Treatment of Bullous Pemphigoid With Dupilumab: A Case Series of 30 Patients.

Bullous pemphigoid is often difficult to treat with the limited therapies available. Here, we describe clinical outcomes among 30 adults with bullous pemphigoid patients treated with dupilumab. We performed a multicenter, retrospective case series between March 2020 to August 2022. Patients received a loading dose of dupilumab 600 mg, followed by 300 mg maintenance dose with varying administration frequency tailored to individual patient response. All patients experienced at least some improvement in blister formation and pruritus, with 23 (76.7%) of patients demonstrating either complete clearance of blistering or marked response. Complete clearance of pruritus or marked response was noted in 25 (83.3%) of patients. Eight patients were effectively maintained solely on dupilumab. One (3.3%) patient reported an injection site reaction. Thirty patients represent a small sample, however, to our knowledge, this is the second largest group of BP treated with dupilumab. Furthermore, we provide an understandable framework for clinicians outside of academics to follow and assess treatment responses in their BP patients treated with dupilumab. Dupilumab should be considered as a therapeutic option in patients with bullous pemphigoid given its ability to induce sustained blistering and pruritus response in both typical and refractory cases while maintaining a favorable safety profile. J Drugs Dermatol. 2024;23(6):e144-e148. doi:10.36849/JDD.8258e.

Hidradenitis Suppurativa Found Associated With Cytokine Storm.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that generates multiple cytokines. Here, we present an example of the cytokines forming a cytokine storm and its effects on the patient. CASE PRESENTATION: We report the case of a 55-year-old man who had severe but stable HS. Serum samples were collected from the patient and extraordinarily elevated cytokine concentrations were identified in the patient's serum.  Conclusion: Cytokine storms may be a condition associated with HS posing additional risk to patient survival. J Drugs Dermatol. 2024;23(5):e134-e136.     doi:10.36849/JDD.7860R1e.

Rash and Poor Wound Healing After Mastectomy.

A patient who had recently undergone bilateral mastectomy had erythema, edema, pain, pruritus, serous fluid drainage at the incision sites, and an erythematous papulovesicular rash on the trunk and extremities. A skin swab bacterial culture result was negative, and the skin findings did not improve with antibiotics. What is the diagnosis and what would you do next?

Leukemia Cutis in Skin of Color.

The various presentations of many dermatologic conditions among various skin types are slowly being elucidated throughout the recent years. These differences present as an issue as it leads to delayed diagnosis, treatment, and poorer quality of life. Herein, we present the characteristics of leukemia cutis in a skin of color patient with diagnosed chronic myelomonocytic leukemia. Adjei S, Temiz LA, Miller AC, et al. Leukemia cutis in skin of color. J Drugs Dermatol. 2023;22(7):687-689. doi:10.36849/JDD.7020.

Antibiotic Resistance in Dermatology Part 2: Combating Resistance.

Virtually any antibiotic can be used in dermatology given the broad range of conditions treated. With the widespread use of antibiotics and the rapid emergence of resistant organisms, it is important to understand how dermatologists can combat this issue.

Antibiotic Resistance in Dermatology Part 1: Mechanisms of Resistance.

Virtually any antibiotic can be used in dermatology given the broad range of conditions treated. With the widespread use of antibiotics and the rapid emergence of resistant organisms, it is important to understand the mechanisms at play that contribute to resistance.

Erythema multiforme after third COVID-19 vaccination (Pfizer-BioNTech).

We present a case of erythema multiforme (EM) associated with a third (booster) dose of COVID-19 vaccination in a patient who had no cutaneous reactions to previous doses. To our knowledge, this is the first documented case of vaccine-associated EM occurring after a third/booster vaccination. Furthermore, our case emphasizes the need to remain vigilant for vaccine-associated EM in any patient recently vaccinated, regardless of whether previous vaccinations were administered without cutaneous reactions.

Tirbanibulin for the Treatment of Actinic Keratosis: A Review.

