversity in a novel psoriasis study
Skin of Color
Skin of Color
PSO-lutions for everyone!
Psoriasis can manifest differently in individuals with skin of color (SoC), yet SoC has been underrepresented in psoriasis clinical trials. The VISIBLE study set out to address this gap by integrating culturally competent care, objective skin-tone measurements, and enhanced photography to evaluate treatment outcomes across a racially and ethnically diverse group.
What did they find?
Main Takeaway: Intentional trial designs can successfully recruit and retain SoC populations, paving the way for more equitable and comprehensive psoriasis care.
Psoriasis can manifest differently in individuals with skin of color (SoC), yet SoC has been underrepresented in psoriasis clinical trials. The VISIBLE study set out to address this gap by integrating culturally competent care, objective skin-tone measurements, and enhanced photography to evaluate treatment outcomes across a racially and ethnically diverse group.
What did they find?
- Over 70% of participants had Fitzpatrick skin types IV-VI.
- All 211 enrolled participants self-identified as a race or ethnicity other than White.
- Enrollment proceeded at a rate roughly 7 times faster than in past psoriasis trials.
- The trial included a dedicated scalp psoriasis group, an often underdiagnosed aspect of the disease in SoC.
Main Takeaway: Intentional trial designs can successfully recruit and retain SoC populations, paving the way for more equitable and comprehensive psoriasis care.
DERMLITE Dermoscopy QUESTION OF THE WEEK
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