COVID19
A study compared individuals who received SARS-CoV-2 vaccination with and without prior COVID-19 infection. Individuals with prior COVID-19 infection followed by 2 doses of mRNA vaccine (3 separate exposures to spike antigen) developed higher spike ANTIBODY measurements than individuals who only received comparable vaccination.
TO READ MORE: Zhong D, et al. Durability of Antibody Levels After Vaccination With mRNA SARS-CoV-2 Vaccine in Individuals With or Without Prior Infection. JAMA. 2021; November 1. doi:10.1001/jama.2021.19996.
Prior SARS-CoV-2 vaccination reduces the overall death rate and severity of disease among those with “BREAKTHROUGH” infection compared to those who are hospitalized but did not receive vaccination.
TO READ MORE: Tenforde MW, et al. Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA. 2021; November 4. doi:10.1001/jama.2021.19499.
A single center (St. Joseph’s Health Network, Paterson, NJ) prospective study found that 47.9% of verified COVID-19 patients had PERSISTENT SYMPTOMS a year after initial diagnosis. Most notably, patients experienced dyspnea, fatigue, anxiety, and difficulty focusing (“brain fog”) regardless of whether they received solely outpatient care or required hospitalization.
TO READ MORE: Millet C, et al. “COVID-19: Other Considerations in Management.” Presented at: the virtual CHEST Annual Meeting; 2021; Oct. 17-20.
(Editor’s note: Similar publications have suggested both higher and slightly lower percentages of COVID-19 patients suffer from long term sequelae. It doesn’t really matter what the “exact” number is, clinicians need to recognize that many people do experience important post-COVID problems for at least a year after their acute illness.)
PEDIATRIC DERMATOLOGY
Patients with KAWASAKI DISEASE who do not have coronary aneurysms are not at increased risk for cardiac events in adulthood. In contrast, pediatric patients with persistent moderate to large aneurysms require ongoing cardiology care as adults (over age 18).
TO READ MORE: Dahdah N, et al. Falling Through the Cracks: The Current Gap in the Health Care Transition of Patients With Kawasaki Disease. J Am Heart Assoc. 2021; Oct. 19. doi: 10.1161/JAHA.121.023310.
A retrospective Chinese study included 1,398 patients with Kawasaki disease hospitalized in 7 affiliated facilities of Chongqing Medical University. Resistance to intravenous immunoglobulin (IVIG) and subsequent development of coronary aneurysms could be predicted (70% sensitivity, 90% specificity) by looking for four concurrent findings: elevated ALT, thrombocytopenia, elevated procalcitonin, and elevated total bilirubin.
TO READ MORE: Liu J, et al. A Machine Learning Model to Predict INTRAVENOUS IMMUNOGLOBULIN-RESISTANT KAWASAKI DISEASE Patients: A Retrospective Study Based on the Chongqing Population. Front Pediatr. 2021; Nov 8. doi: 10.3389/fped.2021.756095.
INFECTIOUS DISEASES
A retrospective Chinese study of 213 patients suffering from POST-HERPETIC NEURALGIA disclosed that medication resistant pain was associated with: older age and male gender, severe lesions at disease onset, and pre-zoster anxiety or depression.
TO READ MORE: Zhou J, et al. Clinical characteristics, treatment effectiveness, and predictors of response to pharmacotherapeutic interventions among patients with herpetic-related neuralgia: A retrospective analysis. Pain Ther. 2021; Dec. doi:10.1007/s40122-021-00303-7.
A case series cohort study compared 849,397 Shingrix-vaccinated and 1,817,099 Zostavax-vaccinated Medicare beneficiaries aged 65 years or older. This study confirmed a prior analysis of the Vaccine Safety Datalink which showed an increased risk of Guillain-Barre Syndrome among those receiving Shingrix. However, the actual quantified risk is 3 excess cases of GBS per one million vaccinations administered.
TO READ MORE: Goud R, et al. Risk of Guillain-Barré Syndrome Following Recombinant Zoster Vaccine in Medicare Beneficiaries. JAMA Intern Med. 2021; Dec 1. doi:10.1001/jamainternmed.2021.6227.
ATOPIC DERMATITIS
Patients who seek information on atopic dermatitis often turn to INTERNET VIDEOS. Patients favor lay produced rather than professional produced products, despite the fact that the latter are more reliable and of higher quality.
TO READ MORE: Martin A, et al. Atopic dermatitis topical therapies: Study of YouTube videos as a source of patient information. Cutis 2021; Sept. doi: 10.12788/cutis.0333.