Actinic keratosis (AK) is a common precancerous condition found on chronically sun-damaged skin, particularly on the face, scalp, arms, and legs. Early and effective treatment of AKs is important to prevent progression to squamous cell carcinoma. Many topical treatments for AKs are often limited because of poor tolerability, prolonged treatment duration, and reduced adherence. Tirbanibulin 1% ointment, a new topical field therapy for AKs, reduces these issues. It requires a consecutive 5-day application period and is effective, demonstrating complete (100%) clearance of AK lesions in 49% of patients, partial (>75%) clearance in 72%, and a median reduction in lesion count of 87.5% while exhibiting a favorable safety profile, mild adverse events, improved tolerability, and long-term results.

Benign Neonatal Hemangiomatosis.

BACKGROUND: Benign neonatal hemangiomatosis (BNH) is a rare, self-limiting subtype of infantile hemangiomas (IHs), in which infants with multiple cutaneous hemangiomas lack visceral involvement. Other subtypes of IHs exist that may mimic BNH and can be life-threatening depending on hemangioma location and size. CLINICAL FINDINGS: At birth, a 29 5 / 7 -week preterm female presented with several pinhead-sized pink papules distributed throughout her body. At 10 days of age, the patient had 12 enlarged domed-shaped red papules in a generalized distribution throughout her body. Over several weeks, the number and size of the domed-shaped red papules continued to increase to a total of 26 located on the head, chest, abdomen, back, legs and arms. They were of firm consistency with both smooth and lobulated surfaces. PRIMARY DIAGNOSIS: A diagnosis of BNH was made after extensive workup did not reveal any extracutaneous hemangiomas. INTERVENTIONS: Due to the lack of extracutaneous involvement and low-risk location/size of hemangiomas in our patient, no interventions were pursued and an observation-only approach was implemented. OUTCOMES: The patient remained stable while followed up over 8 months, with the size of the hemangiomas only increasing slightly in proportion to the patient's natural body growth. PRACTICE RECOMMENDATIONS: Given the life-threatening nature of certain hemangioma subtypes, it is important to implement a proper workup and subtype diagnosis as early as possible in any infant with multiple hemangiomas.

Sarecycline: A Narrow-Spectrum Antibiotic.

Tetracycline-class drugs have been used for first-line treatment of moderate-to-severe acne and rosacea for decades. Recently, a new third generation tetracycline, sarecycline, was US FDA-approved for the treatment of moderate-to-severe acne. This narrow-spectrum tetracycline-derived antibiotic has been shown to be effective with an improved safety profile.

Dermal Duct Tumor: A Diagnostic Dilemma.

Poromas or poroid tumors are a group of rare, benign cutaneous neoplasms derived from the terminal eccrine or apocrine sweat gland duct. There are four poroma variants with overlapping features: dermal duct tumor (DDT), eccrine poroma, hidroacanthoma simplex, and poroid hidradenoma, of which DDT is the least common. Clinically, the variants have a nonspecific appearance and present as solitary dome-shaped papules, plaques, or nodules. They can be indistinguishable from each other and a multitude of differential diagnoses, necessitating a better understanding of the characteristics that make the diagnosis of poroid neoplasms. However, there remains a paucity of information on these lesions, especially DDTs, given their infrequent occurrence. Herein, we review the literature on DDTs with an emphasis on epidemiology, pathogenesis, clinical features, diagnosis, and management.

Janus Kinase and Tyrosine Kinase Inhibitors in Dermatology: A Review of Their Utilization, Safety Profile and Future Applications.

