Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review.

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate-to-severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL-4 receptor alpha subunit inhibition, thus blocking IL-4 and IL-13 signaling pathways. It has been shown to be an effective, well-tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and eosinophilic esophagitis (EoE). However, an increasing incidence of dupilumab-induced ocular surface disease (DIOSD) has been reported in patients treated with dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate-to-severe. DIOSD was either dermatologist-, allergist-, or ophthalmologist-assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on dupilumab treatment. Further studies are warranted in order to establish a causal relationship between dupilumab and ocular surface disease. Nevertheless, ophthalmological evaluations prior to dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE, and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to dupilumab treatment. However, TARC measurements should be resumed for research purposes only.

Minimizing the dermatoscopic morphologic overlap between basal and squamous cell carcinoma: a retrospective analysis of initially misclassified tumours.

BACKGROUND: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) have well-established dermatoscopic criteria that make them relatively easy to recognize on a clinical basis. However, even with the addition of dermatoscopy, a morphologic overlap between the two tumours does exist. OBJECTIVES: To analyse the dermatoscopic morphology of clinically and dermatoscopically misclassified BCCs and SCCs, to identify factors causing the erroneous clinical interpretation and, therefore, minimize the morphologic overlap between BCC and SCC. METHODS: Retrospective study including histopathologically diagnosed BCCs or SCCs that had been clinically inversely diagnosed. Their dermatoscopic images were blindly evaluated for the presence of predefined criteria. Descriptive statistics were performed and univariate and multivariate predictors were calculated. RESULTS: A total of 68 cases were included, 41 of which were BCCs and 27 SCCs. Most tumours in both groups were non-pigmented, ulcerated and displayed a polymorphous vascular pattern. The presence of erosions was positively associated to BCC (5.2-fold higher odds, P = 0.05), whereas scales/keratin masses were positively associated to SCC (3.7-fold higher odds, P = 0.07), although marginally not statistically significant. CONCLUSIONS: Clinically misclassified BCCs and SCCs are usually non-pigmented ulcerated tumours. Erosions and keratin masses/scales are more robust criteria as compared to vascular structures for the differential diagnosis between BCC and SCC.