A 24-week head-to-head, multi-national, randomized, double-blinded study compared oral UPADACITINIB (30mg daily) to subcutaneous dupilumab (300mg every other week) in adult patients with atopic dermatitis. About 340 subjects received each agent. A higher percentage of those who received upadacitinib achieved EASI75 and EASI100. However, upadacitinib was associated with an increased risk of serious infection (eczema herpeticum and herpes zoster) and laboratory-related adverse events.
TO READ MORE: Blauvelt A, et al. Efficacy and Safety of Upadacitinib vs Dupilumab in Adults With Moderate-to-Severe Atopic Dermatitis. A randomized Clinical Trial. JAMA Dermatol. 2021; Sept. doi:10.1001/jamadermatol.2021.3023.
CUTANEOUS ONCOLOGY, SURGERY AND LASERS
This study, the largest ACTINIC KERATOSIS genomic dataset to date, demonstrates that actinic keratosis and cutaneous squamous cell carcinomas are remarkably similar at the genomic level in terms of tumor mutational burden, patterns of driver genes, and copy number aberration. Dysregulated TGFβ signaling may represent an important event in AK to cSCC progression.
TO READ MORE: Thomson J, et al. The Genomic Landscape of Actinic Keratosis. J Invest Dermatol. 2021; July. doi:10.1016/j.jid.2020.12.024.
Prior studies had indicated an alarming increase in the proportion of dermatological surgery patients who received a post-op narcotic analgesic. However, this recent cross-sectional, nationally representative study using Optum Clinformatics DataMart shows that the proportion of Mohs surgery patients receiving a prescription for an OPIOID agent has been declining in recent years. The authors speculate that this represents response of both dermatologic surgeons and patients to public health concerns regarding the opioid epidemic.
To read more: Veerabagu SA, et al. Rates of opioid prescriptions obtained after Mohs surgery. A claims database analysis from 2009 to 2020. JAMA Dermatol. 2021; Nov 1. doi: 10.1001/jamadermatol.2021.3468.
A retrospective Portuguese study strongly suggests that pretreatment of head and neck non-superficial basal cell carcinomas with IMIQUIMOD resulted in a significantly reduced number of Mohs micrographic surgery stages until clearing and fewer complex closures required. Imiquimod was administered five times weekly for six weeks in advance of the definitive procedure.
TO READ MORE: Queirós C, et al. Topical imiquimod as neoadjuvant therapy before Mohs micrographic surgery for basal cell carcinoma in the head and neck region: findings from a large retrospective study. Br J Dermatol. 2021; Oct. doi: 10.1111/bjd.20487.
HAIR AND NAILS
A roundtable discussion among well-known experts in ONYCHOMYCOSIS recommended combining both topical and oral therapy for elderly, diabetic and immunocompromised patients, as well as those who have more extensive disease.
TO READ MORE: Lipner SR, et al. Therapeutic Recommendations for the Treatment of Toenail Onychomycosis in the US. J Drugs Dermatol. 2021; Oct 1. doi: 10.36849/JDD.6291.
ALOPECIA is among the most distressing events associated with chemotherapy. Scalp cooling can prevent or, at least, minimize the adverse event. However, there is a significant geographic disparity related to the availability (and therefore use) of scalp cooling. Nearly a third of all Medicare-billed chemotherapy infusions occur 50 or more miles away from a center offering scalp cooling. Suburban and rural areas seemingly have the fewest centers immediately available for scalp cooling.
TO READ MORE: Singer S, et al. Geographic disparities in access to scalp cooling for the prevention of chemotherapy-induced alopecia in the United States. J Am Acad Dermatol. 2021; Nov. doi: 10.1016/j.jaad.2020.06.073.
A small, prospective Phase 2 study of Black breast cancer patients receiving scalp cooling as a preventative intervention for CHEMOTHERAPY-INDUCED ALOPECIA was discontinued early due to a clear lack of efficacy. Grade 3 alopecia (>50% hair loss) was observed in 93% of Black study participants.
TO READ MORE: Dilawari A, et al. Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer? Oncologist. 2021 Apr. doi: 10.1002/onco.13690.
(Editor’s note: Initial large-scale studies on this modality were done in Europe with nearly all subjects being Caucasian.)
DRUGS AND DEVICES
DRESS and maculopapular drug reaction patients were prospectively compared on a battery of clinical, biochemical and serological markers. With a sensitivity of 96% and a specificity of 100%, DRESS was diagnosed when the patient had body surface area involvement of >35% at baseline, and absolute eosinophil count of >450 cells/mm3, and a high-sensitivity C-reactive protein of >5mg /L.
TO READ MORE: Choudhary R, et al. Clinical, biochemical, and serologic predictors of drug reaction with eosinophilia and systemic symptoms syndrome: A prospective case-control study. J Am Acad Dermatol. 2021; Oct. doi: 10.1016/j.jaad.2021.03.075.
