Sixty-First issue
May 29, 2024
Emerging Trichophyton Indotineae infections show resistance to standard antifungals, New York City study reveals
JAMA Dermatology
JAMA Dermatology
Terbinafine can't handle the heat, but Itraconazole cools things down when it comes to T. Indotineae infections!
Trichophyton Indotineae is an emerging dermatophyte responsible for extensive tinea infections, which are often resistant to terbinafine. This retrospective cohort study aimed to investigate the clinical features, antifungal susceptibility, and genomic sequencing of T. indotineae infections.
What did they find?
Main Takeaway: Emerging Trichophyton Indotineae infections display extensive, refractory infections, which are often terbinafine resistant.
Trichophyton Indotineae is an emerging dermatophyte responsible for extensive tinea infections, which are often resistant to terbinafine. This retrospective cohort study aimed to investigate the clinical features, antifungal susceptibility, and genomic sequencing of T. indotineae infections.
What did they find?
- The examined cohort was comprised of 11 patients (6 males, 5 females, median age 39).
- Terbinafine treatment failure was associated with squalene epoxidase sequence variations L393S and F397L and terbinafine minimum inhibitory concentration values ≥ 0.5 μg/mL.
- Fluconazole and griseofulvin were partially effective, with 2 of 4 and 2 of 5 patients showing improvement, respectively.
- Itraconazole was generally effective, with 5 of 7 patients experiencing improvement or clearance of the infection.
- Whole-genome sequencing revealed that US isolates formed a distinct cluster from prior Indian isolates, indicating a probable origin from Bangladesh based on patient travel history.
Main Takeaway: Emerging Trichophyton Indotineae infections display extensive, refractory infections, which are often terbinafine resistant.
Comparison of patients with isolated cutaneous lupus erythematosus versus systemic lupus erythematosus with cutaneous lupus erythematosus as the sole clinical feature
Journal of American Academy Dermatology
Journal of American Academy Dermatology
Lab values in cutaneous lupus are like ominous fortune cookies: the results might be small, but the implications can be profound.
Lupus erythematosus (LE) can manifest as cutaneous LE (CLE), a limited skin disease, or systemic LE (SLE). Up to 80% of SLE patients experience skin involvement. Lab manifestations such as leukopenia, mild thrombocytopenia, decreased complement levels, and positive anti-dsDNA or anti-Sm antibodies help identify CLE patients at high risk of developing severe SLE (sSLE). This monocentric cohort study aimed to compare isolated CLE and CLE with laboratory SLE to predict the progression risk of CLE to sSLE.
What did they find?
Limitations: A consensus definition of sSLE does not exist.
Main Takeaway: Patients with CLE with laboratory SLE may have a higher risk of progression to sSLE.
Lupus erythematosus (LE) can manifest as cutaneous LE (CLE), a limited skin disease, or systemic LE (SLE). Up to 80% of SLE patients experience skin involvement. Lab manifestations such as leukopenia, mild thrombocytopenia, decreased complement levels, and positive anti-dsDNA or anti-Sm antibodies help identify CLE patients at high risk of developing severe SLE (sSLE). This monocentric cohort study aimed to compare isolated CLE and CLE with laboratory SLE to predict the progression risk of CLE to sSLE.
What did they find?
- 20 of the 149 patients with CLE had CLE with laboratory SLE
- CLE with laboratory SLE had a higher risk of progressing to sSLE than isolated CLE (HR = 6.69, 95% CI: 1.93-23.14, P < 0.001).
- Patients with CLE with laboratory SLE were younger at diagnosis (median age 23 vs 33 years old), received more corticosteroids (OR = 3.33, 95% CI: 1.26-9.09, P = 0.017) and biologic therapy (OR = 5.05, 95% CI: 1.47-17.5, P = 0.016), and had lower rates of CLE remission (OR = 0.30, 95% CI: 0.10-0.88, P = 0.020) than those with isolated CLE.
- Progression to sSLE occurred in 7% of patients, consistent with previous studies; however, this study found a longer progression time of 11.6 years.
Limitations: A consensus definition of sSLE does not exist.
Main Takeaway: Patients with CLE with laboratory SLE may have a higher risk of progression to sSLE.
Contact hypersensitivity reaction: a not-so-sweaty situation!
Contact hypersensitivity (CHS) reactions occur when dendritic cells take up allergens in the skin, leading to an allergen-specific T-cell response. Typically, allergic contact dermatitis and atopic dermatitis are studied using CHS models in mice ear skin, which lack sweat glands, overlooking the potential role of sweating in contact dermatitis and atopic dermatitis. As such, researchers sought to analyze the effect of sweat suppression on CHS reactions. Sweat suppression was induced in the footpad of mice, followed by an introduction of a hapten. The inflammatory response was compared between sweat-suppressed mice and controls.
