The latest medical research on Dermatology

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about dermatology gathered by our medical AI research bot.

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Secukinumab for the Treatment of Adult-Onset Pityriasis Rubra Pilaris: A Single-Arm Clinical Trial with Transcriptomic Analysis.

British Journal of Dermatology

The pathogenesis of pityriasis rubra pilaris (PRP) is not completely understood, but IL-17 has been shown to play a critical role. There are no reliable immunomodulatory agents to treat PRP. We conducted an open-label, single-arm clinical trial of secukinumab, a monoclonal antibody that inhibits IL-17A, for the treatment of PRP.

To evaluate the clinical efficacy of secukinumab and define the transcriptomic landscape of PRP and its response to IL-17A blockade.

Twelve patients with PRP were recruited for an open-label trial of secukinumab. Patients received a 24-week course of secukinumab. The primary endpoint was a ≥75% reduction in Psoriatic Area Severity Index score (PASI-75) from baseline to week 28. Secondary endpoints included PASI-90, change in Physician Global Assessment (PGA), and change in Dermatology Life Quality Index (DLQI) score. RNA sequencing was performed on lesional and non-lesional skin biopsies obtained at baseline and week 2. Sample groups were compared to identify differential gene expression and pathway enrichment.

At week 28, 6 patients (55%) achieved PASI-75, and 3 patients (27%) achieved PASI-90. PGA (P=0.008) and DLQI scores (P=0.010) showed significant improvement with treatment. No serious treatment-related adverse events were encountered. Treatment with secukinumab normalized transcriptional differences between lesional and nonlesional skin. Transcriptomic data from nonresponsive patients suggest that overactivity of innate immune pathways may be driving resistance to secukinumab.

Secukinumab appears to be an effective treatment for PRP and warrants further investigation. PRP is a transcriptionally heterogeneous disease, reflecting its variable response to therapy. Agents targeting other IL-17 isoforms and innate immune mediators should be considered for future clinical trials.

Common genetic variants associated with melanoma risk or naevus count in wild-type MC1R melanoma patients.

British Journal of Dermatology

Hypomorphic MC1R variants are the most prevalent genetic determinants of melanoma risk in the Caucasian population. However, the genetic background of wild-type (WT) MC1R melanoma patients is poorly studied.

To analyse the role of candidate common genetic variants on the melanoma risk and the naevi count in Spanish wild-type MC1R melanoma patients.

We examined 753 MC1R-WT individuals from Spain (497 patients and 256 controls). We used the OpenArray RT-PCR to genotype a panel of 221 common genetic variants involved in melanoma, nevogenesis, hormonal pathways, and proinflammatory pathways. Genetic models were tested using multivariate logistic regression models. Non-parametric multifactor dimensionality reduction (MDR) was used to detect gene-gene interactions within each biological subgroup of variants.

We found that variant rs12913832 in HERC2 gene, which is associated with blue eye colour, increased melanoma risk in MC1R-WT individuals (OR=1.97, 95% CI=1.48-2.63; adjusted P<0.001; corrected P<0.001). We also observed a trend between rs3798577 variant in the oestrogen receptor alpha gene (ESR1) and a lower naevus count, which was restricted to female MC1R-WT melanoma patients (OR=0.51, 95% CI=0.33-0.79; adjusted P=0.002; corrected P=0.105). This sex-dependent association was statistically significant in a larger cohort of melanoma patients regardless of their MC1R status (N=1497, OR=0.71, 95% CI=0.57-0.88; adjusted P=0.002), reinforcing the hypothesis of an association between hormonal pathways and susceptibility to melanocytic proliferation. Last, the MDR analysis revealed four genetic combinations associated with melanoma risk or naevus count in MC1R-WT patients.

Our data suggest that epistatic interaction among common variants related to melanocyte biology or pro-inflammatory pathways might influence melanocytic proliferation in MC1R-WT individuals.

Isotretinoin Laboratory Monitoring in Acne Treatment: A Delphi Consensus Study.

JAMA Dermatology

Although isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice.

To establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne.

Using a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research.

The primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters.

The 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%).

This Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.

An Ode to Kodachrome: The Color Film That Transformed Dermatologic Medical Education.

JAMA Dermatology

From its debut in 1935 until its discontinuation in 2009, Eastman Kodak Company's Kodachrome color reversal film was a cornerstone for dermatologic teaching innovations that transformed 20th century medical education. This Special Communication examines Kodachrome's contributions to the field of dermatology, as well as its lessons for improving inclusive representation of patients of all skin tones in 21st century dermatologic curricula.