Extensive, prospective evaluation of 45 consecutive DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS) patients at a single London hospital disclosed that extremely high fever, short latency, and persistent reaction were associated with more severe disease. The presence of facial edema also correlated with a severe disease course.
TO READ MORE: Momen SE, et al. Discriminating minor and major forms of drug reaction with eosinophilia and systemic symptoms: Facial edema aligns to the severe phenotype. J Am Acad Dermatol. 2021; Sept. doi: 10.1016/j.jaad.2021.04.020
(Editor’s note: Sulfa drugs, carbamazepine, vancomycin, allopurinol, and phenytoin were common causes.)
GENERAL DERMATOLOGY
An online Chinese survey disclosed that 204 or 409 VITILIGO patients suffered from insomnia. Many indicated that the initial appearance, worsening or recurrence of vitiligo, particularly involving the head and neck, were associated with the onset of insomnia. Female vitiligo patients were about twice as likely as male patients to develop insomnia.
TO READ MORE: Liu JW, et al. Location, Spreading and Oral Corticosteroids are Associated with Insomnia in Vitiligo Patients: A Case–Control Study. Clin Cosmet Investig Dermatol. 2021; August 3. doi: 10.2147/CCID.S322963.
AUTOECZEMATIZATION, or “id reaction,” is most commonly seen in association with tinea pedis and severe stasis dermatitis. In children, tinea capitis can cause autoeczematization. Id reaction presents as an intensely pruritic eruption of vesicles which may crust and turn into papules. The most important thing is to treat the underlying disorder.
TO READ MORE: Bertoli MJ, et al. Autoeczematization: A strange id reaction of the skin. Cutis. 2021; Sept. doi: 10.12788/cutis.0342.
A retrospective analysis from Taiwan using that country’s National Health Insurance Research Database compared 23,509 individuals with HEPATITIS C virus infection to 94,036 age and sex-matched controls without HCV infection. Those with HCV infection were more likely than controls to develop psoriasis, lichen planus, vitiligo, alopecia areata and cutaneous lupus erythematosus. The median duration between HCV infection and the onset of inflammatory skin disease was 3.4 years.
TO READ MORE: Ma SH, et al. Association between hepatitis C virus infection and subsequent chronic inflammatory skin disease. J Dermatol. 2021; Dec. doi: 10.1111/1346-8138.16129.
A method of laser-related, painless, NEEDLE-FREE INJECTION has been developed by Dutch scientists. Within a millisecond, laser-formed heat pushes the injectable liquid into the skin at a speed of over 60 miles per hour, with virtually no pain. Full-scale clinical trials will begin shortly.
TO READ MORE: Verkaik E. ‘Virtually painless’ needle-free injections developed in the Netherlands. Reuters. 2021; Oct 13. ‘Virtually painless’ needle-free injections developed in Netherlands | Reuters. Accessed Jan 17, 2022.
A retrospective review of 842 medical records matched for gender, age, and ethnicity were reviewed to detect differences between dermatologic disorders among homeless and non-homeless individuals. The most striking difference was an increase in infectious diseases (bacterial, fungal and ectoparasitic) among the homeless.
TO READ MORE: O’Quinn M, et al. Cutaneous Manifestations and Clinical Disparities in Patients Without Housing. Cutis. 2021; Oct. doi: 10.12788/cutis.0367.
ACNE
Utilizing the IBM MarketScan Research Databases, investigators found that acne patients treated with ISOTRETINOIN did not show an increase in suicidal ideation or suicide attempt compared to either acne patients treated with antibiotics or the general age-matched population.
TO READ MORE: Ugonabo N, et al. Psychiatric disorders and suicidal behavior in patients with acne prescribed oral antibiotics versus isotretinoin: Analysis of a large commercial insurance claims database. J Am Acad Dermatol. 2021; Oct. doi: 10.1016/j.jaad.2021.01.107.
(Editor’s note: Although all recent literature speaks against isotretinoin administration as a cause of suicidal ideation or suicide attempts, I still like to have written clearance from the mental health professional who might be providing counseling to my isotretinoin patients.)
SARECYCLINE, a narrow spectrum tetracycline derivative already approved for moderate to severe acne, was specifically evaluated for chest and back acne. It was found to be effective for these more difficult areas.
TO READ MORE: Del Rosso JQ, et al. Management of Truncal Acne With Oral Sarecycline: Pooled Results from Two Phase-3 Clinical Trials. J Drugs Dermatol. 2021; June. doi: 10.36849/JDD.2021.6204.
