Highlights of noteworthy, peer-reviewed, evidence-based articles in dermatology.
Validation of the Patient-Oriented SCORing for Atopic Dermatitis tool for black skin.
Faye O, Meledie N’Djong AP, Dadie S, et al. J Eur Acad Dermatol Venereol. 2020;34(4):795–799. Epub 2019 Nov 7.
Summary. Researchers sought to evaluate the performance of a version of the patient-oriented (PO) SCORing for Atopic Dermatitis (SCORAD)—an atopic dermatitis (AD) severity patient self-assessment tool—that was specifically adapted for use in black-skinned children and adults. The study included 72 children and 41 adults with AD from seven sub-Saharan countries who were evaluated by their physicians using the physician version of SCORAD and by the patients themselves (or their parents) using the adapted PO-SCORAD. Results of the study showed significant correlation between AD severity scores from PO-SCORAD administered by the patients (or their parents) and scores from SCORAD administered by their physicians (r=0.66, P<0.0001). The researchers concluded that the adapted version of PO-SCORAD for black skin may be a useful and easily administered tool for patients to self-assess AD severity between doctor appointments, which might encourage patient engagement in their treatment plan as well as provide physicians with additional information to better understand a patient’s disease pathway and optimize treatment.
Innovation in atopic dermatitis: from pathogenesis to treatment.
Munera-Campos M, Carrascosa JM. Actas Dermosifiliogr. 2020;111(3):205-221. Epub 2020 Jan 20.
Summary. In this article, the authors review the main advances in the treatment of atopic dermatitis. Understanding of its pathogenesis, primarily driven by the Th2 pathway, has improved in recent years, but this insight is oversimplified and not generalizable. The authors acknowledge and explore the significant contributions from the Th22 pathway, the Th1 and Th17 axes, epidermal barrier dysfunction, pruritus, and JAK/STAT signaling. They found that a better understanding of these inflammatory pathways in AD as well as the pathways implicated in pruritus could lead to the development of drugs that specifically target different cytokines as well as drugs with broad action targeting intracellular signaling. They conclude by saying that progress in the study of new therapies and stratification of AD into different subtypes and subphenotypes in the coming years is essential to developing effective, long-term treatments with an acceptable safety profile.
Oxidative stress and atopic dermatitis
Bertino L, Guarneri F, Cannavò SP, Casciaro M, et al. Antioxidants (Basel). 2020;9(3):196. Epub 2020 Feb 26.
Summary. In this review article, the authors reviewed 33 in-vivo studies on humans regarding oxidative stress and atopic dermatitis published in the last 28 years. Based on their review, the authors suggested that oxidative stress may have a significant role in atopic dermatitis; however, they acknowledged that our understanding of this relationship is incomplete due to limitations of the reviewed literature that prevented the data from each paper from being pooled and compared. These limitations included small, relatively homogenous study populations and the use of many biomarkers in different tissues and with different methods. They concluded that larger studies are needed to clarify the effect of oxidative stress on atopic dermatitis, which is important for improving our understanding of this disease and its potential clinical and therapeutic implications.
Efficacy of Dupilumab in Different Racial Subgroups of Adults With Moderate-to-Severe Atopic Dermatitis in Three Randomized, Placebo-Controlled Phase 3 Trials
Alexis AF, Rendon M, Silverberg JI, et al. J Drugs Dermatol. 2019;18(8):804-813.
Summary. Using data from three Phase III trials (LIBERTY AD SOLO 1, SOLO 2, and CHRONOS) authors of this post-hoc analysis assessed efficacy and safety of dupilumab versus placebo by racial subgroup. A total of 2,058 patients (White n=1,429, Asian n=501, Black/African American n=128) were included in the analysis. Dupilumab was generally well tolerated, with an acceptable safety profile in all racial subgroups. Serious adverse events occurred more frequently with placebo; treatment discontinuations due to adverse events were rare in all treatment groups. Results from this analysis suggest that clinical improvement and a favorable benefit-risk profile can be achieved with dupilumab treatment in patients of White, Asian, and Black/African American racial subgroups with moderate-to-severe AD inadequately controlled with topical medications.
COVID-19 and Dermatology practice
COVID-19 and dermatology: a comprehensive guide for dermatologists
Fahmy DH, El-Amawy HS, El-Samongy MA, et al. J Eur Acad Dermatol Venereol. 2020;34(7):1388-1394. Epub 2020 Jun 10.
Summary. On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease-2019 (COVID-19) a pandemic disease caused by SARS-CoV-2. The COVID-19 pandemic has been the most serious health crisis facing the modern world resulting in unprecedented efforts to contain this pandemic and its consequences. This guide breaks down COVID-19’s cutaneous manifestations, impact on dermatology practice, and the potential use of dermatological drugs for its management. It concludes with a summary of recommendations for infection control in dermatology clinics.
COVID-19 and immunosuppressive therapy in dermatology
Schwartz RA, Pradhan S, Murrell DF, et al. Dermatol Ther. 2020;33(6):e14140. Epub 2020 Sep 3.
