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BACKGROUND: Management of hidradenitis suppurativa (HS) is challenging since no single treatment provides consistently effective results, leaving patients with frequent relapses. Dapsone combines anti-microbial and anti-inflammatory properties that address aspects of HS pathogenesis. Few studies have evaluated the efficacy of oral dapsone on HS, especially in severe disease. OBJECTIVE: This study aims to evaluate the clinical outcomes of patients with moderate-to-severe HS treated with dapsone. METHODS: This retrospective chart review evaluated HS patients treated with oral dapsone over the past 10 years at one center. Treatment outcomes were classified based on Hurley staging, physician exam, and symptom progression. Adverse effects and concomitant treatment with dapsone were reviewed. RESULTS: Nineteen (19) patients with moderate-to-severe (Hurley Stage II-III) HS treated with oral dapsone were identified. Within 1-3 months, on dosages of dapsone varying from 25-100 mg/day, 3 patients (15.8%) had a clinically significant improvement in symptoms, 10 patients (52.6%) had a slight improvement, and 6 patients (31.6%) had no change in disease state; no patients deteriorated. The majority who improved were also on other medications, most commonly adalimumab. 4 patients experienced adverse effects, with nausea being most common; otherwise, dapsone was well-tolerated. CONCLUSIONS: Dapsone may have some efficacy for moderate-to-severe HS and seems well-tolerated. J Drugs Dermatol. 2023;22(11):e12-e16 doi:10.36849/JDD.4936e.
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Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hidradenite Supurativa , Humanos , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/tratamento farmacológico , Estudos Retrospectivos , Adalimumab , Dapsona/efeitos adversosRESUMO
BACKGROUND: Atopic dermatitis (AD) is an inflammatory skin condition with dry, scaly, and intensely itchy skin. Treatment failure is the result of poor adherence. OBJECTIVE: In this study, we assessed the impact of an internet-based survey on adherence to topical crisaborole 2% ointment in patients with mild AD. METHODS: Participants were randomized to the intervention or control group. The intervention group received weekly email surveys regarding adherence for 6 weeks, then monthly for 12 months. All participants came in for 5 visits over the year. RESULTS: Twenty-eight subjects were recruited for the study (n=19 adults, n=9 pediatrics). Adherence for adults that remained in study (n=6) was 60%. Adherence of the adult control and intervention groups were 49% and 45%, respectively (P>0.05). Adherence for pediatric participants that remained in study (n=2) was 6%. The adherence of the pediatric control and intervention groups were 27% and 29%, respectively (P>0.05). DISCUSSION: Medication adherence was low. The survey intervention did not improve adherence. However, more participants in the intervention group completed the study than in the control group of adults. Regular communication from the provider may help patients feel supported and continue treatment. CLINICALTRIALS: gov identifier: NCT03250663 J Drugs Dermatol. 2022;21(10):1043-1048. doi:10.36849/JDD.6280.
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Dermatite Atópica , Fármacos Dermatológicos , Adulto , Compostos de Boro , Compostos Bicíclicos Heterocíclicos com Pontes , Criança , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Humanos , Pomadas , Resultado do TratamentoAssuntos
Golfe , Queimadura Solar , Humanos , Luz Solar , Protetores Solares/uso terapêutico , Raios UltravioletaRESUMO
Individuals with chronic illnesses turn to online communities to engage in asynchronous peer-to-peer exchanges to better understand and manage their disease. Messages and advice exchanged by online users with vitiligo are not well characterized. We conducted a qualitative study to explore the content exchanged by individuals with vitiligo in online forums. An interpretive research paradigm was utilized to assess public online forum content. A systematic search using the phrases online forum vitiligo support, vitiligo online message board, and vitiligo forums identified 39 relevant forums; 9 of them met inclusion criteria, with 382 total anonymous users. Major themes and subthemes included vitiligo disease management, homeopathy/home remedies, psychosocial impact, public perceptions, and camouflage/concealment.
