eightieth issue
March 5, 2025
Risk of cardiovascular morbidity and mortality in Stevens-Johnson Syndrome/toxic epidermal necrolysis survivors
JAMA Dermatology
JAMA Dermatology
Recovery doesn’t always mean risk-free—heart health matters post-SJS/TEN.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions characterized by widespread epidermal detachment and necrosis. While survivors endure significant long-term sequelae, the risks of cardiovascular morbidity and mortality post-SJS/TEN remain underexplored. This nationwide cohort study aimed to assess the long-term cardiovascular risks in SJS/TEN survivors compared to matched controls.
What did they find?
Main Takeaway: SJS/TEN survivors face significantly increased cardiovascular morbidity and mortality for years post-recovery. These findings underscore the need for proactive cardiovascular screening and risk mitigation, especially in older individuals and ICU-treated survivors.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions characterized by widespread epidermal detachment and necrosis. While survivors endure significant long-term sequelae, the risks of cardiovascular morbidity and mortality post-SJS/TEN remain underexplored. This nationwide cohort study aimed to assess the long-term cardiovascular risks in SJS/TEN survivors compared to matched controls.
What did they find?
- 10,571 SJS/TEN survivors were assessed for cerebrovascular accidents (CVA) and 11,084 for ischemic heart disease (IHD).
- SJS/TEN survivors had a 65% increased risk of stroke (HR 1.65, 95% CI 1.57-1.72) and a 58% increased risk of IHD (HR 1.58, 95% CI 1.51-1.65).
- The risk of cardiovascular mortality was significantly higher (CVA mortality: HR 1.69, IHD mortality: HR 1.55) in SJS/TEN survivors.
- Risks peaked at 1 year post-SJS/TEN and persisted for 4 to 7 years.
- Older survivors and those admitted to the ICU at diagnosis had the highest cardiovascular mortality risks.
Main Takeaway: SJS/TEN survivors face significantly increased cardiovascular morbidity and mortality for years post-recovery. These findings underscore the need for proactive cardiovascular screening and risk mitigation, especially in older individuals and ICU-treated survivors.
Human papillomavirus infection is associated with increased risk of new-onset hidradenitis suppurativa: A population-based cohort study
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Breaking out in more ways than one – the HPV-HS connection!
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an unclear cause, affecting up to 4% of the global population. While smoking, obesity, and genetics contribute to HS risk, the role of infectious agents remains uncertain. Human papillomavirus (HPV), the most common sexually transmitted infection in the U.S., alters local immune responses and may influence HS development. Given these biological and epidemiologic links, this database cohort study examined the association between HPV infection and new-onset HS.
What did they find?
Main Takeaway: HPV infection may increase the risk of developing HS, with the highest risk in older adults and those with diabetes, tobacco use, or HIV. These findings highlight the need for further research on infection-driven pathways in HS.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an unclear cause, affecting up to 4% of the global population. While smoking, obesity, and genetics contribute to HS risk, the role of infectious agents remains uncertain. Human papillomavirus (HPV), the most common sexually transmitted infection in the U.S., alters local immune responses and may influence HS development. Given these biological and epidemiologic links, this database cohort study examined the association between HPV infection and new-onset HS.
What did they find?
- Among HPV and control cohorts (both n = 582,007), individuals with HPV infection had a significantly higher risk of developing HS (hazard ratio [HR]: 1.356, 95% confidence interval [CI]: 1.290-1.427).
- HS risk was elevated across all sexes, age groups, and BMIs, peaking in individuals ≥65 years (HR 1.95, 95% CI 1.47-2.58).
- Individuals with both HPV and diabetes mellitus (HR: 3.140, 95% CI: 2.675-3.685) or tobacco use (HR: 2.936, 95% CI: 2.482, 3.473) had a higher risk of HS compared to those without these conditions.
- Individuals with both HPV and HIV demonstrated an increased risk of HS (HR: 1.663, 95% CI: 1.223-2.262); however, the presence of HPV in patients with HIV did not significantly alter the risk of HS onset.
Main Takeaway: HPV infection may increase the risk of developing HS, with the highest risk in older adults and those with diabetes, tobacco use, or HIV. These findings highlight the need for further research on infection-driven pathways in HS.
Microbiome-based therapy for vitiligo
Journal of Investigative Dermatology
Journal of Investigative Dermatology
Vitiligo? Vitiligone!
Vitiligo is an autoimmune pigmentary disorder characterized by melanocyte loss, leading to patchy depigmentation. Inflammatory cells, particularly T cells, play a key role, with CD8+ T cells correlating with disease severity. Given its inflammatory nature, standard treatment includes topical corticosteroids, immunomodulators, and phototherapy. Emerging research suggests that an altered skin microbiome may contribute to depigmentation. This study investigated the effects of Bacillus subtilis exopolysaccharides (EPSs) in vitiligo-prone mice through weekly intraperitoneal injections over 18 weeks.
