seventy-Ninth issue
February 19, 2025
Rituximab Redefined - Reducing relapse with the right regimen!
Pemphigus is an autoimmune disorder characterized by IgG autoantibodies targeting desmosomal cell adhesion proteins, resulting in blistering of the skin and mucous membranes. Rituximab, an anti-CD20 monoclonal antibody that depletes B-cells, is an approved treatment for pemphigus. However, the RITUX 3 trial reported a relapse rate of 17.6% within 1 year following treatment. This multicenter cohort study aimed to evaluate the efficacy of an additional rituximab infusion administered 6 months after completing the initial treatment regimen in patients who achieved complete remission but exhibited at least one predictor of relapse.
What did they find?
Pemphigus is an autoimmune disorder characterized by IgG autoantibodies targeting desmosomal cell adhesion proteins, resulting in blistering of the skin and mucous membranes. Rituximab, an anti-CD20 monoclonal antibody that depletes B-cells, is an approved treatment for pemphigus. However, the RITUX 3 trial reported a relapse rate of 17.6% within 1 year following treatment. This multicenter cohort study aimed to evaluate the efficacy of an additional rituximab infusion administered 6 months after completing the initial treatment regimen in patients who achieved complete remission but exhibited at least one predictor of relapse.
What did they find?
- 88.5% of patients were in complete remission 6 months after regimen treatment, with 39.0% of these patients having at least 1 predictor of relapse at month 3.
- After receiving an additional rituximab infusion, no patients with predictors of relapse experienced relapse at 1-year post-treatment.
- Of patients who did not receive an additional infusion but did not have predictors of relapse (n=47), 2 experienced relapse at 1 year post-treatment.
- The overall 1-year relapse rate was 2.6%. The number of patients needing to be re-treated to avoid 1 relapse was 3.6 (95% CI = 1.6-46.5).
Continued treatment efficacy of new JAK3 inhibitor ritlecetinib through week 48: An analysis of the phase 2b/3 ALLEGRO trial
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Rogaine not cutting it? Try ritlecitnib instead!
Alopecia areata (AA) is an autoimmune, relapsing form of non-scarring hair loss encompassing a broad spectrum of phenotypic variants. Ritlecitinib, an oral dual Janus Kinase 3 (JAK3)/tyrosine kinase inhibitor, was approved in June 2023 for the treatment of severe AA in adolescents and adults aged 12 or older. This study evaluated the efficacy and safety of continued ritlecitinib from weeks 24 to 48 in the randomized, double-blind, placebo-controlled, combined dose-ranging ALLEGRO trial.
What did they find?
Alopecia areata (AA) is an autoimmune, relapsing form of non-scarring hair loss encompassing a broad spectrum of phenotypic variants. Ritlecitinib, an oral dual Janus Kinase 3 (JAK3)/tyrosine kinase inhibitor, was approved in June 2023 for the treatment of severe AA in adolescents and adults aged 12 or older. This study evaluated the efficacy and safety of continued ritlecitinib from weeks 24 to 48 in the randomized, double-blind, placebo-controlled, combined dose-ranging ALLEGRO trial.
What did they find?
- Of patients treated with ritlecitinib who achieved a Severity of Alopecia Tool (SALT) score of ≤20 at week 24, ≥85% maintained their response through week 48.
- Among those with a SALT score of ≤10 at week 24, ≥68% maintained their response through week 48.
- 22-34% of patients who had not achieved a SALT score ≤20 at week 24 went on to achieve this response by week 48.
- 20-26% of patients who had not achieved a SALT score ≤10 at week 24 achieved this response by week 48.
Can magnets and silicone sheets prevent ear keloid recurrences?
Innovation/Scoop
Innovation/Scoop
Pressure therapy provides an ear-resistible approach to keloid treatment!
Keloids are raised, thickened areas of scar tissue that form at the site of skin injury, often extending beyond the original wound. Keloids frequently present challenges during removal due to their high recurrence rates. However, keloids on the ear often demonstrate lower recurrence rates and better outcomes when treated with direct pressure therapy. Despite its benefits, there is no standardized method for delivering pressure therapy, leading many patients to create makeshift solutions, such as using swimming nose clips. These improvised methods lack adjustability and may damage surrounding tissues. This study explored the use of magnetic discs, in conjunction with silicon sheets, to deliver pressure therapy.