What did they find?
Main Takeaway: Sweat appears to play an important role in maintaining skin barrier function and its suppression can potentially worsen CHS, highlighting the importance of considering sweat in models of allergic contact dermatitis and atopic dermatitis.
Contact hypersensitivity (CHS) reactions occur when dendritic cells take up allergens in the skin, leading to an allergen-specific T-cell response. Typically, allergic contact dermatitis and atopic dermatitis are studied using CHS models in mice ear skin, which lack sweat glands, overlooking the potential role of sweating in contact dermatitis and atopic dermatitis. As such, researchers sought to analyze the effect of sweat suppression on CHS reactions. Sweat suppression was induced in the footpad of mice, followed by an introduction of a hapten. The inflammatory response was compared between sweat-suppressed mice and controls.
What did they find?
- Compared to controls, there was a >5-fold penetration of haptens (P<0.01) through the skin in sweat-suppressed mice.
- Sweat-suppressed mice had a higher allergen-specific T cell response (P<0.05) after hapten exposure than controls.
- Sweat-suppressed mice had a stronger elicitation response (P<0.05) following re-exposure to the hapten at 7 days compared to controls.
Main Takeaway: Sweat appears to play an important role in maintaining skin barrier function and its suppression can potentially worsen CHS, highlighting the importance of considering sweat in models of allergic contact dermatitis and atopic dermatitis.
Perineural inflammation as a novel feature in lichen sclerosus: A case series of histologic and clinical features
Journal of Dermatopathology
Journal of Dermatopathology
Let’s assess LS
Lichen sclerosus (LS) is an inflammatory skin disorder with an unknown etiology that occurs more frequently in females. LS's histologic features can be nonspecific and often mimic other conditions with an interface reaction pattern. Prior studies have identified perineural inflammation (PNinf) as a novel histologic feature of LS. Researchers sought to validate PNinf in LS and compared samples from female (n=45) and male (n=8) patients.
What did they find?
Main Takeaway: Perineural inflammation is a recurring histologic feature of LS. Its association with male patients, atrophic changes, spongiosis, and dermal plasma cells can provide insight into the unknown etiology of LS.
Lichen sclerosus (LS) is an inflammatory skin disorder with an unknown etiology that occurs more frequently in females. LS's histologic features can be nonspecific and often mimic other conditions with an interface reaction pattern. Prior studies have identified perineural inflammation (PNinf) as a novel histologic feature of LS. Researchers sought to validate PNinf in LS and compared samples from female (n=45) and male (n=8) patients.
What did they find?
- Male samples were more likely to show PNinf than females (P<0.001).
- Both samples from males and samples demonstrating PNinf were more likely to have atrophic changes (P<0.05) and spongiosis (P<0.01).
- Dermal plasma cells were more likely to appear in male cases (P<0.05) and those with PNinf (P<0.01).
Main Takeaway: Perineural inflammation is a recurring histologic feature of LS. Its association with male patients, atrophic changes, spongiosis, and dermal plasma cells can provide insight into the unknown etiology of LS.
Is immunosuppression a culprit in CSCC outcomes for transplant patients?
Journal of Dermatologic Surgery
Journal of Dermatologic Surgery
Don’t recant your transplant– tumor traits hold the fate!
Solid organ transplant recipients (SOTRs) are known to have an increased risk of developing cutaneous squamous cell carcinoma (CSCC), yet it remains unclear if transplant status independently predicts poor outcomes. This retrospective cohort study analyzed 632 tumors from 78 SOTRs and 262 controls to assess the impact of transplant status on CSCC prognosis.
What did they find?
Main Takeaway: Transplant status did not independently worsen CSCC outcomes when accounting for tumor stage, age, sex, site, and time to poor outcome, highlighting the importance of considering tumor characteristics over immunosuppression in predicting prognosis.
Solid organ transplant recipients (SOTRs) are known to have an increased risk of developing cutaneous squamous cell carcinoma (CSCC), yet it remains unclear if transplant status independently predicts poor outcomes. This retrospective cohort study analyzed 632 tumors from 78 SOTRs and 262 controls to assess the impact of transplant status on CSCC prognosis.
What did they find?
- Tumor stage (P < 0.001) and head/neck location (P < 0.001 for ear/lip/temple, P = 0.003 for other head/neck locations) were the only statistically significant predictors of poor outcomes.
- 17% of SOTRs experienced poor outcomes compared to 15% of non-SOTRs, a statistically non-significant difference.
- Local recurrence was the most common poor outcome in both groups: 12% of SOTRs versus 10% of non-SOTRs.
- Multimodal treatment showed no independent effect on poor outcomes.
