Journal Club Spotlight: November 2020

Journal of the American Academy of Dermatology - Nov 2020

Immune checkpoint inhibitors to treat cutaneous malignancies
Immune checkpoint inhibitor-related dermatologic adverse events
  • The CME article discusses immune checkpoint inhibitors (CPI) in the treatment of cutaneous malignancies. CPI’s allow the body’s immune cells, namely T-cell lymphocytes, to activate and destroy tumor cells. Ipilimumab + Nivolumab/Pembrolizumab demonstrated better overall survival than ipilimumab alone in the treatment of metastatic melanoma. Cemiplimab is the only CPI approved for the treatment of cutaneous squamous cell carcinoma. Avelomab and pembrolizumab are the only approved CPI’s for Merkel cell carcinoma. CTLA-4 inhibitors are associated with more frequent and severe cutaneous adverse events compared with PD-1/PDL-1 inhibitors. Cutaneous eruptions are the most common CPI-adverse event. Topical steroids are beneficial in moderate eruptions whereas systemic steroids may be needed in severe eruptions.
Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial
  • Dupilumab + topical corticosteroids are efficacious and safe in children with severe atopic dermatitis with significant improvement in symptoms and quality of life.
The effect of platelet-rich plasma on female androgenetic alopecia: A randomized controlled trial
  • 57% of female patients with androgenic alopecia treated with platelet-rich plasma demonstrated improvement in hair growth vs 7% of those treated with placebo (normal saline). Side effects from PRP scalp injections include headache, scalp tightness, swelling, and post-injection bleeding.
Lack of association between chilblains outbreak and severe acute respiratory syndrome coronavirus 2: Histologic and serologic findings from a new immunoassay
  • There was no association between chilblains or pernio with SARS-CoV-2 in 33 patients with pernio who received a dermatology consult within 8 days of the eruption.

 

Journal of Drugs in Dermatology - Nov 2020

Therapies for Psoriasis: Clinical and Economic Comparisons
  • Direct medical costs associated with psoriasis care prior to biologic therapy range from hundreds to thousands of dollars/person/year
  • Total direct costs in the U.S. related to psoriasis in 2013 topped $135 billion dollars
  • The most commonly prescribed therapy is topical therapy (clobetasol/calcipotriene) which has an excellent safety profile.
  • Systemic therapies are associated with more adverse events (lab abnormalities, infections, injections site reaction, etc) and are much more expensive
  • Narrowband UV therapy and excimer laser therapy are effective and do not increase the risk of infection which is important to consider during the Covid-19 pandemic
Oral Tetracyclines and Acne: A Systematic Review for Dermatologists
  • As a class, tetracycline antibiotics work by inhibiting bacterial protein synthesis and inhibiting neutrophil chemotaxis thus exhibiting an anti-inflammatory effect.
  • Sarecycline is a novel oral tetracycline FDA approved for the treatment of inflammatory acne with an indication for moderate to severe acne. It is once-daily, weight-based dosing. Similar to other tetracyclines, headache and GI distress were the most common adverse events
  • Doxycycline 100 mg twice daily is one of the most common antibiotics used in inflammatory acne with a good efficacy and safety profile. Side effects include GI upset and headache. This medicine is photosensitizing as well.
  • Minocycline dosing ranges from 50 - 135 mg daily and is typically weight-based. It is more lipophilic and has a greater ability to cross the blood-brain-barrier which explains the increased rate of CNS vestibular side effects. Minocycline also carries the potential for inducing cutaneous pigment deposition and carries the risk of causing drug-induced lupus
  • It is critical for the prescribing provider to be a steward of proper antibiotic use. Prolonged (>3 months) use of broad-spectrum antibiotics has the potential to cause gut dysbiosis and C. acne resistance. Combining oral antibiotics with other mainstays of acne management (topical retinoids, benzoyl peroxide, topical dapsone) and evaluation every 6-8 weeks can help reduce the adverse events associated with oral antibiotic use.

 

We strive to provide succinct yet explanatory updates from the Dermatologic current literature. The journals covered each month may change; however, we will always provide objective, unbiased concise reviews of the current literature.