What did they find?
Main Takeaway: Microbial dysbiosis may contribute to vitiligo pathogenesis. EPSs from Bacillus subtilis reduced depigmentation and CD8+ T cells, suggesting microbiome-based therapy could be a promising future treatment for vitiligo.
Vitiligo is an autoimmune pigmentary disorder characterized by melanocyte loss, leading to patchy depigmentation. Inflammatory cells, particularly T cells, play a key role, with CD8+ T cells correlating with disease severity. Given its inflammatory nature, standard treatment includes topical corticosteroids, immunomodulators, and phototherapy. Emerging research suggests that an altered skin microbiome may contribute to depigmentation. This study investigated the effects of Bacillus subtilis exopolysaccharides (EPSs) in vitiligo-prone mice through weekly intraperitoneal injections over 18 weeks.
What did they find?
- EPS-treated mice showed reduced dorsal, 68.4% (P = 0.015), and ventral, 52.7% (P = 0.015), depigmentation over 18 weeks.
- T-cells decreased by 35.7% (P = 0.014) in EPS-treated mice.
- Cytotoxic CD8+ T cells were reduced by 63.6% in the skin of the EPS-treated mice when compared to the untreated mice (P = 0.0006).
Main Takeaway: Microbial dysbiosis may contribute to vitiligo pathogenesis. EPSs from Bacillus subtilis reduced depigmentation and CD8+ T cells, suggesting microbiome-based therapy could be a promising future treatment for vitiligo.
The cutaneous pathology of erythromelalgia and its role in establishing critical clues regarding pathogenesis
American Journal of Dermatopathology
American Journal of Dermatopathology
Answering your ~burning~ questions about erythromelalgia!
Erythromelalgia is a rare cutaneous pain syndrome causing acral burning pain and flushing, relieved by cold and rest. While primary erythromelalgia stems from sodium channel gene mutations, secondary cases are linked to autoimmune conditions. However, its histopathology remains poorly defined. This study retrospectively analyzed acral biopsies from patients with clinically diagnosed erythromelalgia (n = 9) to characterize its histopathologic features.
What did they find?
Main Takeaway: Erythromelagia is a dysautonomia syndrome with reproducible histopathologic findings of vascular ectasia and denervation of the eccrine coil and arteries. These findings provide valuable insight into its underlying pathology.
Erythromelalgia is a rare cutaneous pain syndrome causing acral burning pain and flushing, relieved by cold and rest. While primary erythromelalgia stems from sodium channel gene mutations, secondary cases are linked to autoimmune conditions. However, its histopathology remains poorly defined. This study retrospectively analyzed acral biopsies from patients with clinically diagnosed erythromelalgia (n = 9) to characterize its histopathologic features.
What did they find?
- Superficial vascular ectasia, with associated complement C5b-9 deposition, was observed in 8 out of 9 cases (89%).
- 3 out of 9 patients (33%) had concurrent autoimmune disease, and 2 of these cases showed upregulation of type I interferon in endothelial cells.
- In 100% of samples, CD56 stain revealed autonomic denervation of the eccrine coil and arteries.
Main Takeaway: Erythromelagia is a dysautonomia syndrome with reproducible histopathologic findings of vascular ectasia and denervation of the eccrine coil and arteries. These findings provide valuable insight into its underlying pathology.
Topical therapies for periorbital dyschromia: A 30-year review of the literature
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
Science finally shows that coffee alone won’t fix your dark circles!
Periorbital dyschromia (POD), or dark circles, is a common cosmetic concern with various causes, making treatment difficult. This systematic review analyzed 30 years of literature to assess the effectiveness of topical treatments for POD, evaluating ingredients such as acids, vitamins, caffeine, growth factors, and more. The review included 22 studies, covering 726 patients, and evaluated treatments' impacts on pigmentation, skin texture, and overall aesthetics.
What did they find?
Main Takeaway: Topical therapies show promise for treating dark circles, improving pigmentation, skin texture, and hydration. However, further research is needed to establish evidence-based treatment recommendations.
Periorbital dyschromia (POD), or dark circles, is a common cosmetic concern with various causes, making treatment difficult. This systematic review analyzed 30 years of literature to assess the effectiveness of topical treatments for POD, evaluating ingredients such as acids, vitamins, caffeine, growth factors, and more. The review included 22 studies, covering 726 patients, and evaluated treatments' impacts on pigmentation, skin texture, and overall aesthetics.
