Serum levels of serum amyloid A, interleukin-6 and C-reactive protein correlate with severity of hidradenitis suppurativa.

BACKGROUND: Validated biomarkers enabling an objective, dynamic assessment of hidradenitis suppurativa (HS) disease severity do not exist. The aim of our study was to determine the serum concentration of four potential biomarkers with respect to HS disease severity. METHODS: We recruited 50 patients with hidradenitis suppurativa. After obtaining informed consent, patients were requested to fill out multiple questionnaires. Severity of HS was determined based on Hurley and Sartorius scores by an experienced dermatologist. Blood sampling included Serum Amyloid A (SAA), Interleukin-6 (IL-6), C-reactive protein (CRP) and S100 protein (S100) in a certified laboratory. RESULTS: Moderate and statistically significant correlations of SAA, IL-6 and CRP with the clinical scores Hurley and Sartorius were observed. The respective Spearman's correlation coefficients (r) were: Hurley 0.38, 0.46, 0.35 and Sartorius 0.51, 0.48, 0.48. No relevant changes were detected when comparing S100 to both Hurley (r=0.06) and Sartorius (r=0.09). CONCLUSIONS: Our data suggest that an association between SAA, IL-6, CRP and HS disease severity could exist. Further research is needed to define their potential as biomarkers for quantifying and monitoring disease activity and response to treatment.

Biologics and small molecules in patients with scalp psoriasis: a systematic review.

BACKGROUND: Scalp psoriasis is common in psoriasis patients, difficult to treat and manifests a significant burden on quality of life. OBJECTIVE: Efficacy assessment of biologics and small molecules in scalp psoriasis with reported safety and quality of life. METHODS: Biological therapies and small molecules licensed for treatment of plaque psoriasis are assessed. Fourteen studies reporting results from RCTs are included. Efficacy assessment is measured through improvement of Psoriasis Scalp Severity Index (PSSI), Scalp Physician Global Assessment (ScPGA) and/or Scalp-Specific Investigator's Global Assessment (ss-IGA). RESULTS: Among biologics measured by PSSI, brodalumab, secukinumab and in a subgroup ixekizumab showed high efficacy in moderate to severe scalp psoriasis. Both brodalumab and ixekizumab demonstrated rapid response within 2 weeks. Guselkumab was superior to adalimumab and ixekizumab was superior to etanercept. Apremilast showed long-term efficacy. Only few studies reported quality of life in treatment of scalp involvement which showed improvement. All treatments demonstrated acceptable safety profile. CONCLUSION: Effective treatment of scalp psoriasis is essential for improving the quality of life of psoriasis patients. Both Biologics and small molecules proved efficacy. This review may help choosing the appropriate treatment in cases where scalp psoriasis is the main complaint. A unified measurement tool for scalp psoriasis severity is needed to facilitate comparisons.

Efficacy of a skin care cream with TRPV1 inhibitor 4-t-butylcyclohexanol in the topical therapy of perioral dermatitis.

BACKGROUND: Perioral dermatitis is a clinically distinctive reaction pattern of facial dermatitis, including redness, dryness, burning, pruritus and skin tightness. A gold standard treatment remains unclear. OBJECTIVES: Our study evaluates the clinical value of a skin care cream with the transient receptor potential vanilloid type 1 inhibitor 4-t-butylcyclohexanol in POD patients over 8 weeks. METHODS: This open, unblinded 8-week clinical trial included 48 patients. A skin care cream containing 4-t-butylcyclohexanol was applied over a period of 8 weeks. Standardized questionnaires were used at baseline, 4 and 8 weeks, for history documentation, objective and subjective severity scores, and quality of life assessments. Six different skin physiology parameters were assessed at all timepoints. RESULTS: The perioral dermatitis severity score decreased significantly during the treatment period. This was mirrored by significantly lower patients' subjective numerical rating score and an improved quality of life score. Transepidermal water loss, stratum corneum hydration and skin erythema improved significantly during the treatment period. CONCLUSION: This transient receptor potential vanilloid type 1 inhibitor-based skin care cream improved subjective and objective parameters of perioral dermatitis. Decreased transepidermal water loss values and increased stratum corneum hydration demonstrate a restored skin barrier function. Consequently, the topical inhibition of these receptors is a promising management option for POD.

Dupilumab for treatment of atopic dermatitis.

INTRODUCTION: Dupilumab is a new treatment option for patients with moderate-to-severe atopic dermatitis. It blocks IL-4/IL13-signaling and thereby inhibits receptor signaling downstream the JAK-STAT-pathway. Three of the main disease mechanisms of atopic dermatitis are affected by blocking this pathway; the decrease of skin barrier function, the class switch to IgE and the TH2-differentiation. Areas Covered: Dupilumab showed promising results in clinical trials of phase I-III. Clinical outcome parameters such as SCORAD, EASI, IGA and BSA improved with dupilumab. A positive effect on patient-reported outcomes like DLQI or pruritus-rating-scales was also demonstrated. The safety profile of dupilumab is superior to conventional immunosuppressive drugs, such as cyclosporine or methotrexate. Injection-site reactions and conjunctivitis were the most relevant side-effects. Skin infections were less frequently observed compared to placebo. Data on the use of dupilumab during pregnancy or in children are not published to date. Expert Commentary: Dupilumab was approved by the FDA in April 2017 for the treatment of adult patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.