What did they find?
Keloids are raised, thickened areas of scar tissue that form at the site of skin injury, often extending beyond the original wound. Keloids frequently present challenges during removal due to their high recurrence rates. However, keloids on the ear often demonstrate lower recurrence rates and better outcomes when treated with direct pressure therapy. Despite its benefits, there is no standardized method for delivering pressure therapy, leading many patients to create makeshift solutions, such as using swimming nose clips. These improvised methods lack adjustability and may damage surrounding tissues. This study explored the use of magnetic discs, in conjunction with silicon sheets, to deliver pressure therapy.
What did they find?
- Magnetic discs can provide uniform, adjustable pressure to the affected area, and when combined with silicone sheets, they offer additional scar prevention benefits and reduce allergic reactions, helping to prevent keloid reformation.
- Silicone sheets are designed to conform to the earlobe, with thickness customizable based on the desired magnetic pressure.
- The examined treatment protocol involves a 3-hour application period followed by a 2-hour rest period, during the day, continued for 6 months.
Don’t brush your oral health aside!
Ichthyoses are a group of cornification disorders characterized by “fish-like” scaling of the skin, resulting from abnormal keratinocyte differentiation and defective desquamation. Literature regarding dental anomalies in congenital ichthyoses is limited, prompting this retrospective literature review aimed at describing dental abnormalities across different ichthyosis subtypes and emphasizing the importance of early dental referral and long-term follow-up.
What did they find?
Ichthyoses are a group of cornification disorders characterized by “fish-like” scaling of the skin, resulting from abnormal keratinocyte differentiation and defective desquamation. Literature regarding dental anomalies in congenital ichthyoses is limited, prompting this retrospective literature review aimed at describing dental abnormalities across different ichthyosis subtypes and emphasizing the importance of early dental referral and long-term follow-up.
What did they find?
- 94 articles (28 countries) describing 154 patients with ichthyosis, 48.1% male, 42.2% female, and 9.7% unspecified sex. Ages ranged from 0 to 72 years, with a mean of 16 years.
- 8 syndromic ichthyoses (e.g., KID syndrome, SLS) and 5 nonsyndromic forms (e.g., ARCI, ichthyosis vulgaris) were reported. The most common types were SLS (24%), KID syndrome (18.8%), TTD (16.2%), and ARCI (10.4%).
- The most common dental findings were caries (51.3%) and structural defects (40.9%), including issues with shape, size, enamel, and color of teeth.
- Genetic mutations such as GJB2 in KID syndrome and KRT75 in trichothiodystrophy were linked to dental anomalies like enamel defects, while CNNM4 mutations in Jalili syndrome were associated with enamel and dentin mineralization issues.
Children with obesity and weight gain are at an increased risk for follicular occlusion triad
British Journal of Dermatology
British Journal of Dermatology
Increased BMI, increased breakouts!
Follicular occlusion triad (FOT) is a group of interrelated disorders characterized by hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. The relationship between childhood obesity, weight gain, and early-onset FOT remains poorly understood. This longitudinal cohort study analyzed data from 2,012,928 Korean children who underwent health screenings at ages 30–36 months and 42–48 months, to evaluate the association between BMI and BMI changes with early-onset FOT.
What did they find?
Follicular occlusion triad (FOT) is a group of interrelated disorders characterized by hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. The relationship between childhood obesity, weight gain, and early-onset FOT remains poorly understood. This longitudinal cohort study analyzed data from 2,012,928 Korean children who underwent health screenings at ages 30–36 months and 42–48 months, to evaluate the association between BMI and BMI changes with early-onset FOT.
What did they find?
- Children with obesity had a higher risk of developing early-onset FOT compared to those with normal weight (aHR 1.49, 95% CI: 1.21–1.84).
- BMI gain was linked to an increased risk of early-onset FOT, whereas BMI loss was associated with a reduced risk.
- Children transitioning to obesity had an elevated risk of early-onset FOT compared to those maintaining a normal weight (aHR 1.51, 95% CI: 1.07–2.14).
- Children who experienced weight loss showed a decreased risk of early-onset FOT (aHR 0.41, 95% CI: 0.17–0.96).