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Hipopigmentação , Vitiligo , Doença Crônica , Humanos , Internet , Pesquisa Qualitativa , Vitiligo/terapiaRESUMO
BACKGROUND: The novel coronavirus (COVID-19) has an affinity for almost every organ system, including the skin. This review article will compile and compare dermatology guidelines related to the dermatologic care of patients during the COVID-19 pandemic. OBJECTIVE: To review and compare the available guidelines and recommendations on use of biologics and other systemic therapies in dermatology patients. METHODS: We conducted a search for guidelines and recommendations for dermatology providers, with specific attention to the management of biologics and non-biologic systemic agents during COVID-19. International and United States-based guidelines specific to the field of dermatology and guidance for healthcare providers were used as inclusion criteria. Available registries were included as well. CONCLUSION: The guidelines stress a shared decision-making approach with risk-benefit analysis and treatment strategy modifications tailored to each unique patient case. The guidelines were all concordant with one another in highlighting the importance that patients should not discontinue their medications without first speaking with their providers.
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Produtos Biológicos , COVID-19 , Dermatologia , Produtos Biológicos/uso terapêutico , Humanos , Pandemias , Sistema de Registros , Estados UnidosRESUMO
BACKGROUND: Systemic methotrexate (MTX) is a useful treatment for many dermatologic conditions, however, the risk of adverse events prevents its use in patients with minimal or localized disease. Topical application of MTX may be an option to avoid the systemic adverse effects of oral MTX. OBJECTIVE: To assess what is known about the efficacy and safety of topical methotrexate. METHODS: A search on Pubmed was conducted. There were no limits on publication date. RESULTS: A total of 963 articles were discovered. Using our exclusion criteria, 916 articles were excluded; 47 articles were used for full text assessment. Topical MTX has been used primarily in psoriasis but also in mycosis fungoides, lymphomatoid papulosis, and oral precancerous lesions. Optimal delivery system and formulation for adequate penetration is still under investigation. CONCLUSION: The quality of evidence for the utility of topical methotrexate in psoriasis is good, however, for other dermatologic diseases, the quality is poor. Topical MTX with improved delivery methods may be a viable tool against certain localized dermatologic conditions for patients who do not tolerate oral MTX. Further double-blinded randomized controled studies are needed to substantiate the utility of topical methotrexate.
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Fármacos Dermatológicos , Dermatologia , Micose Fungoide , Psoríase , Neoplasias Cutâneas , Fármacos Dermatológicos/uso terapêutico , Humanos , Metotrexato/uso terapêutico , Micose Fungoide/tratamento farmacológico , Psoríase/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
IMPORTANCE: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is known to cause multiple end-organ complications in its acute phase, but less is known about the long-term association with patients' mental health and quality of life. OBJECTIVE: To examine the chronic physical and psychological sequelae affecting patients with SJS/TEN. DESIGN, SETTING, AND PARTICIPANTS: A survey study conducted at 11 academic health centers in the US evaluated 121 adults diagnosed with SJS/TEN by inpatient consultive dermatologists between January 1, 2009, and September 30, 2019. INTERVENTIONS: Patients completed a survey that included the following validated questionnaires: Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD), and the 12-item Short Form Health Survey (SF-12). The survey also included questions created by the study team regarding fear, patient education, and long-term sequelae relevant to SJS/TEN. MAIN OUTCOMES AND MEASURES: Primary outcome measures were the percentage of patients reporting long-term physical sequelae; the percentage of patients with positive results on PHQ-9, GAD-7, and PC-PTSD screening; and the numeric score on the SF-12 (score of 50 defined as average physical and mental well-being). RESULTS: A total of 121 individuals (73 women [60.3%]; mean [SD] age, 52.5 [17.1] years) completed the survey (response rate, 29.2%). The most common long-term physical sequelae reported were cutaneous problems (102 of 121 [84.3%]), ocular problems (72 of 121 [59.5%]), and oral mucosal problems (61 of 120 [50.8%]). A total of 53.3% (64 of 120) of the respondents had results indicating depression on the PHQ-9, 43.3% (52 of 120) showed signs of anxiety on the GAD-7, and 19.5% had results indicating PTSD on the PC-PTSD. The mean (SD) SF-12 Physical Component Summary score was 42.4 (22.8), and the mean Mental Component Summary score was 46.1 (20.9). A total of 28.2% (33 of 117) of the respondents were unable to work, 68.1% (81 of 119) were fearful of taking new medications, and 30.0% (36 of 120) avoided taking prescribed medications for a diagnosed medical condition. CONCLUSIONS AND RELEVANCE: This survey study found that long-term physical sequelae, depression, and anxiety appear to be common in patients with SJS/TEN, with implications for health and well-being. Improved awareness of these complications may assist health professionals in offering medical care, counseling, and support to patients with SJS/TEN.
