Current Dermatology Reports

Review of Outcome Measures in Trials and Practice for Psoriasis Abstract Purpose of Review The purpose of this review was to determine the most frequently utilized outcome measures in clinical trials and to review the scoring criteria, advantages, disadvantages, and application in research and clinical settings, as well as provide an overview of the published guidelines on the use of outcome measures in clinical practice. Recent Findings The most frequently utilized physician-reported outcome measurement instruments in clinical trials from 2018 to 2019 were Physician Global Assessment (PGA), Psoriasis Area Severity Index (PASI), and body surface area. The most frequently utilized patient-reported outcome measurement instruments were Dermatology Quality of Life Index, EQ-5D-5L, and patient global assessment. Summary In research, further standardization of outcome measures may allow for more useful comparison of different treatment modalities. In clinical practice, although, the PASI provides a detailed measurement of disease severity, and the PGA score has the advantage of being more clinically useful to physicians and patients.

Non-invasive Imaging for Skin Cancers—the European Experience Abstract Purpose of Review The aim of this work is to review the role of advanced non-invasive imaging, such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), in malignant melanomas and non-melanoma skin cancers (NMSCs) using data coming from the most recent literature, with a particular highlight on the results of the European experience. Recent Findings Examination with RCM and OCT increases the accuracy of diagnosis. The most recent diagnostic clues for melanoma and NMSCs are revised. In addition, the application of these techniques in presurgical margin definition and in monitoring the efficacy of topical therapies is discussed. Summary Skin cancer incidence is continuously increasing. While melanoma and squamous cell carcinoma are high-risk skin cancers, basal cell carcinoma can progressively infiltrate and damage the surrounding tissues. Physicians should consider that advanced non-invasive techniques may be employed for an early and accurate diagnosis and an improved management of skin cancers.

Photoallergic Contact Dermatitis Abstract Purpose of Review Photoallergic contact dermatitis (PACD) is a delayed-type hypersensitivity reaction to a photoactivated allergen applied to the skin. The purpose of this review is to provide comprehensive information about the mechanism of photoallergic contact dermatitis and to make an outline of its etiopathogenesis, clinical features, and treatment methods. Recent Findings PACD lesions are generally localized in areas which are exposed to light. However, reactions may spread to covered areas of the body. Most prevalent photoallergens are present in sunscreens and NSAIDs. The diagnosis of PACD is based on patient history and a clinical examination and is confirmed by a photopatch test which allows the distinct separation between PACD and allergic contact dermatitis. Although the basic treatment for PACD is in form of avoiding photoallergens, topical corticosteroids, antihistamines, and immunomodulatory drugs can also be used in the treatment. Summary Photoallergic contact dermatitis is a skin condition caused by UV light exposure after contact with photoallergen or uptake of photosensitizer agent. PACD should always be kept in mind in a patient with history of photosensitivity.

Allergen Specific Immunotherapy in Canine Atopic Dermatitis: an Update Abstract Purpose of Review This review aims to evaluate new insights into allergen immunotherapy (AIT) and review the mechanism, different protocols used, and response rate of this treatment option for canine atopic dermatitis. Recent Findings AIT is the only etiological treatment available for canine atopic dermatitis. Selection of allergens is based on clinical history in conjunction with positive reactions on intradermal and serum testing. During decades AIT was applied subcutaneously (SCIT) using aqueous or aluminum-precipitated solution of allergens, but in the last few years, new routes like sublingual (SLIT), intralymphatic (ILIT), and epicutaneous administration are on the rise. AIT combines a satisfactory success rate (around 70%) with a good safety profile. Adverse effects include mainly increased pruritus and anaphylactic reactions are rarely seen in animals. Pilot studies with different adjuvants to further increase safety and efficacy have been published. Summary AIT is a safe and effective therapy for canine atopic dermatitis. However, as most of the published studies are case series with often rather small numbers of animals included, more and larger randomized studies of immunotherapy are needed in a clinical setting to provide guidance on the optimal selection of allergens, adjuvants, dosing, success rate, and adverse effects of the various protocols of immunotherapy in dogs.

A Review of Botanicals Exhibiting Antifungal Activity Against Malassezia spp. Implicated in Common Skin Conditions Abstract Purpose of Review The integration of botanicals in commercial cosmeceuticals, personal care products, and home remedies has fostered a need for a better understanding of the potential efficacies of these interventions. This review identified plants with antifungal activity against Malassezia, a commensal yeast implicated in inflammatory skin conditions. We sought to discover plants with potent activity comparable or superior to current antifungal agents. Recent Findings Malassezia plays a unique role in the pathology of skin disease, encoding for extracellular lipases that initiate an inflammatory response on the surface of the skin and prevent attack through the creation of biofilms. Antifungal resistance is on the rise, with current agents demonstrating increasing minimum inhibitory concentrations when tested in vitro. Summary Several plant species exhibited anti-Malassezia activity, including Nyctanthes arbor-tristis, Allium sativum, and Hypericum perforatum, among others. We recommend further research aimed at identification of the plant secondary metabolites responsible for this activity.

