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Pityriasis rosea (PR) is a benign self-limited rash that presents as multiple erythematous patches on the trunk and limbs. While the exact etiology of PR remains unknown, human herpesviruses 6 and 7 have been implicated in its pathogenesis. PR treatment is centered on relieving symptoms, however, no standardized treatment exists for PR. A 2019 Cochrane review provided a comprehensive analysis of the efficacy and safety of available PR treatments that have been studied in randomized controlled trials (RCTs). This review analyzed 14 parallel RCTs and assessed 2 primary outcomes: good or excellent rash improvement within 2 weeks (participant-rated) and serious adverse events. Secondary outcomes were also measured, including resolution of itch within 2 weeks (participant-rated), and good or excellent rash improvement within 2 weeks (provider-rated). Two RCTs found significant provider-rated rash improvement with acyclovir compared to placebo and vitamins or when used in addition to a topical regimen. However, the trials employed varying doses of acyclovir, and the review was unable to recommend a specific dose for PR treatment.

The Symposium on Hidradenitis Suppurativa Advances (SHSA) is a joint meeting of the United States Hidradenitis Suppurativa Foundation (HSF) and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This annual cross-disciplinary meeting brings together experts from around the world in an opportunity to discuss the most recent advances in the study of hidradenitis suppurativa (HS). The fifth annual meeting was held virtually on 9-11 October 2020. A record 347 attendees, including 79 people with HS, from 20 different countries attended. Key take-home points included: Clinicians can optimize each visit by listening, provide education, and discuss treatments; a patient decision aid for HS (HS-PDA) is a freely available tool (www.informed-decisions.org); COVID-19 severity in HS patients was not different for patients treated with/without a biologic; comorbidity screening recommendations will be published soon; neutrophil extracellular traps (NETs) may play a role in HS; memory B cells, T helper 1 cytokines, and interleukin 1 signaling contributes to HS pathogenesis and are targets for new therapies; novel therapies are showing promise including a new JAK1 inhibitor (INCB054707) and brodalumab; and HS-specific outcome measures have emerged to better monitor disease severity, flare, and progression including a patient reported measure (HiSQOL) and an HS-specific investigator global assessment. J Drugs Dermatol. 2021;20(8):868-873. doi:10.36849/JDD.5836.

UNSTRUCTURED No abstract - this is a short review of the Global Burden of Disease-Cochrane project meant for the 25 year special edition publication

Proliferative nodules arising within congenital melanocytic nevi often present a diagnostic challenge given a close resemblance to melanoma. Several morphologic variants have been characterized. In difficult cases, ancillary molecular tests can be used to better exclude the possibility of malignant degeneration. Herein, we report a case of an unusual proliferative nodule with overlapping features of angiomatoid Spitz tumor and ancient melanocytic nevus, which demonstrated normal findings on both chromosomal microarray and a gene expression profiling assay.

Introduction: Capecitabine is an oral chemotherapy frequently used in the treatment of metastatic breast and colorectal cancers. Drug-induced cutaneous hyperpigmentation is a rare adverse effect of capecitabine, which is almost exclusively reported with development of hand-foot syndrome (HFS). Here, we report a case of capecitabine-induced hyperpigmentation affecting the hands, feet, face, and tongue in the complete absence of HFS.Case report: An 82-year old man presented with progressive hyperpigmentation of his hands, feet, face, and tongue shortly after initiating capecitabine for treatment of colon adenocarcinoma. There was no associated erythema, edema, blistering, desquamation, tingling, or tenderness. After completion of capecitabine therapy, he endorsed 95% resolution of all hyperpigmentation.Discussion: Previous reports of capecitabine-induced hyperpigmentation have argued that it may be a sign of impending toxicity and should be a part of the HFS grading scale. Others argue that the two are separate entities, yet the mechanism is still unknown. This case supports that capecitabine can cause hyperpigmentation independent of HFS, and thus, should be evaluated as a separate entity of HFS if other symptoms are lacking.

UNSTRUCTURED Atopic eczema is a chronic inflammatory skin condition, affecting 5% to 20% of people worldwide, with no current cure. While there are many available treatment options that help improve atopic eczema, patients in whom these treatments did not work or who fear their long-term effects may look to diet for solutions. Nutritional supplements are a vast and growing industry, and patients often turn to oral supplements as complementary or alternative treatment options for a variety of health conditions. Nutritional supplements are not required to prove efficacy or safety before becoming available to consumers, as they are regulated by the FDA as foods instead of drugs. Given their growing popularity and industry characteristics, it is important for physicians to be knowledgeable about these ingredients in order to counsel patients. A 2012 Cochrane review, “Dietary supplements for established atopic eczema” offers a comprehensive review of evidence regarding popular dietary supplements used in atopic eczema.

Hair supplements are a vast and growing industry. Patients often turn to oral supplements to address hair concerns as they are easily accessible. There are numerous products on the market, many with thousands of reviews (both positive and negative). Nutritional supplements are regulated by the FDA as foods instead of drugs, meaning they do not have to prove their efficacy and safety before becoming available to consumers. While some oral supplements have strong evidence supporting their use for hair growth, many ingredients have not been tested in clinical trials, have only in vitro evidence for hair growth, or have only been tested in animals. Given these industry characteristics, it is important for dermatologists to be aware of the safety and utility of these ingredients to provide appropriate counseling to their patients. The goal of this review is to evaluate the efficacy of popular hair growth oral supplement ingredients and formulations. This review does not address the topical formulations of these ingredients and their effects on hair growth.

Background Finite clinical data and understanding of COVID-19 immunopathology has led to limited, opinion-based recommendations for management of immune-mediated inflammatory disease (IMID) patients on immunosuppressive (IS) therapeutics. Objective Determine if IS therapeutic type impacts COVID-19 risk among IMID patients. Methods We conducted a retrospective cohort analysis of Henry Ford Health System (HFHS) patients tested for COVID-19 between February 1st and April 18th, 2020 treated with IS medication for IMID. Therapeutic class of IS medication, comorbidities, and demographic factors were combined into multivariate models to determine predictors of COVID-19 infection, admission, ventilation, and mortality. Results Of 213 IMID patients, 36.2% tested positive for COVID-19, who had no greater odds of being hospitalized or requiring ventilation relative to the general population. No IS therapeutic worsened the course of disease after multivariate correction, though multi-drug regimens and biologics predicted an increased and decreased rate of hospitalization, respectively, with the latter driven by TNFα inhibitors. Limitations A single-center study somewhat limits generalization to community-based settings. Only patients tested for COVID-19 were analyzed. Conclusion IS therapies for IMIDs are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae when controlling for other factors, and TNFα inhibitors may decrease odds of severe infection., • Little is known about the impact of systemic immunosuppressive (IS) medications common to dermatology on COVID-19 risk. • IS for IMID were not associated with increased risk of SARS-CoV-2 infection or severe sequelae, and anti-TNFα monotherapy was associated with decreased admission rate. Patients can be reassured continuing these medications during COVID-19.