Sixty-Fourth issue
July 10, 2024
What clinical characteristics are associated with the efficacy of psoriasis biologics?
JAMA Dermatology
JAMA Dermatology
Biologic Blues: How BMI and smoking cloud psoriasis treatment
Psoriasis is an inflammatory skin disease often treated by biologic medications that target immune system proteins. Existing literature on the clinical characteristics indicating the efficacy of psoriasis biologics is inconsistent. This meta-analysis examined studies that reported the clinical characteristics of psoriasis patients treated with biologic regimens, using the Psoriasis Area and Severity Index 90% (PASI 90) at 6 months as the primary indicator of treatment efficacy.
What did they find?
Main Takeaway: Increased BMI, prior exposure to biologics, and smoking appear to be associated with inferior responses to biologic medications for psoriasis. Knowledge regarding patient clinical characteristics which may modulate treatment response to biologics can contribute to personalized treatment for psoriasis patients.
Psoriasis is an inflammatory skin disease often treated by biologic medications that target immune system proteins. Existing literature on the clinical characteristics indicating the efficacy of psoriasis biologics is inconsistent. This meta-analysis examined studies that reported the clinical characteristics of psoriasis patients treated with biologic regimens, using the Psoriasis Area and Severity Index 90% (PASI 90) at 6 months as the primary indicator of treatment efficacy.
What did they find?
- Moderate to strong evidence of negative associations between the achievement of PASI 90 at 6 months and previous exposure to biologics (OR=0.44; 95% CI=0.29-0.67), previous smoking (OR=0.81; 95% CI=0.67-0.98), and current smoking (OR=0.78; 95% CI=0.66-0.91).
- Limited evidence of negative associations between the achievement of PASI 90 at 6 months and older age (OR=0.99; 95% CI=0.98-1.00) and higher body mass index (OR=0.96; 95% CI=0.94-0.99).
- A strong negative association between achievement of PASI 90 at 3 months and BMI of 30 or higher (OR=0.57; 95% CI=0.48-0.66).
- Treatment response was not associated with diabetes, disease duration, hypertension, psoriatic arthritis, and sex in observational nor randomized control trials.
Main Takeaway: Increased BMI, prior exposure to biologics, and smoking appear to be associated with inferior responses to biologic medications for psoriasis. Knowledge regarding patient clinical characteristics which may modulate treatment response to biologics can contribute to personalized treatment for psoriasis patients.
Autoimmune blistering disorders and cardiovascular risks: A population-based cohort study
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
ASCVD on top of a blistering disorder? Now that makes my heart hurt.
Autoimmune blistering disorders (ABDs) are chronic conditions marked by skin and/or mucous membrane blisters resulting from autoantibodies against structural proteins. ABDs are classically grouped based on the location of blisters, either epidermal (pemphigus) or subepidermal (pemphigoid). This population-based cohort study examined if ABDs are associated with increased risk of major adverse cardiovascular events such as atherosclerotic cardiovascular disease (ASCVD), heart failure, arrhythmia, venous thromboembolism (VTE), and cardiovascular death.
What did they find?
Main Takeaway: Similar to other immune-mediated inflammatory conditions, such as psoriasis and atopic dermatitis, autoimmune blistering conditions are associated with an increased risk for cardiovascular events.
Autoimmune blistering disorders (ABDs) are chronic conditions marked by skin and/or mucous membrane blisters resulting from autoantibodies against structural proteins. ABDs are classically grouped based on the location of blisters, either epidermal (pemphigus) or subepidermal (pemphigoid). This population-based cohort study examined if ABDs are associated with increased risk of major adverse cardiovascular events such as atherosclerotic cardiovascular disease (ASCVD), heart failure, arrhythmia, venous thromboembolism (VTE), and cardiovascular death.
What did they find?
- Adult patients diagnosed with ABDs (n = 3322) between 1996-2021 were compared to an age- and sex-matched cohort from the general population (n = 33,195).