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Síndrome de Stevens-Johnson , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Mucosa Bucal , Exame Físico/métodos , Qualidade de Vida , Estudos Retrospectivos , Síndrome de Stevens-Johnson/tratamento farmacológicoRESUMO
Severe, uncontrolled atopic dermatitis (AD) persisting from childhood to adulthood can have enduring quality of life (QoL) impacts on daily functioning, academics, career, family and social life, and mental health. In addition, AD has an impact on direct and indirect healthcare resource utilization. Several studies have attempted to quantify the quality of life and direct/indirect economic burden of AD. However, these estimates may not capture the more intangible disease-related burden and associated economic burden. This was a qualitative case report that aimed to investigate the full lifetime impact of severe, uncontrolled AD on all aspects of a single patient's life. This case report emphasizes the enormous cumulative lifetime impact of severe, uncontrolled AD and where the qualitative indirect impact may not be fully captured. After obtaining consent, a patient, diagnosed with severe AD since birth, was asked close- and open-ended questions about AD history, direct and indirect healthcare resource utilization, and impact of AD on work, home, family, social life, daily functioning, and mental health over the course of her lifetime. Our patient attributed her severe, uncontrolled AD since birth to causing poor sleep quality, depression, anxiety, and difficulty with social connections and to her choosing an alternative, less physically demanding career. Early effects on sleep and school performance, along with impact on social connections, likely contribute to weaker career opportunities and further social isolation with age.
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Pyoderma gangrenosum is a rare neutrophilic dermatosis that is commonly treated with systemic corticosteroids; however, their potent side effects may warrant tapering, and non-steroidal systemic immunosuppressants may help maintain or bolster disease clearance during weaning. Although cyclosporine is regarded as a favorable corticosteroid-sparing agent, it is associated with several side effects, such as renal toxicity and hypertension, that may limit its feasibility. Mycophenolate mofetil is a well-tolerated alternative with limited data. Institutional review board approval was obtained to review patients from a single institution who received mycophenolate mofetil for pyoderma gangrenosum between January 1, 2010, and December 31, 2019. A systematic MEDLINE (PubMed) review was performed of articles containing linked keywords: "mycophenolate mofetil" and "pyoderma gangrenosum". Patient demographics, presentation details, and treatment regimen characteristics were recorded. Fourteen of our pyoderma gangrenosum patients were treated with mycophenolate mofetil concomitantly with prednisone. Ninety-three percent of our patients achieved improvement within 12 months (mean 4.5 months), including five patients who experienced complete healing. Outcomes in literature patients were comparable; 77% either improved or maintained clearance with mycophenolate mofetil. Greater than 80% of total patients experienced healing or adequate disease control at a median dose of 2000 mg daily. The most common side effects of mycophenolate mofetil were myelosuppression and gastrointestinal upset, which were both seen in 18% of patients. Although this study is subject to publication bias, mycophenolate mofetil appears to be an efficacious and well-tolerated adjunctive therapy option for pyoderma gangrenosum.
