Sixty-Sixth issue
August 7, 2024
Multinational drug survival study of omalizumab in patients with chronic urticaria and potential predictors for discontinuation
JAMA Dermatology
JAMA Dermatology
Omalizumab - it’s the wheal deal for treatment of chronic urticaria!
Chronic urticaria is characterized by recurrent angioedema and/or pruritic hives for longer than 6 weeks. Current treatment options include omalizumab, a monoclonal antibody. Drug survival, the duration for which patients continue drug treatment, encompasses overall outcomes related to efficacy, safety, and the preferences of both patients and physicians. This international multicenter cohort study analyzed the drug survival of omalizumab in chronic urticaria patients.
What did they find?
Main Takeaway: As most cases of discontinuation were due to well-controlled disease, this study demonstrates the efficacy of omalizumab in treating chronic urticaria. Understanding drug survival rates and factors contributing to discontinuation can guide physician and patient decision-making and expectations around treatment duration.
Chronic urticaria is characterized by recurrent angioedema and/or pruritic hives for longer than 6 weeks. Current treatment options include omalizumab, a monoclonal antibody. Drug survival, the duration for which patients continue drug treatment, encompasses overall outcomes related to efficacy, safety, and the preferences of both patients and physicians. This international multicenter cohort study analyzed the drug survival of omalizumab in chronic urticaria patients.
What did they find?
- The median survival time of omalizumab was 3.3 years (95% CI=2.9-4.0).
- Discontinuation of treatment was primarily due to well-controlled disease (65%), ineffectiveness (18%), and adverse effects (4%).
- Discontinuation due to well-controlled disease was positively associated with fast treatment response (HR=1.45, 95% CI=1.20-1.75) and negatively associated with disease duration of more than 2 years (HR=0.81, 95% CI=0.67-0.98).
- Discontinuation due to ineffectiveness was positively associated with autoimmune disease and immunosuppressive co-treatment when starting omalizumab (HR=1.65, 95% CI=1.12-2.42) and negatively associated with spontaneous wheals (HR=0.62, 95% CI=0.41-0.93) and access to higher dosages (HR=0.40, 95% CI=0.27-0.58).
Main Takeaway: As most cases of discontinuation were due to well-controlled disease, this study demonstrates the efficacy of omalizumab in treating chronic urticaria. Understanding drug survival rates and factors contributing to discontinuation can guide physician and patient decision-making and expectations around treatment duration.
Germline cancer susceptibility in individuals with melanoma
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Unfortunately, these days, more and more folks are fittin’ in them melanoma genes.
Melanoma is the leading cause of skin cancer death and differs from nonmelanoma skin cancers due to its increased propensity to spread locally and distantly. Inherited risk of melanoma has been estimated at 2-2.5% with various implicated gene mutations, including CDKN2A, BAP1, and MITF. This prospective cohort study enrolled 400 patients previously diagnosed with melanoma and who had a personal or family history of cancer to determine hereditary melanoma risk and germline variants. The authors also compared their data to 3 existing melanoma patient cohorts.
What did they find?
Main Takeaway: Based on this cohort’s data, individuals with melanoma have a genetic predisposition ranging from 10.6% to 15.8%.
Melanoma is the leading cause of skin cancer death and differs from nonmelanoma skin cancers due to its increased propensity to spread locally and distantly. Inherited risk of melanoma has been estimated at 2-2.5% with various implicated gene mutations, including CDKN2A, BAP1, and MITF. This prospective cohort study enrolled 400 patients previously diagnosed with melanoma and who had a personal or family history of cancer to determine hereditary melanoma risk and germline variants. The authors also compared their data to 3 existing melanoma patient cohorts.
What did they find?
- Incidence of germline pathogenic/likely pathogenic variants was 15.3%.
- Among the 61 patients with pathogenic/likely pathogenic variants, 33% harbored gene mutations with confirmed melanoma associations, including BAP1, BRCA2, CDKN2A, MITF, and TP53.
- Of the 61 patients with pathogenic/likely pathogenic variants, 30 had gene mutations implicated in homologous repair.