- Patients with ABDs had an elevated 1 year risk of ASCVD (3.4% vs. 1.6%), heart failure (1.9% vs. 0.7%), arrhythmia (3.8% vs. 1.3%), VTE (1.9% vs. 0.3%), and cardiovascular death (3.3% vs. 0.9%) compared to control.
- Hazard ratios for the outcomes were 1.24 (1.09-1.40) for ASCVD, 1.48 (1.24-1.77) for heart failure, 1.16 (1.02-1.32) for arrhythmia, 1.87 (1.50-2.34) for VTE, and 2.01 (1.76-2.29) for cardiovascular death.
- Both pemphigus and pemphigoid groups shared similar results.
Main Takeaway: Similar to other immune-mediated inflammatory conditions, such as psoriasis and atopic dermatitis, autoimmune blistering conditions are associated with an increased risk for cardiovascular events.
Exposure to antibiotics in utero or early-in-life can increase the risk of developing atopic dermatitis during childhood
British Journal of Dermatology
British Journal of Dermatology
Antibiotics save the day again, but not without making you sAD.
Atopic dermatitis (AD) is a chronic inflammatory disease that affects patients across all demographics. Antibiotic exposure has previously been associated with alterations to the skin microbiome, increasing the risk of developing AD. However, exposure to antibiotics in utero or during early-life has yet to be fully examined in the medical literature. This population-based cohort study utilized IQVIA Medical Research Data between 2004 and 2021 to identify mother-child pairs that had exposure to antibiotics.
What did they find?
Limitations: Although the researchers ensured that the antibiotic exposures were before the child’s diagnosis of AD, it is possible the antibiotic may have been prescribed for an early manifestation of AD, leading to protopathic bias.
Main Takeaway: Children that were exposed to antibiotics in utero or within the first 90 days of life seem to be at an increased risk of developing AD during childhood.
Atopic dermatitis (AD) is a chronic inflammatory disease that affects patients across all demographics. Antibiotic exposure has previously been associated with alterations to the skin microbiome, increasing the risk of developing AD. However, exposure to antibiotics in utero or during early-life has yet to be fully examined in the medical literature. This population-based cohort study utilized IQVIA Medical Research Data between 2004 and 2021 to identify mother-child pairs that had exposure to antibiotics.
What did they find?
- There was an increased risk of childhood AD after in utero antibiotic exposure (HR 1.38, 95% CI 1.36–1.39).
- Greater risk was seen with no maternal history of AD (HR 1.71, 95% CI 1.69–1.72) and with penicillin use (HR 1.43, 95% CI 1.41–1.44).
- Antibiotic exposure within the first 90 days of life was associated with a 40-80% increased risk of childhood AD, depending on the antibiotic.
Limitations: Although the researchers ensured that the antibiotic exposures were before the child’s diagnosis of AD, it is possible the antibiotic may have been prescribed for an early manifestation of AD, leading to protopathic bias.
Main Takeaway: Children that were exposed to antibiotics in utero or within the first 90 days of life seem to be at an increased risk of developing AD during childhood.
App-solutely Sun-sational!
Ultraviolet (UV) exposure is known to increase the risk of skin cancer, especially when habits start in childhood and adolescence. This cross-sectional study investigated how a mobile app demonstrating the effects of UV exposure on skin aging could motivate young individuals to safeguard themselves from the sun. Before using the app, 87 participants answered questions about their views on sun safety and their current sun safety habits. The app then used augmented reality to demonstrate how their faces might age prematurely with prolonged UV exposure. After the intervention, participants answered a survey to determine if using the app motivated them to practice better sun safety in the future.
What did they find?
Main Takeaway: A photoaging smartphone application may effectively raise awareness, influence behaviors, and potentially contribute to long-term sun protection habits in adolescent individuals.
Ultraviolet (UV) exposure is known to increase the risk of skin cancer, especially when habits start in childhood and adolescence. This cross-sectional study investigated how a mobile app demonstrating the effects of UV exposure on skin aging could motivate young individuals to safeguard themselves from the sun. Before using the app, 87 participants answered questions about their views on sun safety and their current sun safety habits. The app then used augmented reality to demonstrate how their faces might age prematurely with prolonged UV exposure. After the intervention, participants answered a survey to determine if using the app motivated them to practice better sun safety in the future.