New Strategies for Prevention and Treatment of Insect Bite Hypersensitivity in Horses Abstract Purpose of Review Treatment of equine insect bite hypersensitivity (IBH) needs to be improved. Allergen-specific immunotherapy (ASIT), the only curative treatment of allergy, currently has only a limited efficacy for treatment of IBH. This review highlights the latest findings in prophylactic and therapeutic strategies. Recent Findings Prophylactic vaccination against IBH using recombinant Culicoides allergen has been developed in unexposed Icelandic horses and is ready to be tested. Therapeutic virus-like particle (VLP)–based vaccines targeting equine interleukin- (IL-) 5 or IL-31 improved clinical signs of IBH by induction of anti-cytokine antibodies thus reducing eosinophil counts or allergic pruritus, respectively. Summary First studies for development of ASIT using pure r-Culicoides allergens have yielded promising results and need now to be tested in clinical studies for both prevention and treatment of IBH. Therapeutic vaccines inducing neutralizing antibodies against IL-5 or IL-31 will be valuable future treatments for reduction of clinical signs of IBH.

An Approach to Retiform Purpura for the Inpatient Dermatologist Abstract Purpose of Review Retiform purpura is a potentially ominous cutaneous sign that develops secondary to vascular compromise by either vasculitis or a vasculopathic disorder. The wide array of associated complications mandate a thorough investigation in a timely fashion. This review provides an overview of the frequent causes of retiform purpura in hospitalized adult patients and proposes a diagnostic approach for the inpatient dermatologist. Recent Findings Early recognition of the primary cutaneous morphology in retiform purpura is especially important as this can help generate a focused differential and workup plan. A high-yield skin biopsy result warrants a proper site selection and an adequate depth. Further workup and treatment depend on the underlying pathogenic process. For patients with underlying systemic vasculitis, rituximab is emerging as an effective treatment. Rivaroxaban was found to have excess risk (increased thromboembolic and bleeding events) and no benefit when compared to warfarin in a trial of high-risk anti-phospholipid syndrome patients. Summary The differential diagnosis of retiform purpura is broad and a systematic approach is required to identify and treat the underlying cause.

Inpatient Management of Autoimmune Blistering Diseases: an Update, Review, and Practical Guide Abstract Purpose of Review Review the evaluation, management, and treatment of hospitalized autoimmune blistering diseases (AIBD) patients based on the current literature and expert opinion. Recent Findings The cost and prevalence of hospitalization for AIBD patients are increasing in the USA. Many factors associated with hospitalization of AIBD patients are related to patient access to dermatology care. Infections are a major cause for hospital admission among AIBD patients. The use of rituximab, especially early in the disease course, has transformed the outcomes among patients with pemphigus. Summary After reading this review, dermatologists should be more familiar with the inpatient AIBD clinical evaluation, including the medical history, physical examination, and laboratory work-up; the management of complications of AIBD and therapy; and the treatment ladder for selecting a steroid-sparing therapy for AIBD patients.

Paraneoplastic Syndromes for the Inpatient Dermatologist Abstract Purpose of Review There are a variety of distinct clinical presentations of skin diseases associated with an internal malignancy. Herein, we review some of the cutaneous manifestations of paraneoplastic syndromes and dermatoses that may be evaluated in the inpatient setting. Descriptions of clinical findings, associated systemic signs and symptoms, and diagnostic work-up are presented. Recent Findings Paraneoplastic syndromes are very rare. Isolated case reports with subsequent pooled literature reviews make up the majority of recent published literature. Summary The association between certain skin conditions and malignancies is well established, making them important signs or harbingers of internal disease. Recognizing these paraneoplastic dermatoses during inpatient consultations can result in timely discovery of malignancy.

Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: a Review and Update Abstract Purpose of Review This review highlights current concepts in the management of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Recent Findings A new scoring system, the ABCD-10, was recently developed to better estimate mortality among SJS/TEN patients. Supportive care remains the mainstay of treatment, and includes wound care, fluid and electrolyte management, management of medical co-morbidities, and infection control. The value of adjuvant therapy remains unclear, but new recent retrospective studies suggest that the combination therapies may be efficacious. Recent prospective studies investigating cyclosporine and etanercept have shown promise in the treatment of SJS/TEN. Summary SJS and TEN are severe mucocutaneous drug reactions associated with high morbidity and mortality. Supportive care is the most universally accepted therapy, although specific strategies may vary among institutions. Adjuvant therapies include corticosteroids, IVIG, cyclosporine, TNF alpha inhibitors, and plasmapheresis but prospective data is still lacking. Clinical trials that may better elucidate their efficacy are currently under way.