Sixty-Seventh issue
August 21, 2024
Baricitinib withdrawal and retreatment in patients with severe alopecia areata: the BRAVE-AA1 randomized clinical trial
JAMA Dermatology
JAMA Dermatology
The hair-raising truth about alopecia: how stopping baricitinib can backfire
Severe alopecia areata (AA) is a chronic autoimmune condition characterized by significant hair loss. Baricitinib, a Janus kinase inhibitor, has shown efficacy in treating severe AA, but the need for continuous therapy after achieving hair regrowth remains unclear. This randomized clinical trial aimed to assess the short-term and long-term relapse rates following treatment withdrawal in 654 patients with severe AA who responded to 52 weeks of baricitinib therapy.
What did they find?
Main Takeaway: This trial demonstrates that severe AA is a chronic, remitting, and relapsing condition that requires maintenance therapy to sustain hair regrowth, as discontinuing baricitinib after successful regrowth resulted in a significant loss of treatment benefit for most patients.
Severe alopecia areata (AA) is a chronic autoimmune condition characterized by significant hair loss. Baricitinib, a Janus kinase inhibitor, has shown efficacy in treating severe AA, but the need for continuous therapy after achieving hair regrowth remains unclear. This randomized clinical trial aimed to assess the short-term and long-term relapse rates following treatment withdrawal in 654 patients with severe AA who responded to 52 weeks of baricitinib therapy.
What did they find?
- At 4 weeks of treatment withdrawal, 0% of patients experienced a loss of treatment benefit.
- By 8 weeks, 10% to 11% of patients had lost treatment benefit.
- By week 152, more than 80% of patients experienced a loss of treatment benefit.
- Patients who continued baricitinib therapy had only a 7% loss of benefit at week 152.
- Upon retreatment during the follow-up period, 63% of patients taking baricitinib 2 mg and 85% of patients taking baricitinib 4 mg regained their response.
Main Takeaway: This trial demonstrates that severe AA is a chronic, remitting, and relapsing condition that requires maintenance therapy to sustain hair regrowth, as discontinuing baricitinib after successful regrowth resulted in a significant loss of treatment benefit for most patients.
Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T-cell lymphoma
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
The duality of dupilumab: the atopic dermatitis hero with a surprising CTCL risk
The monoclonal antibody, dupilumab, is indicated for treating moderate to severe atopic dermatitis (AD) in patients 6 months and older. Previous reports have noted an association between dupilumab use and cutaneous T-cell lymphoma (CTCL). Using a retrospective cohort, this study aimed to investigate a possible increased susceptibility to CTCL development in individuals treated with dupilumab.
What did they find?
Main Takeaway: There may be an association between the use of dupilumab and an increased risk of developing, even among patients with a history of disease-modifying antirheumatic drug use. Additionally, dupilumab use might be linked to a reduced risk of basal cell carcinoma and melanoma.
The monoclonal antibody, dupilumab, is indicated for treating moderate to severe atopic dermatitis (AD) in patients 6 months and older. Previous reports have noted an association between dupilumab use and cutaneous T-cell lymphoma (CTCL). Using a retrospective cohort, this study aimed to investigate a possible increased susceptibility to CTCL development in individuals treated with dupilumab.
What did they find?
- Patient cohorts included 22,889 patients with atopic dermatitis treated with dupilumab and a matched cohort of 22,889 patients with atopic dermatitis who were not treated with dupilumab.
- Patients prescribed dupilumab had a higher risk of developing CTCL than patients not treated with dupilumab (OR 4.1003, 95% confidence interval 2.055-8.192).
- The increased risk of CTCL associated with dupilumab use continued to be statistically significant even after adjusting for previous disease-modifying antirheumatic drug use (OR 3.202, 95% confidence interval 1.573-6.514).
- Patients prescribed dupilumab had a lower risk of developing basal cell carcinoma (OR 0.398, 95% confidence interval 0.214-0.74) and melanoma (OR 0.498, 95% confidence interval 0.256-0.969) compared to patients who were not treated with dupilumab.
Main Takeaway: There may be an association between the use of dupilumab and an increased risk of developing, even among patients with a history of disease-modifying antirheumatic drug use. Additionally, dupilumab use might be linked to a reduced risk of basal cell carcinoma and melanoma.
The role of IRAK4 in hidradenitis suppurativa
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Abscessing over the possibility of more targeted treatments for HS!