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Ácido Micofenólico , Pioderma Gangrenoso , Corticosteroides/uso terapêutico , Ciclosporina , Humanos , Imunossupressores/efeitos adversos , Ácido Micofenólico/efeitos adversos , Pioderma Gangrenoso/tratamento farmacológicoRESUMO
Atopic dermatitis (AD) is a common, chronic inflammatory skin disease that oftentimes requires complex therapy. Poor adherence is a major barrier to AD treatment success. An interspecialty, virtual roundtable panel was held, through which clinical dermatologists, allergists, and behavioral and social psychologists discussed AD management and adherence. Relevant literature was reviewed, and the content of this article was organized based on the roundtable discussion. Current guidelines for AD treatment include maintenance and acute therapy for mild-to-severe AD. Therapy is often complex and requires significant patient involvement, which may contribute to poor treatment adherence. Behavioral and social psychology strategies that may help improve adherence include scheduling timely follow-up appointments, using a clearly written eczema action plan (EAP), reducing perceived treatment burden, utilizing anchoring techniques, sharing anecdotes, and rewarding children using positive reinforcement and stickers. There are multiple practical ways by which providers can improve both the management and treatment adherence of patients with AD.
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Imunossupressores/uso terapêutico , Líquen Plano/tratamento farmacológico , Ácido Micofenólico/uso terapêutico , Idoso , Avaliação de Medicamentos , Substituição de Medicamentos , Redução da Medicação , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Esteroides Fluorados/uso terapêutico , Resultado do TratamentoRESUMO
ABSTRACT: Levamisole, an anthelmintic and immunomodulatory drug, was withdrawn from the US market in 1999 due to adverse effects, including agranulocytosis and vasculitis. In recent years, levamisole has been used as a common cocaine adulterant, and its use has led to an autoimmune syndrome characterized by an antineutrophil cytoplasmic antibody-associated vasculitis presenting with necrotic retiform purpura on the face and extremities. We present a case of recurrent levamisole-induced vasculitis initially misdiagnosed as systemic lupus erythematosus to highlight this easily misdiagnosed entity and to demonstrate re-exposure leading to recurrent vasculitis with more extensive clinical manifestations.
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/induzido quimicamente , Cocaína/efeitos adversos , Cocaína/química , Contaminação de Medicamentos , Levamisol/efeitos adversos , Lúpus Eritematoso Sistêmico , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Drug expenditure in the United States has continued to increase unsustainably; the specialty of dermatology has been particularly affected. Resources are limited - someone has to make decisions about what treatments will be covered and how they will be reimbursed. Step therapy is a cost-control method used by insurers to encourage the use of the most cost-effective treatments before more expensive options are attempted. However, a rigid step therapy policy can be problematic when protocols are out of date, or delay necessary treatment leading to unnecessary suffering, increased morbidity, and overall cost. To address some of these concerns, the proposed Safe Step Act (S. 2546 and H.R. 2279) attempts to create a requirement that insurers provide a transparent, expeditious exceptions process for step therapy protocols. Increased flexibility in this process will allow for the unique circumstances of individual patients and improve access to expensive drugs for special cases. However, this bill may be exploited, further weakening insurers' ability to negotiate on cost. We should be cautious about measures that reduce the effectiveness of this tool, particularly if we, as a society, aim to expand access to basic care to all Americans.
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Controle de Custos , Custos de Cuidados de Saúde , Seguro Saúde/legislação & jurisprudência , Controle de Custos/legislação & jurisprudência , Employee Retirement Income Security Act/legislação & jurisprudência , Gastos em Saúde , Seguro Saúde/economia , Estados UnidosRESUMO
Atopic dermatitis (AD) is a prevalent inflammatory skin condition that, depending on its severity, can cause enormous morbidity. Corticosteroids and systemic immunosuppression, traditionally standard of care for difficult-to-treat disease, have many undesirable side effects. The desire for targeted treatments along with an improved understanding of the pathophysiology of AD has spurred the development of novel treatments. In this article, we review promising new treatments and discuss how their targets-IL-13, IL-31, OX40 (CD134), and the Janus kinase family of proteins-participate in the pathogenesis of AD. We review the published phase II and III data for dupilumab, tralokinumab, lebrikizumab, nemolizumab, anti-OX40 antibody, baricitinib, abrocitinib, and upadacitinib. The introduction of new agents may offer new options, but it remains to be seen how narrow-acting agents, like single interleukin inhibitors, will compare in safety and efficacy to broad-acting agents such as JAK inhibitors.