Main Takeaway: Based on this cohort’s data, individuals with melanoma have a genetic predisposition ranging from 10.6% to 15.8%.
Direct immunofluorescence images of autoimmune bullous disorders can be accurately analyzed by artificial intelligence
British Journal of Dermatology
British Journal of Dermatology
AI is really making a DIFference in dermatology!
Autoimmune bullous disorders (AIBDs) are often diagnosed using direct immunofluorescence (DIF) based on the pattern of antibody deposition seen. Artificial intelligence (AI), particularly deep learning (DL) algorithms, may aid in the recognition of DIF patterns, potentially improving patient outcomes. DIF images from skin biopsies suspicious of AIBDs were collected between 2022 and 2024, categorized into three classes by dermatologists, and used to train seven DL models.
What did they find?
Limitations: This study used 436 fluorescence images for training, which was likely insufficient for the DL models to truly learn the classifications for AIBDs.
Main Takeaway: High-performing AI models, especially those that employ deep learning techniques, have a high accuracy rate in classifying DIF images of skin biopsies.
Autoimmune bullous disorders (AIBDs) are often diagnosed using direct immunofluorescence (DIF) based on the pattern of antibody deposition seen. Artificial intelligence (AI), particularly deep learning (DL) algorithms, may aid in the recognition of DIF patterns, potentially improving patient outcomes. DIF images from skin biopsies suspicious of AIBDs were collected between 2022 and 2024, categorized into three classes by dermatologists, and used to train seven DL models.
What did they find?
- After training, the highest-performing model achieved an accuracy rate of 94.6%, misclassifying only 4 of 93 images.
- After training, the highest-performing model had an average sensitivity of 95.3% and an average specificity of 97.5% across the three classes.
Limitations: This study used 436 fluorescence images for training, which was likely insufficient for the DL models to truly learn the classifications for AIBDs.
Main Takeaway: High-performing AI models, especially those that employ deep learning techniques, have a high accuracy rate in classifying DIF images of skin biopsies.
Is cutaneous Crohn's disease more than skin deep in children? Insights from a groundbreaking case series of pediatric patients
Pediatric Dermatology
Pediatric Dermatology
Crohn-ing Achievement: Shedding Light on Kids' Skin-Deep Struggles
Cutaneous Crohn's disease (CCD) is a rare and often overlooked condition that causes noncaseating, granulomatous skin lesions. This retrospective cross-sectional study aimed to characterize patient demographics, clinical characteristics, histology, and treatment of 89 confirmed cases of CCD in pediatric patients.
What did they find?
- Most pediatric patients with CCD were male (55%) and commonly presented with genital edema (82%) and erythema (53%), often alongside intestinal Crohn's disease (78%).
- Oral corticosteroids (71%) and metronidazole (39%) were the most frequently used treatments.
- Tumor necrosis factor (TNF)-blockade was a highly effective treatment option, with 94% (16/17) of patients experiencing partial or total clearance.
- Ustekinumab led to 67% (2/3) total clearance and 33% (1/3) partial clearance.
- Dual biologic therapy was utilized in two cases, both of which resulted in total clearance.
Main Takeaway: Despite its rarity and diagnostic difficulties, pediatric CCD appears to be effectively managed with biologic therapies, including TNF blockers and IL-12/23 inhibitors.
Can non-conventional skincare products influence the development of eczema in patients in Kenya?
Global Dermatology
Global Dermatology
Increasing eczema rates have everyone ‘itching’ to find a cause!
Atopic dermatitis (AD) is a common skin condition characterized by redness, swelling, and itching, and may become chronic. AD rates have risen in Kenya and other parts of Africa in recent years. Theorized explanations for this rise include evolving environmental factors, industrialization, and local skincare practices such as unrefined petrolatum product use. This retrospective cross-sectional study aims to evaluate the prevalence of AD and the skincare practices among patients in Kenya.
What did they find?