Hidradenitis suppurativa (HS) is a difficult-to-treat inflammatory skin disease that significantly impairs patients’ quality of life. In HS, there is increased activation of the IL-1 receptor/toll-like receptor (IL-1R/TLR) pathway, leading to elevated levels of downstream cytokines. Researchers sought to explore the role of IL-1 receptor-associated kinase-4 (IRAK-4), a kinase downstream of the IL-1R/TLR pathway, and KT-474, a degrader of IRAK4, as a potential therapy for HS. IRAK4 expression was measured in whole blood and lesional, perilesional, and nonlesional skin biopsies in 30 patients with HS and was compared to respective samples from healthy volunteers (HVs).
What did they find?
Main Takeaway: Overexpression of IRAK-4 in HS may lead to increased proinflammatory cytokines. KT-474 has been shown to decrease IRAK-4 levels, suggesting it could be a potential therapeutic option for HS.
Hidradenitis suppurativa (HS) is a difficult-to-treat inflammatory skin disease that significantly impairs patients’ quality of life. In HS, there is increased activation of the IL-1 receptor/toll-like receptor (IL-1R/TLR) pathway, leading to elevated levels of downstream cytokines. Researchers sought to explore the role of IL-1 receptor-associated kinase-4 (IRAK-4), a kinase downstream of the IL-1R/TLR pathway, and KT-474, a degrader of IRAK4, as a potential therapy for HS. IRAK4 expression was measured in whole blood and lesional, perilesional, and nonlesional skin biopsies in 30 patients with HS and was compared to respective samples from healthy volunteers (HVs).
What did they find?
- Nonlesional biopsies from HS patients had a greater number of IRAK4-positive cells than nonlesional biopsies from HVs (P = 0.0003).
- IRAK4 levels were greater in lesional compared to nonlesional tissue in HS patients (P ≤ 0.0001).
- Ex vivo whole blood treated with KT-474 from both HS patients and HVs showed IRAK4 levels near the lower limit of detection (P < 0.0001).
Main Takeaway: Overexpression of IRAK-4 in HS may lead to increased proinflammatory cytokines. KT-474 has been shown to decrease IRAK-4 levels, suggesting it could be a potential therapeutic option for HS.
Histopathologic features of drug reaction with eosinophilia and systemic symptoms (DRESS)
Journal of Dermatopathology
Journal of Dermatopathology
Hot off the DRESS
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening hypersensitivity response that occurs 2 to 8 weeks after starting a new medication. The RegiSCAR clinical scoring system is used to classify patients with suspected cases of DRESS, and criteria include “biopsy findings suggestive of DRESS.” However, the histopathologic features of DRESS are undefined in the literature. Researchers retrospectively compared histologic features of active DRESS (n=15) to a matched group of patients with maculopapular drug rashes (MDR) (n=15).
What did they find?
Main Takeaway: The key histopathologic features of DRESS inclued interface dermatitis, lichenoid dermatitis, periadnexal interface dermatitis, pigment incontinence, and neutrophil predominance over eosinophils.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a life-threatening hypersensitivity response that occurs 2 to 8 weeks after starting a new medication. The RegiSCAR clinical scoring system is used to classify patients with suspected cases of DRESS, and criteria include “biopsy findings suggestive of DRESS.” However, the histopathologic features of DRESS are undefined in the literature. Researchers retrospectively compared histologic features of active DRESS (n=15) to a matched group of patients with maculopapular drug rashes (MDR) (n=15).
What did they find?
- Neutrophilic infiltrate was more common than eosinophilic inflammation and was present in the majority of DRESS samples (66.7%).
- DRESS samples showed significantly more interface dermatitis (P = 0.04), lichenoid dermatitis (P = 0.0007), pigment incontinence (P = 0.04), and periadnexal interface dermatitis (P = 0.002) compared to MDR samples.
- MDR samples showed more perivascular dermatitis and eosinophilic inflammation compared to DRESS samples.
Main Takeaway: The key histopathologic features of DRESS inclued interface dermatitis, lichenoid dermatitis, periadnexal interface dermatitis, pigment incontinence, and neutrophil predominance over eosinophils.
Can a needle-free injector turn back the clock on aging skin?
Dermatologic Surgery
Dermatologic Surgery
Forget the needles—this new technology delivers skin rejuvenation at the speed of light!
There is a growing interest in anti-aging treatments. Among the various options, poly-dl-lactic acid (PDLA) mesotherapy, a form of polylactic acid (PLA) filler, stands out due to its effectiveness in skin rejuvenation. In this clinical trial, researchers investigated the effects of PDLA dermal injections delivered via a laser-induced needle-free microjet injector in 27 female patients. Over five sessions, participants were evaluated for various aging skin concerns, including facial uplifting, darkness, redness, roughness, pore size, subjective satisfaction, and side effects. These parameters were assessed before each session and four weeks after treatment completion.