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Dermatite Atópica , Fármacos Dermatológicos , Inibidores de Checkpoint Imunológico/farmacologia , Terapia de Alvo Molecular , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Fármacos Dermatológicos/imunologia , Fármacos Dermatológicos/farmacologia , Drogas em Investigação , Humanos , Inibidores de Janus Quinases/farmacologia , Terapia de Alvo Molecular/métodos , Terapia de Alvo Molecular/tendênciasAssuntos
Aconselhamento/métodos , Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Dor/psicologia , Pele/efeitos dos fármacos , Administração Cutânea , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Fármacos Dermatológicos/efeitos adversos , Humanos , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Dor/induzido quimicamente , Autorrelato/estatística & dados numéricos , Pele/imunologia , Resultado do TratamentoRESUMO
INTRODUCTION: The role of accountability in promoting patient adherence to medication is not well characterized. An accountability measurement tool (AMT) has been developed to quantify accountability but has not been investigated for use with patients with skin disease. We aim to test the reliability and validity of the AMT for patients with psoriasis. METHODS: A 12-item AMT was used for patients with psoriasis. English-speaking adults with psoriasis who were expected to continue their medication were asked to complete the questionnaire. Reliability was measured using Cronbach's alpha. Validity was measured using Pearson's correlation coefficient and t-tests between the AMT and other validated scales measuring fear of negative evaluation and self-regulation. RESULTS: A total of 30 patients were recruited for this study. The AMT demonstrated excellent internal consistency (Cronbach's [Formula: see text] = 0.86). Total accountability positively correlated with fear of negative evaluation (r = 0.59), autonomous motivation (r = 0.46), introjected regulation (r = 0.60), and external regulation (r = 0.57), demonstrating good convergent validity. Divergent validity was supported by nonsignificant associations between psoriasis accountability and age, gender, race, education level, years with physician, and amotivation. CONCLUSIONS: The AMT has been further validated for measuring accountability in patients with psoriasis.
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Objective: To review phase II and III clinical trial data to evaluate the efficacy and safety of the halobetasol propionate/tazarotene (HP/TAZ) combination lotion (Duobrii), a medication approved by the Food and Drug Administration in April 2019 for adults with plaque psoriasis. Data Sources: A systematic search (January 2005 to July 2019) of MEDLINE (PubMed) and EMBASE databases was performed using the terms halobetasol, tazarotene, halobetasol/tazarotene, Duobrii, and IDP-118. Study Selection and Data Extraction: Relevant English-language articles reporting on phase II and phase III clinical trials were included. Data from the individual trials were extracted independently and then cross-checked to ensure accuracy. Data Synthesis: HP/TAZ was safe and efficacious compared with HP alone, TAZ alone, or vehicle. More patients achieved treatment success, described as a ≥2-grade improvement on Investigator Global Assessment Scale, over 8 weeks of treatment and at the 4-week follow-up after treatment cessation. The most common adverse events were dermatitis, pain, and pruritus, which occurred more often in the TAZ groups compared with the HP/TAZ cohorts. Relevance to Patient Care and Clinical Practice: The once-daily HP/TAZ combination lotion simplifies psoriasis treatment and may facilitate adherence, which may improve psoriasis outcomes. Conclusions: HP/TAZ combination lotion is efficacious and safe for plaque psoriasis treatment, with more patients achieving end points and fewer side effects than in HP, TAZ, or vehicle-treated controls. Drug synergy may play a role. Importantly, patient adherence to a once-daily combinational therapy is likely to contribute to efficacy.