Reasons for Patient Call-backs while being Treated with Topical 5-fluorouracil: A Retrospective Chart Review.

Objective: To assess the frequency and character of adverse events (AE) associated with 5-FU and compare rate of these events to topical tacrolimus, another irritating topical treatment, as a control. Methods: Patients prescribed 5-FU for Actinic keratosis (AK) between 1/2015 to 10/2021 were contacted via phone to assess frequency of AE and why they did or did not contact their dermatologist via retrospective chart review. A similar retrospective chart review was done for patients prescribed topical tacrolimus between 1/2015 to 10/2021. Results: Participants frequently reported AE with 5-FU treatment (58%), which most commonly included redness or inflammation (38%) and burning, stinging, or pain (27%). There were 33 call backs for 5-FU (37 distinct questions) and the most common reasons included issues obtaining the medication (n=12) and inquiries about severe LSR (n=11). There were two call backs for topical tacrolimus related to issues obtaining the medication. Limitations: Topical tacrolimus as a control helps address the lack of objective assessment of AE severity and potential recall bias limitations of the study methodology. Conlcusion: Participants in our cohort frequently reported AE, and those who reported AE often contacted their dermatologist. The irritation induced by 5-FU is of greater severity compared to topical tacrolimus, as evidenced by much greater call-back rate. Addressing the risks and benefits of 5-FU, severity of LSR, and use of alternative treatments may improve AK treatment outcomes.

Review of Tralokinumab in the Treatment of Atopic Dermatitis.

OBJECTIVE: To review pharmacokinetics, efficacy, and safety of tralokinumab in treatment of atopic dermatitis (AD). DATA SOURCES: Literature review was conducted using MEDLINE (PubMed), EMBASE, and ClinicalTrials.gov for articles published between January 2010 and May 2022. STUDY SELECTION AND DATA EXTRACTION: Articles in English discussing tralokinumab in AD were included. DATA SYNTHESIS: In one phase 2 trial, more subjects treated with tralokinumab 150 and 300 mg achieved an Investigator's Global Assessment (IGA) of 0/1 with minimum ≥2 point IGA reduction (23%), versus placebo (11.8%, P = 0.10). During 2 phase 3 trials, more subjects treated with tralokinumab achieved IGA success (ECZTRA 1: 15.8% and ECZTRA 2: 22.2%), versus placebo (7.1% and 10.9%, respectively; P = 0.002 and P < 0.001). During one phase 3 trial, in conjunction with topical corticosteroids (TCS), more subjects treated with tralokinumab 300 mg achieved IGA success (ECZTRA 3: 38.9%), versus placebo (26.2%, P = 0.015). During another phase 3 trial in subjects with resistance or contraindication to oral cyclosporine, more subjects treated with tralokinumab 300 mg achieved an Eczema Area Severity Index 75 (64.2%), versus placebo (50.5%, P = 0.018). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Tralokinumab is efficacious for moderate-to-severe AD, as monotherapy, in conjunction with TCS, and resistance or contraindication to cyclosporine. Although IL-4 and IL-13 are both implicated in AD's pathogenesis, IL-13 is overexpressed, and head-to-head trials are needed to assess efficacy of tralokinumab, versus dupilumab. Compared with upadacitinib and abrocitinib, tralokinumab is not associated with black-box warnings. CONCLUSIONS: Tralokinumab is an efficacious and safe systemic treatment for moderate-to-severe AD.

Acromegaly Presenting with Resistant Acne Vulgaris.

Acne vulgaris is one of the most frequent skin diseases worldwide, triggered by multiple endogenous and exogenous factors. Hormones, particularly growth hormone (GH), insulin-like growth factor-1, insulin, CRH, and glucocorticoids, play a major role in the pathogenesis and exacerbation of acne. Excess GH seen in acromegalic patients may result in increased size and function of sweat glands and sebaceous glands, which may contribute to the patient's worsening acne and interfere with dermatologic treatment. Therefore, understanding the pathogenesis of acne will help in treating resistant acne by diagnosing and treating the underlying etiology using multidisciplinary treatment.

Hand Dermatitis Secondary to Exposure to Butternut Squash.

Cucurbita moschata, also known as butternut squash, is a common ingredient in numerous seasonal recipes but is an uncommon cause of cutaneous reactions. We present a 28-year-old male who developed dry and flaking skin of his right palm and fingers after coming in contact with butternut squash, which does not typically serve as an allergen that precipitates contact dermatitis. Given the unilateral localization of the dermatitis, timeline of the development of symptoms, and history of contact with butternut squash, the patient likely developed contact dermatitis of the right hand in response to exposure to butternut squash. Contact dermatitis with butternut squash appears to be an uncommon phenomenon, but it may occur more often and not be reported.