Janus kinase inhibitors, also commonly referred to as JAK inhibitors, are a novel drug class that target and block cytokine signaling mediated by the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway, thereby regulating immune response and cell growth. Although JAK inhibitors are mainly used for rheumatological conditions such as rheumatoid arthritis, their application in the field of dermatology is actively being investigated. Tofacitinib is US FDA-approved for psoriatic arthritis and showing promise for treating psoriasis. Most recently, regulatory approvals for the US were gained by ruxolitinib as a first-inclass, selective, topical therapy for atopic dermatitis and oral upadacitinib for active psoriatic psoriasis. Additionally, abrocitinib and upadacitinib have demonstrated efficacy in atopic dermatitis and are pending FDA approval for this indication. The therapeutic potential of JAK inhibitors in dermatological conditions such as alopecia areata, psoriasis, atopic dermatitis, vitiligo, and dermatomyositis are showing promising results in clinical trials. Adverse events for JAK inhibitors seem to be similar to that of biologic drugs. Common adverse effects include increased risk of infections and thromboembolic events. Further investigation is needed to not only better understand the safety profile of JAK inhibitors, but also their full utility within the field of dermatology.

Herpes manuum: a new name for non-digit herpetic whitlow.

Herpes simplex virus (HSV) is one of the most prevalent infections worldwide. It consists of two types: HSV1 and HSV2 that primarily cause orofacial and genital disease. However, both types can infect any site. Rarely, HSV infection of the hand occurs and is often documented as herpetic whitlow. Herpetic whitlow is primarily recognized as an HSV infection of the digits and thus HSV infection of the hand is largely associated with infection of the fingers. This is problematic, as HSV is often left off the differential diagnosis of non-digit hand pathology. We present two cases of non-digit HSV infection of the hand that were misdiagnosed as bacterial infections. As our cases and others demonstrate, the lack of knowledge that HSV infections can occur on the hand leads to confusion and delayed diagnosis among a myriad of providers. Therefore, we seek to introduce the term "herpes manuum" to increase awareness that HSV can appear on the hand in locations aside from the digits and thus differentiate it from herpetic whitlow. By doing so, we hope to encourage more timely diagnosis of HSV hand infections to decrease associated morbidity.

Treatment of Granuloma Annulare With Pentoxifylline and Oral Vitamin E: A Case Series.

Granuloma annulare (GA) is a difficult-to-treat granulomatous skin disorder characterized by multiple annular, raised, and erythematous lesions. While numerous therapies have been proposed, there is currently no clear gold standard of treatment. We present a series of five patients with biopsy-proven generalized GA who were treated with pentoxifylline and oral vitamin E. Each patient in this series had at least a one-year history of GA refractory to other treatments. After three months of treatment, four of the five patients demonstrated objective improvement in their lesions through before and after clinical photographs. No patients suffered any adverse events on this treatment regimen. As our series has demonstrated modest benefits in concurrence with previously published studies, we recommend combination therapy with pentoxifylline and vitamin E as a strong contender for first- or second-line treatment for generalized GA. Pentoxifylline and vitamin E are advantageous for their tolerability, cost-effectiveness, minimal drug interactions, and convenience.

Treatment of acrodermatitis continua of hallopeau with ixekizumab.

Acrodermatitis continua of hallopeau (ACH) is a rare chronic inflammatory variant of pustular psoriasis often restricted to the distal portions the digits in the hands and feet. ACH is of a chronic relapsing nature and is invariably recalcitrant to many available topical and systemic anti-psoriatic therapies. On account of its low prevalence and high resistance to treatments, no clinical guideline of ACH exists. We present a patient with ACH resistant to multiple therapies, including the biologic adalimumab, who was successfully treated with an IL-17 inhibitor (ixekizumab). We believe our unique treatment with an excellent outcome may assist other dermatologists if faced with this condition.

Augmented reality: a novel means of measurement in dermatology.

Accurate measurement of skin lesions influences diagnosis, treatment, disease monitoring, prognosis, and even reimbursement in the practice of dermatology. As dermatologists expand technology that is integrated in patient care, measurement has the opportunity to become more accurate, more easily integrated into daily practice, and more easily incorporated into the realm of research. Herein, we review the benefits, limitations, and future direction of augmented reality (AR) in relationship to measurement of dermatologic conditions. This can include simple linear dimensions, area calculations, and even assessments that will drive clinical interventions. Additionally, we highlight current baseline mobile application tools that may lay the groundwork for further validation, augmentation, and utility of these technologies.