What did they find?
- Topical treatments showed improvement in pigmentation, elasticity, and wrinkles compared to placebo.
- 81% of studies using chromometers and spectrophotometers reported reduced pigmentation.
- 41% of studies found improvement in skin texture and wrinkles.
- 27% of studies noted increased skin hydration, while 23% saw reduced POD volume.
Main Takeaway: Topical therapies show promise for treating dark circles, improving pigmentation, skin texture, and hydration. However, further research is needed to establish evidence-based treatment recommendations.
Is Poly-D,L-Lactic Acid effective and safe for lower eyelid rejuvenation?
Journal of Cutaneous Dermatology
Journal of Cutaneous Dermatology
It’s time to bag the eye-bags–there’s a new approach in town!
Injectable fillers provide a minimally invasive solution for lower eyelid tear trough correction, with hyaluronic acid (HA) and calcium hydroxyapatite (CaHA) being the traditional choices. Poly-D,L-lactic acid (PDLLA), a collagen-stimulating filler, may offer longer-lasting results with fewer side effects. This study evaluated PDLLA injections in four Korean women with tear trough deformities, assessing outcomes at 1 week, 1 month, and 6 months post-treatment using the Hirmand classification.
What did they find?
Injectable fillers provide a minimally invasive solution for lower eyelid tear trough correction, with hyaluronic acid (HA) and calcium hydroxyapatite (CaHA) being the traditional choices. Poly-D,L-lactic acid (PDLLA), a collagen-stimulating filler, may offer longer-lasting results with fewer side effects. This study evaluated PDLLA injections in four Korean women with tear trough deformities, assessing outcomes at 1 week, 1 month, and 6 months post-treatment using the Hirmand classification.
What did they find?
- In two cases of Class II tear trough deformity, one achieved complete resolution, while the other improved to a Class I deformity within one week post-treatment. Both demonstrated reduced hollowness and enhanced volume.
- One case of a Class I tear trough deformity achieved complete resolution at 6 months post-treatment.
- One case of a Class III tear trough deformity improved to a Class II deformity one week post-treatment, with notable reduction in hollowness and enhanced volume.
- All participants had sustained improvement after 6 months, with high ratings of patient satisfaction.
Higher odds of Dupilumab prescriptions for Black patients With atopic dermatitis
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Dupilumab for all or just different odds?
Dupilumab is a biologic used to treat moderate to severe atopic dermatitis. This study analyzed prescribing patterns from the DataDerm registry to identify differences based on race, insurance status, and other demographic factors.
What did they find?
Dupilumab is a biologic used to treat moderate to severe atopic dermatitis. This study analyzed prescribing patterns from the DataDerm registry to identify differences based on race, insurance status, and other demographic factors.
What did they find?
- Black patients had nearly twice the odds of being prescribed dupilumab compared to White patients.
- More than half (54.75%) of dupilumab prescriptions were for privately insured patients, while Medicare and uninsured patients had lower odds.
- Men and younger adults (18-39 years) were more likely to receive prescriptions.
DERMLITE Dermoscopy QUESTION OF THE WEEK
Low-dose oral minoxidil initiation for patients with hair loss: An international modified Delphi consensus statement
Hair loss significantly impacts quality of life and has diverse causes, ranging from hereditary, autoimmune, infectious, endocrinologic, and medication-induced. Low-dose oral minoxidil (LDOM) is emerging as a convenient and effective alternative to topical treatments. While smaller studies support its safety and efficacy, larger trials are limited, highlighting the need for expert consensus-based guidelines on LDOM prescribing and monitoring. A modified Delphi study involving 43 hair loss experts from 12 countries was conducted to build consensus on LDOM’s dosing, safety, efficacy, and monitoring.
What did they find?
Main Takeaway: These guidelines equip clinicians with structured recommendations to optimize LDOM use, addressing a range of hair loss conditions and improving treatment outcomes and patient quality of life.
What did they find?
- LDOM provides direct benefit for conditions involving follicular miniaturization and hair cycle disruption, such as androgenetic alopecia, alopecia areata, telogen effluvium, traction alopecia, and chemotherapy-induced alopecia. It can also offer supportive benefits for scarring alopecias, including lichen planopilaris, frontal fibrosing alopecia, and central centrifugal alopecia.
- Efficacy is generally observed within 3–6 months, and recommendations include tailored starting doses by age and sex, along with guidelines for monitoring and managing potential adverse effects.
Main Takeaway: These guidelines equip clinicians with structured recommendations to optimize LDOM use, addressing a range of hair loss conditions and improving treatment outcomes and patient quality of life.
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Copyright © 2023 - All Rights Reserved.