Kodachrome's color quality, its slide transparency format, and its broad commercial availability democratized the creation, sharing, and teaching of visual information about skin disease in the 20th century. Kodachrome's usefulness as a complement to bedside teaching modernized medical school curricula, dermatologic conferences, and the American Board of Dermatology certifying examination, which inspired the Kodachrome-style of didactic that remains central to dermatologic training programs today. However, Kodachrome film was also the product of a prejudiced era when color film technology and photographic best practices were optimized for white skin. These biases are still evident in industry standards, photographic techniques, and the historically unjust representation of skin of color in educational resources.

Kodachrome film contributed substantially to shaping 20th-century medical education; however, its legacy is a reminder that diverse and inclusive image representation in dermatologic curricula is vital to counteracting implicit biases, correcting assumptions about disease epidemiology, and providing high-quality care for patients of all skin tones. Historical biases that have harmed representations of racial and ethnic minorities in dermatologic curricula are being addressed through improvements in digital photographic technologies, photographic best practices that serve a broader range of skin tones, inclusive skin color representation in contemporary educational resources, and skin-of-color specific curriculum for learners.

Brain metabolic changes in patients with disseminated malignant melanoma under immunotherapy.

Melanoma Research

Although there is evidence that chemotherapy can have side effects on metabolism and brain function, there are few studies on the occurrence of the...

Long-term survival of patients with advanced melanoma treated with BRAF-MEK inhibitors.

Melanoma Research

Recent results of patients with advanced melanoma treated with first-line BRAF-MEK inhibitors in clinical trials showed 5-year survival in one-third of patients with a median overall survival (OS) of more than 2 years. This study aimed to investigate these patients' real-world survival and identify the characteristics of long-term survivors.

The study population consisted of patients with advanced cutaneous melanoma with a BRAF-V600 mutated tumor who were treated with first-line BRAF-MEK inhibitors between 2013 and 2017. Long-term survival was defined as a minimum OS of 2 years from start therapy.

The median progression-free survival (mPFS) and median OS (mOS) of real-world patients (n = 435) were respectively 8.0 (95% CI, 6.8-9.4) and 11.7 (95% CI, 10.3-13.5) months. Two-year survival was reached by 28% of the patients, 22% reached 3-year survival and 19% reached 4-year survival. Real-world patients often had brain metastases (41%), stage IV M1c disease (87%), ECOG PS ≥2 (21%), ≥3 organ sites (62%) and elevated LDH of ≥250 U/I (49%). Trial-eligible real-world patients had an mOS of 17.3 months. Patients surviving more than 2 years (n = 116) more often had an ECOG PS ≤1 (83%), normal LDH (60%), no brain metastases (60%), no liver metastases (63%) and <3 organ sites (60%).

Long-term survival of real-world patients treated with first-line BRAF-MEK inhibitors is significantly lower than that of trial patients, which is probably explained by poorer baseline characteristics of patients treated in daily practice. Long-term survivors generally had more favorable characteristics with regard to age, LDH level and metastatic sites, compared to patients not reaching long-term survival.

Generalized Pustular Psoriasis in Pregnancy: Current and Future Treatments.

American Journal of Clinical Dermatology

Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease characterized by sudden widespread eruption of sterile pustules wi...

JAK in the [Black] Box: A Dermatology Perspective on Systemic JAK Inhibitor Safety.

American Journal of Clinical Dermatology

Janus kinase (JAK) inhibitors are immunomodulatory agents with broad potential for use within dermatology. However, the US Food and Drug Administra...

Biomarkers of Tretinoin Precursors and Tretinoin Efficacy in Patients With Moderate to Severe Facial Photodamage: A Randomized Clinical Trial.

JAMA Dermatology

Topical formulations of tretinoin precursors (retinol and its ester derivatives) are widely available over the counter and may offer similar clinical benefits to those of tretinoin for treatment of photoaging. However, which of the many purported molecular effects of retinoids most strongly drives clinical improvements in tretinoin-treated skin remains unclear.

To evaluate the clinical efficacy of topical tretinoin precursors (TTP) vs tretinoin (RA) in treating moderate to severe facial photodamage and to identify potential biomarkers that correlate with clinical efficacy.

