Search

Introduction/Background Studies have shown that patients with vs without alopecia areata (AA) have a higher risk of developing atopic dermatitis (AD). However, the real-world prevalence and incidence of moderate-to-severe AD in patients with AA are not well characterized. Objectives To assess the real-world prevalence and incidence of comorbid AD among patients with AA using data from a US administrative claims database. Methods This retrospective analysis evaluated claims from the Merative Marketscan Commercial Claims and Encounters database. Eligible patients were aged ≥12 years at index date (first AA diagnosis), received an AA diagnosis (≥1 inpatient encounter or ≥2 outpatient encounters/claims based on International Classification of Diseases, Clinical Modification, 10th Revision [ICD-10-CM]: L63.x or 9th Revision [ICD-9-CM]: 704.01) between 01/01/2017–07/31/2023, and had continuous plan enrollment for 5 years prior to index. AA disease severity was evaluated during the 6-month follow-up period post-index date. Patients were considered to have moderate-to-severe AA if they were diagnosed with alopecia universalis (ICD-10-CM: L63.1) or alopecia totalis (ICD-10-CM: L63.0) or if they received prescriptions for any systemic immunomodulators, oral corticosteroids, nonsteroidal systemic agents, or phototherapy within 6 months post-index date. Very severe AA (subset of moderate-to-severe AA) was defined by a diagnosis of alopecia universalis (ICD-10-CM: L63.1) or alopecia totalis (ICD-10-CM: L63.0). AD was defined as ≥1 inpatient or ≥2 outpatient claims with diagnosis codes for AD (ICD-10-CM L20.x) or other AD-related conditions (ICD-9-CM 691.8). Moderate-to-severe AD was defined per the AD criteria plus claims indicating 1 of the following: ≥1 dispensing of dupilumab; ≥2 dispensing of high-potency topical corticosteroids or systemic immunosuppressants; or ≥3 dispensing of medium potency topical corticosteroids, topical tacrolimus, phototherapy, or oral/parenteral corticosteroids. AD prevalence was assessed during the 5 years pre-index period; prevalence was also assessed over a longer duration and included those with ≥1 AD diagnosis from 01/01/2007–index. AD incidence was assessed from the 7th month after the AA index date through the time of AD diagnosis or end of continuous enrollment. Relative risk for developing AD comorbidity among patients with AA was evaluated using Cox proportional hazards model, controlling for age, sex, obesity, Charlson Comorbidity Index (CCI), and geographic region. Results Of 429,903 patients identified with AA in the database, 10,863 met eligibility criteria and 9507 completed ≥6 months of follow-up post-index date (mild AA, n=7087; moderate-to-severe AA, n=2420; very severe AA, n=491). The 1-year period prevalence of AA in the US was 0.16% in 2022. Among the 10,863 eligible patients, 63.0% were female, the mean (SD) age was 40.4 (15.1) years, and the mean (SD) CCI was 0.7 (1.2). Among all eligible patients with AA (n=10,863), the prevalence (within 5 years pre-index date) was 3.1% for any AD and 2.3% for moderate-to-severe AD. Among patients with moderate-to-severe AA (n=2420), the prevalence was 4.8% for any AD and 4.2% for moderate-to-severe AD. The prevalence of any AD any time prior to index among all eligible patients with AA and moderate-to-severe AA was 11.9% and 14.6%, respectively. AD incidence at follow-up was 4 per 1000 person-years in patients with mild AA, 7 per 1000 person-years for moderate-to-severe AA, and 6 per 1000 person-years for very severe AA. Mean (SD) time to AD diagnosis after AA index date was 2.1 (1.7) years for patients with mild AA, 2.0 (1.7) years for moderate-to-severe AA, and 2.0 (1.7) years for very severe AA. Risk of developing AD was greater in patients with moderate-to-severe vs mild AA (adjusted hazard ratio 1.63 [95% CI 1.01, 2.64]). Conclusions Patients with moderate-to-severe vs mild AA had higher prevalence and incidence of AD comorbidity and higher prevalence of moderate-to-severe AD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to review published literature on antibiotic and antiseptic use and resistance, and explore the utility of benzoyl peroxide in this capacity for dermatologic surgery. METHODS: A literature review was performed to investigate the skin microbiome, guidelines on antibiotic and antiseptic use in dermatologic surgery, and the utility of benzoyl peroxide as an antiseptic. RESULTS: Antiseptics are commonly used in dermatologic surgery to prepare surgical sites, and antibiotics are also employed by some physicians to prevent post-operative infection despite the potential for antibiotic resistance. Benzoyl peroxide, known for its high threshold for antibiotic resistance, has been successfully used in orthopedic surgery to prevent surgical site infection, especially in sebaceous areas of the skin which house a distinct microbiota. LIMITATIONS: Limitations to this review include lack of high-quality, adequately powered research and studies which evaluate the clinical impact of anti-septic use, particularly benzoyl peroxide use, in dermatologic surgery. CONCLUSION: Benzoyl peroxide may be a used as an antiseptic in dermatologic surgery of sebaceous areas to prevent post-operative infections, with a low likelihood of causing microbial resistance. [ABSTRACT FROM AUTHOR]

