THIRTY-THIRD ISSUE
May 3, 2023
Efficacy and Safety of Tralokinumab in Adolescents with Moderate to Severe Atopic Dermatitis: The Phase 3 ECZTRA 6 Randomized Clinical Trial
JAMA Dermatology
Efficacy and Safety of Tralokinumab in Adolescents with Moderate to Severe Atopic Dermatitis: The Phase 3 ECZTRA 6 Randomized Clinical Trial
JAMA Dermatology
A more selective version of dupilumab? Tell me more!
Tralokinumab, a selective IL-13 inhibitor, is the latest monoclonal antibody targeted to treat atopic dermatitis, but its role as monotherapy for adolescents remains unclear. This randomized, double blind, placebo-controlled, phase 3 clinical trial randomized (1:1:1) 289 patients aged 12-17 to receive tralokinumab (150 or 300 mg) or placebo every 2 weeks for 16 weeks. Endpoints included Investigator’s Global Assessment (IGA) score of 0 (clear) or 1 (almost clear) and a 75% improvement in the Eczema Area and Severity Index (EASI 75) at week 16.
What did they find?
Limitations: This study did not utilize an active comparator or a placebo group during the maintenance phase (weeks 16-52).
Main Takeaway: Given its efficacy and tolerability in adolescents, tralokinumab monotherapy may be useful in the treatment of AD in this age group.
Tralokinumab, a selective IL-13 inhibitor, is the latest monoclonal antibody targeted to treat atopic dermatitis, but its role as monotherapy for adolescents remains unclear. This randomized, double blind, placebo-controlled, phase 3 clinical trial randomized (1:1:1) 289 patients aged 12-17 to receive tralokinumab (150 or 300 mg) or placebo every 2 weeks for 16 weeks. Endpoints included Investigator’s Global Assessment (IGA) score of 0 (clear) or 1 (almost clear) and a 75% improvement in the Eczema Area and Severity Index (EASI 75) at week 16.
What did they find?
- Compared to placebo, more patients receiving tralokinumab 150 mg or 300 mg (n = 98 and 97, respectively), achieved an IGA score of 0 or 1 without rescue medication at week 16 (adjusted difference, 17.5% [95% CI, 8.4%-24.6%]; P < .001 and 13.8% [95% CI, 5.3%-22.3%]; P = .002, respectively)
- More patients receiving tralokinumab 150 mg or 300 mg achieved EASI75 without rescue medication at week 16 than placebo (adjusted difference, 22.5% [95% CI, 12.4%-32.6%]; P < .001 and 22.0% [95% CI, 12.0%-32.0%]; P < .001, respectively)
- Efficacy persisted through week 52 in over half of patients who met the primary endpoints at week 16
- No significant adverse events occurred, and frequency of conjunctivitis did not increase with length of use
Limitations: This study did not utilize an active comparator or a placebo group during the maintenance phase (weeks 16-52).
Main Takeaway: Given its efficacy and tolerability in adolescents, tralokinumab monotherapy may be useful in the treatment of AD in this age group.
First of its kind: A multicenter descriptive study on lichen planopilaris and frontal fibrosing alopecia in men
Journal of the American Academy of Dermatology
Don’t fade away from hair loss!
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are forms of primary scarring alopecia that can result in irreversible hair loss if left untreated. Though historically thought to occur primarily in postmenopausal women, reports of LPP and FFA in men have become more frequent. A multicenter descriptive study was performed to assess LPP/FFA characteristics among men in the United States.
Researchers reviewed medical records from specialty hair clinics between January 2010 and September 2021. 270 patients were included, with 215 having a diagnosis of LPP (79.6%), 37 with FFA (13.7%), and 18 with both LPP and FFA (6.7%).
What did they find?
- The average age at diagnosis was 45.77 ± 14.6
- Patients with FFA were commonly affected by hair loss of the beard (21.6%) and sideburns (16.2%)
- Most patients with LPP (61.9%), FFA (54.1%), and overlapping LPP and FFA (50.0%) had a history of scalp pruritus
- Nearly one-third (29.3%) received an incorrect diagnosis before seeing a hair specialist. LPP was commonly mistaken for seborrheic dermatitis; FFA and overlapping LPP and FFA were commonly mistaken for alopecia areata
Main Takeaway: Due to its often-irreversible nature, providers should be more aware of the common presentations of LPP and FFA in men. Receding frontal hairline in men accompanied by symptomatic scalp, body or beard hair loss should be evaluated for a scarring process.
Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are forms of primary scarring alopecia that can result in irreversible hair loss if left untreated. Though historically thought to occur primarily in postmenopausal women, reports of LPP and FFA in men have become more frequent. A multicenter descriptive study was performed to assess LPP/FFA characteristics among men in the United States.
Researchers reviewed medical records from specialty hair clinics between January 2010 and September 2021. 270 patients were included, with 215 having a diagnosis of LPP (79.6%), 37 with FFA (13.7%), and 18 with both LPP and FFA (6.7%).
What did they find?
- The average age at diagnosis was 45.77 ± 14.6
- Patients with FFA were commonly affected by hair loss of the beard (21.6%) and sideburns (16.2%)
- Most patients with LPP (61.9%), FFA (54.1%), and overlapping LPP and FFA (50.0%) had a history of scalp pruritus
- Nearly one-third (29.3%) received an incorrect diagnosis before seeing a hair specialist. LPP was commonly mistaken for seborrheic dermatitis; FFA and overlapping LPP and FFA were commonly mistaken for alopecia areata
Main Takeaway: Due to its often-irreversible nature, providers should be more aware of the common presentations of LPP and FFA in men. Receding frontal hairline in men accompanied by symptomatic scalp, body or beard hair loss should be evaluated for a scarring process.
Are Dehydrated Complete Human Placental Membrane Allografts an Option for Repair of Mohs Surgical Defects?
Dermatologic Surgery
Don’t pitch the placenta!
Dehydrated complete human placental membrane (dCHPM) allografts, which are known to be rich in growth factors, have previously been used to heal chronic wounds. In a retrospective study, the efficacy of using placental membranes for repair of Mohs Micrographic Surgery (MMS) defects of the nose was examined by assessing 20 patients who received a dCHPM allograft after undergoing MMS. Patients and observers scored the scars in a follow-up visit with higher scores indicating the worst possible outcome. Patients reported on 6 components (pain, itching, stiffness, color, thickness, and irregularity) each ranging from 1-10. Observers reported on 5 components (vascularity, pigmentation, thickness, surface irregularities, and surface area) each ranging from 1-10.
What did they find?
Limitations: The main limitations of this study are that it lacks a control group. and includes a small sample size.
Main takeaways: Dehydrated complete human placental membrane allografts are a possible option to repair Mohs surgical defects of the nose due to reported rapid wound healing and favorable scar outcome assessments by both patients and observers.
Dehydrated complete human placental membrane (dCHPM) allografts, which are known to be rich in growth factors, have previously been used to heal chronic wounds. In a retrospective study, the efficacy of using placental membranes for repair of Mohs Micrographic Surgery (MMS) defects of the nose was examined by assessing 20 patients who received a dCHPM allograft after undergoing MMS. Patients and observers scored the scars in a follow-up visit with higher scores indicating the worst possible outcome. Patients reported on 6 components (pain, itching, stiffness, color, thickness, and irregularity) each ranging from 1-10. Observers reported on 5 components (vascularity, pigmentation, thickness, surface irregularities, and surface area) each ranging from 1-10.
What did they find?
- Patients reported minimal pain, itching, stiffness, color, thickness, and irregularity
- On the total scale from 6-60 (normal skin-worst possible scar quality), patients scored their scars on average as 12.6 (SD 7.4)
- On the total scale from 5-50 (normal skin-worst possible scar quality), observers scored the scars on average as 8.4 (SD 3.2)
- Average overall opinion score by patients and observers was 2.5 (SD 1.8) and 1.9 (SD 1.3) respectively, with 1 being the best possible outcome and 10 being the worst possible outcome
Limitations: The main limitations of this study are that it lacks a control group. and includes a small sample size.
Main takeaways: Dehydrated complete human placental membrane allografts are a possible option to repair Mohs surgical defects of the nose due to reported rapid wound healing and favorable scar outcome assessments by both patients and observers.