This randomized, double-blind, single-center, parallel-arm study of 24 patients with moderate to severe facial photodamage was conducted at an academic referral center from November 2010 to December 2011, with data analysis performed from January 2012 to December 2021.

Daily topical application of 0.02% RA or 1.1% TTP formulation containing retinol, retinyl acetate, and retinyl palmitate for 24 weeks.

Photoaging and tolerability were assessed by dermatologist evaluations and patient-reported outcomes. Target gene expression was assessed by real-time quantitative polymerase chain reaction of biopsied tissue from treated areas.

A total of 20 White women were ultimately analyzed (9 randomized to TTP, 11 randomized to RA). At week 24, there was no significant difference in Griffiths photoaging scores among patients receiving TTP vs RA (median, 4 vs 5) (TTP - RA difference: -1; 95% CI, -2 to 1; P = .27). Treatment with TTP was associated with erythema 6 times less frequently than RA (11% vs 64%) (TTP - RA difference: -0.53; 95% CI, -0.88 to -0.17; P = .01). Target gene analysis showed significant CRABP2 messenger RNA (mRNA) induction (confirming retinoic acid receptor signaling) but no significant changes in procollagen I or MMP1/3/9 mRNA in TTP-treated samples. Instead, MMP2 mRNA, which encodes a type IV collagenase, was significantly reduced in TTP-treated samples (week 24 - baseline mRNA difference: -5; 96% CI, -33 to 1.6; P = .02), and changes in MMP2 were strongly correlated with changes in fine wrinkles (r = 0.54; 95% CI, 0.12 to 0.80; P = .01). Interestingly, patients with severe baseline wrinkles exhibited greater improvements (r = -0.74; 95% CI, -0.89 to -0.43; P < .001). This trend was mirrored in MMP2 mRNA, with initial expression strongly predicting subsequent changes (r = -0.78; 95% CI, -0.89 to -0.43; P < .001).

In this randomized clinical trial, there was no significant difference in efficacy between this particular formulation of TTP and tretinoin 0.02%. However, the results of these mechanistic studies highlight MMP2 as a possible mediator of retinoid efficacy in photoaging.

ClinicalTrials.gov Identifier: NCT01283464.

Patient-Relevant Outcomes in Psoriasis: A Systematic Review.

JAMA Dermatology

There is a need to define which outcomes matter to patients with psoriasis to deliver value for the patient when managing their condition.

To generate a comprehensive overview of all outcomes relevant in the management of psoriasis as defined by patients.

A systematic review was performed by searching 3 databases (MEDLINE, Embase, and Web of Science) from August 1, 2019, until March 27, 2021, using a comprehensive search strategy consisting of 4 concepts including psoriasis, patients, outcomes, and relevance. A (citing) reference search was also performed of all retrieved articles. Two independent reviewers screened the retrieved records by title/abstract against the eligibility criteria. Studies were eligible for inclusion if they reported on the importance of outcomes for patients with psoriasis. No language restrictions were used. Data extraction and quality assessment were also performed independently. Quality assessment was done using the QUALSYST tool.

In total, 10 365 records were screened for eligibility, of which 24 studies were included for synthesis. A total of 23 317 patients were evaluated, and 273 (154 unique) items were retrieved. These items were aggregated into 23 outcomes: (almost) complete clearance; symptom control; difficult location clearance; time to clearance; treatment efficacy, sustainability, safety, tolerability, and convenience; comorbidity control; daily and social activity; emotional well-being; intimate relationships; productivity; health-related quality of life; confidence in care; control of disease; communication with care professional; information from other sources than care professional; and cost of care (societal and for the patient). These were then further grouped into 4 core areas: physical/clinical, life impact, resource use, and adverse effects. The mean overall quality of the studies was 75.6% (range, 35.7%-100%).

This systematic review analyzed patient-relevant outcomes reported in patients with psoriasis to aid in the transition to a value-based treatment approach.

Talimogene laherparepvec resulting in near-complete response in a patient with treatment-refractory Merkel cell carcinoma.

Australasian Journal of Dermatology

Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous tumour of neuroendocrine cell origin, which can grow rapidly and metastasise early. ...

Escitalopram-Induced Skin Rash: Dermatitis Medicamentosa.

Indian Journal of Dermatology

Selective serotonin reuptake inhibitors (SSRI) are the most prescribed antidepressant medications for the treatment of depression and other psychia...