What did they find?
- The median age of the 87 participants was 14 years. The majority of participants were White (50.6%), with a higher percentage of females (56.3%) than males (43.7%).
- At baseline, 27.5% of participants reported never or rarely using sunscreen, while 34.5% used it sometimes, and 37.9% mostly or always used sunscreen on sunny days. 44.8% reported no sunburns in the past year, with 48.3% reporting 1-5 sunburns.
- Females were more likely to emphasize sun safety on cloudy days (65.3% vs. 36.8%), while males showed higher motivation to wear protective clothing after using the app (84.2% vs. 65.3%).
- The majority of participants found the app motivating for sun safety behaviors: 85.1% for sunscreen use, 83.9% for avoiding indoor tanning, and 74.4% for wearing hats.
Main Takeaway: A photoaging smartphone application may effectively raise awareness, influence behaviors, and potentially contribute to long-term sun protection habits in adolescent individuals.
Aside from biopsy, what alternative options exist for diagnosing calciphylaxis?
Innovations in Dermatology
Innovations in Dermatology
X-Ray marks the spot in calciphylaxis diagnosis
Calciphylaxis is a debilitating calcification disorder of the small vessels and skin, with a one-year mortality rate of up to 80%, highlighting the cruciality of early diagnosis. However, disease presentation is often subtle, especially in individuals with darker skin. This retrospective cohort study of 23 patients sought to better understand the utility of various modalities for diagnosing calciphylaxis in darker-skinned individuals.
What did they find?
Main Takeaway: X-ray resulted in a shorter time to diagnosis of calciphylaxis when compared to skin biopsy; however, skin biopsy demonstrated higher levels of sensitivity.
Calciphylaxis is a debilitating calcification disorder of the small vessels and skin, with a one-year mortality rate of up to 80%, highlighting the cruciality of early diagnosis. However, disease presentation is often subtle, especially in individuals with darker skin. This retrospective cohort study of 23 patients sought to better understand the utility of various modalities for diagnosing calciphylaxis in darker-skinned individuals.
What did they find?
- 28 imaging tests were performed, 16 of which were diagnostic, including CT scans, nuclear bone scans, X-rays, and ultrasounds.
- Diagnostic confirmation via imaging was much faster (0.79 days) compared to biopsy (8.9 days).
- Of the imaging modalities, X-ray was shown to be the most sensitive, visualized calcified vessels with the highest resolution, and generated the quickest diagnostic results.
- Biopsy confirmed the diagnosis of calciphylaxis in 83% of patients, while imaging confirmed the diagnosis in 57%.
Main Takeaway: X-ray resulted in a shorter time to diagnosis of calciphylaxis when compared to skin biopsy; however, skin biopsy demonstrated higher levels of sensitivity.
Hair loss affects up to 65% of patients undergoing cancer treatment. Madarosis, the loss of eyebrows and eyelashes, from cancer may be more subtle than hair loss on the scalp, but can still be devastating to affected patients. Researchers conducted a literature search related to eyebrow and eyelash loss in patients with cancer. Treatment options ranged from hair regrowth agents, camouflaging techniques, and preventative options.
What did they find?
Main Takeaway: Though great strides have been made in options for camouflaging madarosis, no preventative options for eyebrow and eyelash loss in patients with cancer have been studied to date.
What did they find?
- To date, only Latisse has been studied in patients with cancer-induced eyelash loss.
- Though Rogaine and topical peptides are used in clinical settings for madarosis, neither have been studied specifically in patients with cancer.
- There are presently no effective techniques for prevention of madarosis.
- Scalp cooling therapy is the only FDA-approved preventative method of hair loss during chemotherapy treatments; however, this has not been used on eyebrows or eyelashes.
Main Takeaway: Though great strides have been made in options for camouflaging madarosis, no preventative options for eyebrow and eyelash loss in patients with cancer have been studied to date.
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