Atopic dermatitis (AD) is a common skin condition characterized by redness, swelling, and itching, and may become chronic. AD rates have risen in Kenya and other parts of Africa in recent years. Theorized explanations for this rise include evolving environmental factors, industrialization, and local skincare practices such as unrefined petrolatum product use. This retrospective cross-sectional study aims to evaluate the prevalence of AD and the skincare practices among patients in Kenya.
What did they find?
- AD was diagnosed in 25.5% (302/1183) of the total dermatology patients at a Kenyan hospital. 136 of these patients were sampled for the study.
- 63.2% of the sampled population were females (86/136), and the most affected age group was <5 years (22.8%, 31/136).
- The most common skincare products used by patients with AD included non-conventional products like multipurpose bar soap (38.2%, 52/136) and milking jelly (19.0%, 26/136), an unrefined petroleum containing toxic polycyclic aromatic hydrocarbons.
- Patients with AD were found to have several dermatologic comorbidities, most notably seborrheic dermatitis (34.1%).
Could different imaging modalities be used to diagnose subungual glomus tumors?
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Nail down glomus vs. nonglomus tumors with MRI
Glomus tumors are slow-growing vascular tumors that often develop on the distal digits, including the nail unit. Due to their location, dermatologists are often the first physicians patients with glomus or glomus-like tumors present to. While clinical findings can aid in diagnosis, excision and histopathology are needed for confirmation. To potentially mitigate the need for biopsy, this study investigates the utility of X-ray and MRI in diagnosing subungual glomus tumors. Thirty patients with clinical suspicion of glomus tumors received an MRI and X-ray of their lesions prior to excision and histopathology, which confirmed glomus tumors in 19 of the 30.
What did they find?
Main Takeaway: MRI shows potential as a useful tool for detecting glomus vs. nonglomus tumors
Glomus tumors are slow-growing vascular tumors that often develop on the distal digits, including the nail unit. Due to their location, dermatologists are often the first physicians patients with glomus or glomus-like tumors present to. While clinical findings can aid in diagnosis, excision and histopathology are needed for confirmation. To potentially mitigate the need for biopsy, this study investigates the utility of X-ray and MRI in diagnosing subungual glomus tumors. Thirty patients with clinical suspicion of glomus tumors received an MRI and X-ray of their lesions prior to excision and histopathology, which confirmed glomus tumors in 19 of the 30.
What did they find?
- No significant difference in duration of symptoms, location of tumor, or clinical appearance (P > 0.05) was detected between groups, glomus vs nonglomus.
- MRI correctly identified 89% (17/19) of confirmed glomus tumors while mistakenly identifying 18% (2/11) of confirmed negative glomus tumors as positive (P < 0.0001).
- MRI had 94.4% sensitivity, 80.0% specificity, an 89.5% PPV, and a 88.9% NPV.
- X-ray imaging failed to correctly identify any glomus tumors.
Main Takeaway: MRI shows potential as a useful tool for detecting glomus vs. nonglomus tumors
DERMLITE QUESTION OF THE WEEK
Outdoor sporting events often involve prolonged exposure to ultraviolet radiation. Understanding skin health behaviors of those attending is crucial for developing targeted interventions to reduce skin cancer risk. To assess sun protection practices of spectators at a daytime university football game, researchers asked 222 individuals to complete a questionnaire covering demographics, sun protection habits, barriers to use, and history of skin examinations.
What did they find?
Main takeaway: Despite a high overall rate of sunscreen use, younger participants (aged 18-23) and men were less likely to use sun protection. These findings suggest the need for targeted educational campaigns and efforts to increase skin health literacy among college-aged students and men.
What did they find?
- Age was positively associated with the number of sun protection methods used. Older individuals reported increased utilization of sun protection (P<0.001).
- Gender differences in sun protection habits were significant. Women were more likely to use sunscreen (P<0.001), get skin checks by a dermatologist (P<0.001), and rely on healthcare providers for sun protection information (P<0.001) than men.
- Overall, participant sunscreen usage was 66.7%.
Main takeaway: Despite a high overall rate of sunscreen use, younger participants (aged 18-23) and men were less likely to use sun protection. These findings suggest the need for targeted educational campaigns and efforts to increase skin health literacy among college-aged students and men.
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