What Did They Find?
Main Takeaway: The laser-induced needle-free microjet injector offers a promising, minimally invasive alternative for skin rejuvenation with high patient satisfaction.
There is a growing interest in anti-aging treatments. Among the various options, poly-dl-lactic acid (PDLA) mesotherapy, a form of polylactic acid (PLA) filler, stands out due to its effectiveness in skin rejuvenation. In this clinical trial, researchers investigated the effects of PDLA dermal injections delivered via a laser-induced needle-free microjet injector in 27 female patients. Over five sessions, participants were evaluated for various aging skin concerns, including facial uplifting, darkness, redness, roughness, pore size, subjective satisfaction, and side effects. These parameters were assessed before each session and four weeks after treatment completion.
What Did They Find?
- Significant facial uplifting (0.711 ± 0.42 mm) was observed.
- Improvements in skin darkness (P = 0.013), redness (P = 0.009), and roughness (P = 0.036) were significant.
- Collagen and elastic fibers increased, with marked rises in collagen I and III levels.
- High patient satisfaction with minimal adverse effects.
Main Takeaway: The laser-induced needle-free microjet injector offers a promising, minimally invasive alternative for skin rejuvenation with high patient satisfaction.
Platelet-rich plasma: A new addition to the treatment for lichen planopilaris
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
LPP meet PRP combination therapy!
Lichen planopilaris (LPP) is an inflammatory skin disease affecting hair follicles that leads to atrophy and scarring alopecia of the scalp. While a variety of treatments exist, including high-potency steroids and systemic therapy, improvement is minimal. This single-blinded, controlled, randomized clinical trial assessed the efficacy of adding platelet-rich plasma (PRP) to clobetasol for treating LPP in 24 patients. The Lichen Planopilaris Activity Index (LPPAI) was measured at baseline and 1, 2, and 6 months after treatment.
What did they find?
Main Takeaway: The combination of clobetasol with PRP demonstrated a more significant reduction in LPPAI scores, showing promise in the treatment of lichen planopilaris.
Lichen planopilaris (LPP) is an inflammatory skin disease affecting hair follicles that leads to atrophy and scarring alopecia of the scalp. While a variety of treatments exist, including high-potency steroids and systemic therapy, improvement is minimal. This single-blinded, controlled, randomized clinical trial assessed the efficacy of adding platelet-rich plasma (PRP) to clobetasol for treating LPP in 24 patients. The Lichen Planopilaris Activity Index (LPPAI) was measured at baseline and 1, 2, and 6 months after treatment.
What did they find?
- The PRP group had an overall greater reduction in LPPAI scores over the course of treatment, with a significantly lower mean after the third visit compared to clobetasol alone (1.84 ± 1.23 vs. 3.56 ± 1.98, P = 0.01).
- Both treatment groups showed down trending LPPAI scores until the third visit; however, at the fourth visit, the mean value of LPPAI in the clobetasol group increased (P = 0.001).
- Mean LPPAI scores were significantly higher with clobetasol alone compared to the PRP group at the fourth visit (4.27 ± 1.08 vs. 1.87 ± 1.71, P = 0.01).
Main Takeaway: The combination of clobetasol with PRP demonstrated a more significant reduction in LPPAI scores, showing promise in the treatment of lichen planopilaris.
Frequency of skin biopsies for psoriasis by race and ethnicity
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
Psoriasis diagnosis: Is skin tone throwing us off course?
Psoriasis affects over 7.5 million people in the U.S., spanning all racial and ethnic backgrounds. While the condition is often diagnosed clinically, a skin biopsy may be ordered when symptoms are unclear or treatment is ineffective. This study set forth to examine how frequently biopsies are performed across different racial and ethnic groups.
What did they find?
Psoriasis affects over 7.5 million people in the U.S., spanning all racial and ethnic backgrounds. While the condition is often diagnosed clinically, a skin biopsy may be ordered when symptoms are unclear or treatment is ineffective. This study set forth to examine how frequently biopsies are performed across different racial and ethnic groups.
What did they find?
- Out of 10,008 psoriasis patients, 4.8% (477) underwent a skin biopsy.
- Black patients were twice as likely to have a biopsy (9.8%) compared to White patients (4.1%).
- Asian/Pacific Islander patients had a biopsy rate of 4.7%, and Hispanic patients 3.7%.
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Copyright © 2023 - All Rights Reserved.