The greatest risk factor for skin cancer is exposure to ultraviolet (UV) rays of the sun. Among the three types of solar radiation (UVA, UVB, UVC), UVB rays are most commonly associated with skin cancer. UVB exposure promotes the formation of cyclobutane pyrimidine dimers (CPDs) in the DNA of cells in the epidermal skin layers, which can lead to mutations as DNA repair machinery attempts to repair the damage. These mutations can lead directly to skin carcinogenesis. Previous studies in animal and in human ex vivo skin models have shown that topical application of acyclothymidine dinucleosides protects DNA from UV-induced damage by preventing the formation of CPDs and helps initiate repair through the activation of DNA repair enzymes. Here we review the biological evidence leading to the development and formulation of ProteXidineTM (Topix Pharmaceuticals, Inc., Amityville, NY), as a UV protective agent for topical human application. We also provide clinical data pertaining to four ProteXidineTM formulations (test materials 1-4) tested for their abilities to reduce CPDs in an ex vivo human skin tissue model. J Drugs Dermatol. 2024;23(11):953-956. doi:10.36849/JDD.8420.

What is the ideal topical acne therapeutic? Topical therapeutics for acne vulgaris have advanced considerably over the last decade. Novel vehicular technologies have increased transdermal penetration of active molecules, enhanced their distribution across the skin surface, improved tolerability, and allowed for the incorporation of previously incompatible active compounds. Thus, fixed-combination topical therapeutics were successfully developed and are able to target multiple aspects of acne pathogenesis leading to synergism and increased efficacy. These advancements have paved the way to optimizing acne treatment while incorporating antibiotic stewardship which has become an urgent necessity. J Drugs Dermatol. 2024;23:11(Suppl 1):s4-10.

Background: This paper examines alternative procedural interventions for Seborrheic Dermatitis (SD), aiming to offer clinicians more treatment options and encourage further research., Method: A search was conducted on PubMed using specific search terms related to SD and various dermatological procedures. Studies in English, focusing on SD in human patients, and in-office treatments were included. Data were analyzed for procedure type, effectiveness, and side effects., Results: Nine studies were reviewed, covering phototherapy, indole-3-acetic acid photodynamic therapy (IAA-PDT), Picosecond Nd:YAG laser, botulinum toxin (BoNT) injections, triamcinolone injections, hair growth factor therapy, and precision cryotherapy. Most showed significant efficacy in small cohorts with high patient satisfaction. Hair growth factor therapy had long-term benefits, while narrow-band ultraviolet B phototherapy showed relapse within one month. Intense pulsed light with supramolecular salicylic acid, IAA-PDT, and laser therapy reduced sebum output and Malassezia furfur. Triamcinolone injections were effective against SD's immunological aspects. Hair growth factor therapy and precision cryotherapy have been successfully used to treat scalp SD. The role of BoNT in SD is still being explored; however, current evidence does not support its use., Conclusion: Limited data reveal the need for further research on dermatological procedures for SD. These methods show promise for better patient compliance but face challenges such as cost, variable effectiveness, and unknown long-term safety. Future research should focus on protocol standardization and comprehensive evaluation of long-term outcomes. J Drugs Dermatol. 2024;23(10):819-824. doi:10.36849/JDD.8116.

Granuloma annulare is a benign, non-infectious cutaneous granulomatous disease. Its pathogenesis is not completely elucidated but has recently been thought to involve immunologic and cytokine receptor signaling dysregulation. This includes the involvement of both Th1 and Th2 pathways as well as Th17 and Th22 axes and the Janus kinase/signal transducers and activators of the transcription (JAK-STAT) pathway. First-line treatment is typically intralesional or topical corticosteroids, however, these therapies do not always provide consistent, long-term efficacy for all patients. The successful use of therapies that target the specific inflammatory and immunologic mechanisms that underlie the pathogenesis of GA has been described. Here we describe a case of long-standing GA treated with tapinarof cream 1% applied once daily for 30 days. To our knowledge, this treatment has not yet been adequately described in the literature. J Drugs Dermatol. 2024;23(10):889-893.  doi:10.36849/JDD.8321.

Complementary and alternative medicine (CAM) use has become a field of growing interest in dermatology. However, the prevalence of CAM use is difficult to quantify as it varies based on many factors. Given the exploratory nature of the topic, a scoping review was conducted to identify studies that quantify biologically based CAM use in skin cancer patients. A comprehensive search of Embase, PubMed, and Web of Science databases from inception to August 28th, 2023, was performed. A total of 3,150 articles were identified through the database search. After article screening, 6 studies were suitable for inclusion in this review. Articles included were all questionnaire, survey, or interview style. Biologically based CAM use is prevalent in skin cancer patients. It can be associated with many factors such as location, stage of cancer, and age. CAM use can interact with conventional therapy; therefore, physicians should employ a culturally competent approach to inquiring about CAM use in order to improve patient outcomes and identify patterns and predictors of use.J Drugs Dermatol. 2024;23(5):322-326. doi:10.36849/JDD.8077.

Plaque psoriasis is a chronic, immune-mediated, cutaneous, and systemic inflammatory dermatosis. Its pathogenesis involves the dysregulation of the interleukin (IL)-23/IL-17 signaling pathway. There are a range of treatment options available, encompassing topical agents, biologics, oral systemic therapy, and phototherapy. The utility of combination treatment has also been described and is a budding field of research. Here we describe the first case of adult severe generalized plaque psoriasis treated with once-daily oral deucravacitinib 6 mg combined with tapinarof cream 1% applied once daily. To our knowledge, the combination of these agents has not yet been described in the literature. J Drugs Dermatol. 2024;23(3):     doi:10.36849/JDD.8091.