Main Takeaway: Transplant status did not independently worsen CSCC outcomes when accounting for tumor stage, age, sex, site, and time to poor outcome, highlighting the importance of considering tumor characteristics over immunosuppression in predicting prognosis.
Smooth moves ahead with this new cellulite treatment!
Cellulite, affecting 80-90% of post-pubertal women, is characterized by skin dimpling on the thighs, hips, and buttocks. Recent research has highlighted seaweed's anti-inflammatory and antioxidant metabolites, which may be effective in treating cellulite. In a pilot study, female participants (n=60) received seaweed mud applications with occlusion on their buttocks and posterior thighs for 4 weeks. Photographs, clinical analysis, and histology were collected at baseline and post-treatment.
What did they find?
Main Takeaway: Seaweed mud shows promise in reducing cellulite, decreasing inflammatory cells, and enhancing hydration and elasticity in the thighs and buttocks.
Cellulite, affecting 80-90% of post-pubertal women, is characterized by skin dimpling on the thighs, hips, and buttocks. Recent research has highlighted seaweed's anti-inflammatory and antioxidant metabolites, which may be effective in treating cellulite. In a pilot study, female participants (n=60) received seaweed mud applications with occlusion on their buttocks and posterior thighs for 4 weeks. Photographs, clinical analysis, and histology were collected at baseline and post-treatment.
What did they find?
- Circumferences of the waist, belly, hips, upper and median thigh were reduced after 4-weeks of treatment (P<0.0001)
- Chronic inflammatory lymphocytes, seen in pre-treatment tissue (35.89 ± 7.18 cells/mm3), were significantly reduced or resolved in post-treatment histology (6.55±3.05 cell/mm3, P<0.0001)
- Hydration and elasticity significantly improved after treatment compared to baseline (P<0.0001)
Main Takeaway: Seaweed mud shows promise in reducing cellulite, decreasing inflammatory cells, and enhancing hydration and elasticity in the thighs and buttocks.
When the sun's not the only thing to watch out for
While melanoma is relatively uncommon among Black patients, with an annual incidence of approximately 1 in 100,000 individuals, the associated outcomes are notably troubling, including advanced-stage diagnoses, lower survival rates, and poor response to immunotherapy. This case-series analysis comprehensively explores melanoma characteristics and outcomes within this demographic.
What did they find?
Main Takeaway: Melanoma in Black patients is associated with poor outcomes and often presents on acral skin or in those with compromised immune status.
While melanoma is relatively uncommon among Black patients, with an annual incidence of approximately 1 in 100,000 individuals, the associated outcomes are notably troubling, including advanced-stage diagnoses, lower survival rates, and poor response to immunotherapy. This case-series analysis comprehensively explores melanoma characteristics and outcomes within this demographic.
What did they find?
- 75% of cutaneous melanomas in Black patients occurred on acral skin, primarily on the plantar foot or heel.
- Nonacral melanomas were more common in immunocompromised patients and those with a personal history of other cancers.
- Poor outcomes were seen in patients with advanced acral melanoma, mucosal/ocular melanoma, or melanoma of unknown primary (MUP). These melanomas were often nonresponsive to immunotherapy.
Main Takeaway: Melanoma in Black patients is associated with poor outcomes and often presents on acral skin or in those with compromised immune status.
Nail disorders are often difficult to treat and have implications beyond cosmetic concerns, including pain, decreased quality of life, and reduced functional capacity of hands/feet. To combat this, laser-assisted drug delivery (LADD) enhances the delivery of topical medications through microchannels. A PubMed search conducted in June 2023 to consolidate LADD studies on onychomycosis and nail psoriasis identified 15 relevant studies.
What did they find?:
Limitations: Assessing and comparing laser efficacy between studies has limitations due to variations in laser types, laser settings, and clinician techniques.
Main Takeaway: Though the out-of-pocket cost of LADD may be higher than that of topical or systemic treatment, its clinical efficacy, tolerability, and relatively few side effects may offer an alternative or adjunct therapy option to optimize treatment for onychomycosis and nail psoriasis.
What did they find?:
- LADD of topical amorolfine, terbinafine, and tioconazole was generally more effective at treating onychomycosis than topicals alone.
- LADD of calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail was found to be significantly more effective at treating nail psoriasis than topical treatment alone.
Limitations: Assessing and comparing laser efficacy between studies has limitations due to variations in laser types, laser settings, and clinician techniques.
Main Takeaway: Though the out-of-pocket cost of LADD may be higher than that of topical or systemic treatment, its clinical efficacy, tolerability, and relatively few side effects may offer an alternative or adjunct therapy option to optimize treatment for onychomycosis and nail psoriasis.
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Copyright © 2023 - All Rights Reserved.