What are the social, economic, and health system factors influencing NTD care in Ethiopia?
Global Dermatology
Global Dermatology
Unfair flares! Disparities in dermatologic management of tropical diseases in Ethiopia
Neglected tropical diseases (NTDs) frequently affect the skin, leading to disability, stigma, and social exclusion. In Ethiopia, leprosy and cutaneous leishmaniasis (CL) remain significant public health concerns, with ongoing leprosy transmission of approximately 20,000 CL cases annually. While leprosy services are integrated into Ethiopian general healthcare, CL treatment is restricted to specialized centers, serving fewer than 5% of cases. This mixed-methods study assessed the readiness of healthcare facilities to diagnose and treat skin NTDs, alongside barriers to care as reported by patients, healthcare providers, and government officials.
What did they find?
Neglected tropical diseases (NTDs) frequently affect the skin, leading to disability, stigma, and social exclusion. In Ethiopia, leprosy and cutaneous leishmaniasis (CL) remain significant public health concerns, with ongoing leprosy transmission of approximately 20,000 CL cases annually. While leprosy services are integrated into Ethiopian general healthcare, CL treatment is restricted to specialized centers, serving fewer than 5% of cases. This mixed-methods study assessed the readiness of healthcare facilities to diagnose and treat skin NTDs, alongside barriers to care as reported by patients, healthcare providers, and government officials.
What did they find?
- Data was collected from 41 healthcare facilities, 40 focus groups, and 158 interviews in Kalu district, Ethiopia (Oct 2020–May 2022).
- Healthcare workforce shortages: 13.3 trained health workers per 10,000 people, 55% of WHO-recommended level, with few doctors in government and private facilities.
- Leprosy services were limited: 7/9 health centers could diagnose leprosy, but fewer had trained staff (4/9), multidrug therapy stocked (4/9), or treatment guidelines for staff (1/9).
- CL services were nearly absent as only 2 health centers could diagnose CL, and no centers had trained staff or provided treatment.
Figure 1. Micronodular type basal cell carcinoma under polarized light (A) and UVFD (B) with black arrows denoting MAY globules and red arrows indicating MAY globules not seen under polarized light.
DERMLITE Dermoscopy QUESTION OF THE WEEK
An increasing body of evidence supports the role of 5-alpha reductase inhibitors (5-ARI) in treatment of both nonscarring and scarring alopecia in women. While believed to cause gynecomastia through boosting the peripheral conversion of testosterone to estradiol and thereby stimulating breast epithelial cell proliferation, other long-term effects of oral 5-ARI in women, particularly the risk of developing breast cancer with use for treatment of alopecia, are unknown. In this study, researchers sought to analyze the incidence of breast cancer and benign breast disorders in women exposed to oral 5-ARI. A retrospective cohort study was conducted, with 810 women prescribed oral 5-ARI at a dermatology visit and 5472 age-, race- and ethnicity-matched women seen in dermatology, with all participants initially free of breast cancer and benign breast disorders identified using ICD-9 and ICD-10 codes.
What did they find?
Main Takeaway: The incidence of breast cancer and benign breast disorders were similar in women exposed to oral 5-ARI and controls in this study. This suggests that oral 5-ARI use does not confer an increased risk of breast cancer or benign breast disorders in women.
What did they find?
- The median duration of follow-up after first prescription was 3.7 years (IQR: 1.8-6.4); 56% (458/810) had at least 3 years of follow-up.
- Compared to unexposed women, women exposed to oral 5-ARI had an odds ratio (OR) of breast cancer of 0.95 (95% CI 0.49-1.72).
- Women exposed to oral 5-ARI had an OR of benign breast disorders of 0.76 (95% CI 0.50-1.11) compared to unexposed women.
Main Takeaway: The incidence of breast cancer and benign breast disorders were similar in women exposed to oral 5-ARI and controls in this study. This suggests that oral 5-ARI use does not confer an increased risk of breast cancer or benign breast disorders in women.
ContactInterested in joining the team or advertising with us?
Do you have questions or feedback? Contact us below! |
PODCAST & RESEARCH |
Content of sk(in depth) is for medical education purposes only.
Copyright © 2023 - All Rights Reserved.
Copyright © 2023 - All Rights Reserved.