Microbotox Injection vs Topical Application with Microneedling: What's more Effective at Reducing Facial Pores and Seborrhea
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
This is a ~pore~ attempt at being punny.
Enlarged pores and excess sebum production are frequent skin complaints. Many treatment modalities exist to address these cosmetic concerns including topical creams, light therapy, and chemical peels–all of which vary in effectiveness.
This split face study of 20 participants set out to evaluate the impact of microbotox injection versus topical microbotox during microneedling in reducing the size of enlarged facial pores and seborrhea. The degree of pore size and seborrhea was determined using a pore and sebum score prior to treatment. After application of topical numbing cream, the right side of the face was treated with intradermal microbotox injection while the left side of the face was treated with topical microbotox followed by microneedling. Photographs were taken prior to the procedure and re-evaluated by two blinded dermatologists both 1 month and 4 months post treatment.
What did they find:
Main takeaway: Intradermal injection was more effective than topical application of microbotox following microneedling in minimizing enlarged facial pores and seborrhea.
Enlarged pores and excess sebum production are frequent skin complaints. Many treatment modalities exist to address these cosmetic concerns including topical creams, light therapy, and chemical peels–all of which vary in effectiveness.
This split face study of 20 participants set out to evaluate the impact of microbotox injection versus topical microbotox during microneedling in reducing the size of enlarged facial pores and seborrhea. The degree of pore size and seborrhea was determined using a pore and sebum score prior to treatment. After application of topical numbing cream, the right side of the face was treated with intradermal microbotox injection while the left side of the face was treated with topical microbotox followed by microneedling. Photographs were taken prior to the procedure and re-evaluated by two blinded dermatologists both 1 month and 4 months post treatment.
What did they find:
- 100% of patients reported pain on the injection side of the face (p<0.001) and 100% of patients experienced edema and erythema on the topical treatment side of the face (p<0.001)
- There was a statistically significant reduction of pore and sebum scores in both treatments, with a slightly larger reduction with the microbotox injection treatment (p<0.001)
- Patients were more satisfied with the results of the microbotox injection vs topical microbotox with microneedling (p<0.001)
- 4 months post treatment, effects of the injection side were preserved whereas the topical side with microneedling was not (p<0.001)
Main takeaway: Intradermal injection was more effective than topical application of microbotox following microneedling in minimizing enlarged facial pores and seborrhea.
Are Type 1 Cannabinoid Receptors a new target in psoriasis treatment?
Journal of Investigative Dermatology
Say cannabiNO to itching in psoriasis.
In psoriasis, an increased number of cutaneous sensory neurons and elevated neuropeptides like substance P (SP) may contribute to the development of pruritus. Stimulation of type I cannabinoid receptors (CB1Rs) has been shown to produce anti-pruritic effects in inflammatory skin disorders, making cannabinoid products a prospective treatment of interest for itch in dermatosis.
To determine the role of CB1Rs in psoriasis, researchers induced psoriasis in mice using topical imiquimod and compared the effects of CB1R antagonism versus CB1R agonism to a control.
What did they find?
Main takeaways: CB1R in sensory neurons may be a potential therapeutic target in psoriasis.
In psoriasis, an increased number of cutaneous sensory neurons and elevated neuropeptides like substance P (SP) may contribute to the development of pruritus. Stimulation of type I cannabinoid receptors (CB1Rs) has been shown to produce anti-pruritic effects in inflammatory skin disorders, making cannabinoid products a prospective treatment of interest for itch in dermatosis.
To determine the role of CB1Rs in psoriasis, researchers induced psoriasis in mice using topical imiquimod and compared the effects of CB1R antagonism versus CB1R agonism to a control.
What did they find?
- Subcutaneous injections of a CB1R agonist elicited significant improvement in psoriasiform symptoms (P<0.001) and scratching behavior (P<0.001)
- Subcutaneous injections of a CB1R antagonist elicited significant worsening of psoriasiform symptoms (P<0.01) and scratching behavior (P<0.001)
Main takeaways: CB1R in sensory neurons may be a potential therapeutic target in psoriasis.