Summary. With concern about therapies that may decrease immunity and enhance the severity of an individual’s COVID-19 infection, the use of immunosuppressants has become an important concern during the pandemic. This article focuses on management of atopic dermatitis/eczema, psoriasis, and pemphigus in individuals lacking immunity to COVID-19 but requiring a systemic immunosuppressant. The authors surmise that physicians need to weigh the risk benefit ratio of giving immunosuppressive treatment. If they therapy is given, it should be with low dose and minimum duration. In addition, patients who do not have immunity to COVID-19 should adhere to CDC guidelines and quarantine as a member of a vulnerable population until there is effective vaccination or treatment or herd immunity has been reached.
COVID-19 and cutaneous manifestations: a systematic review
Zhao, Qing et al. J Eur Acad Dermatol Venereol. 2020;34(11):2505-2510. Epub 2020 Jun 28.
Summary. This comprehensive literature review, which began on May 30, 2020, used PubMed, CNKI, medRxiv, and bioRxiv to search for terms related to the novel coronavirus, dermatology, and skin. Forty-four articles met the inclusion criteria. This systematic review presented the clinical characteristics of 507 patients and showed that skin may be the potential target of the infection according to ACE2 expression. The authors acknowledge that many questions remain in this field and that more clinical data should be collected for a better understanding of the cutaneous manifestations caused by COVID-19.
An Evidence-Based Guide to SARS-CoV-2 Vaccination of Patients on Immunotherapies in Dermatology
Gresham LM, Marzario B, Dutz J, Kirchhof MG. J Am Acad Dermatol. 2021;S0190-9622(21)00196-1. Epub 19 Jan 2021.
Summary. The COVID-19 pandemic has incited research aimed at developing a novel SARS-CoV-2 vaccine. As they are developed and made available, the assessment of anticipated safety and efficacy in patients with immune-mediated dermatologic diseases and requiring immunosuppressive and/or immunomodulatory therapy is vital. Conducted by a multidisciplinary committee, this literature review provides guidance on the safety and efficacy of the SARS-CoV-2 vaccines for other clinicians when prescribing immunotherapeutics. The authors acknowledge that the safety and efficacy of SARS-CoV-2 vaccines in this patient group is unknown. However, the approved and distributed vaccines are expected to be safe for patients on immunotherapeutics with some variability in efficacy, depending on the degree of immunosuppression and type of vaccine given.
Psychological issues related to skin disorders
Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial
Hudson MP, Thompson AR, Emerson LM. Compassion-focused self-help for psychological distress associated with skin conditions: a randomized feasibility trial. Psychol Health. 2020;35(9):1095-1114. Epub 2019 Dec 27.
Summary. This study tested the feasibility of a self-help intervention based on Compassion-Focused Theory (CFT), and estimated treatment effects in a population of adults with skin conditions and associated psychological distress. A randomized-controlled design was used, with 176 participants being allocated to either CFT-based self-help or a waitlist control group, who received usual medical care. The two-week intervention was provided via email. The authors found that those who participated in the CFT intervention demonstrated significant, moderate improvements on measures of stress, anxiety, depression, self-compassion, and dermatology-specific quality of life compared to controls. The findings indicate that CFT self-help shows promise in the treatment of psychological distress associated with skin conditions.
Assessment of suicidal behavior in dermatology (Review)
Stanescu M, Totan A, Mircescu D, et al. Exp Ther Med. 2020;20(1):73-77. Epub 2019 Oct 30.
Summary. This study focuses on the importance of early detection of suicidal behavior in dermatological practice, an area that is vastly under-researched. It approaches several dermatological diseases, specifically psoriasis, acne, melanoma, atopic dermatitis, and urticaria, from the perspective of suicidal behavior. The authors conclude by underlining the fact that psychological or psychiatric impairment of patients with dermatological conditions should not be neglected. They say it can require a complex, specific approach by the dermatologist, and, if necessary, may involve a multidisciplinary team, including a psychiatrist.
Vitiligo and anxiety: A systematic review and meta-analysis
Kussainova A, Kassym L, Akhmetova A, et al. PLoS One. 2020;15(11):e0241445. Epub 2020 Nov 10.
Summary. This review evaluates the prevalence of anxiety among patients with vitiligo from different countries and compares it to patients suffering from eczema, psoriasis, and acne. The authors conducted this systemic search for observational studies that examined the prevalence of anxiety in vitiligo patients in November 2019 and found 15 studies comprising 1176 patients with vitiligo. The general prevalence of anxiety among vitiligo patients was equal to 35.8 percent, and there was a statistically significant difference in anxiety rates was found among female and male patients. However, the pooled odds ratio among vitiligo and non-vitiligo patients did not indicate a statistical significance among patients coming from different continents. The pooled prevalence of anxiety among vitiligo patients worldwide was comparable to other severe skin disorders, accentuating the necessity of anxiety awareness in management of patients with skin diseases.
Dupilumab improves patient-reported symptoms of atopic dermatitis, symptoms of anxiety and depression, and health-related quality of life in moderate-to-severe atopic dermatitis: analysis of pooled data from the randomized trials SOLO 1 and SOLO 2
Cork MJ, Eckert L, Simpson EL, et al. J Dermatolog Treat. 2020;31(6):606-614. Epub 2019 Jun 9.
Summary. This analysis evaluates the impact of dupilumab on patient-reported atopic dermatitis (AD) symptoms and QoL. Pooled data were analyzed from two identically designed phase III studies, LIBERTY AD SOLO 1 and SOLO 2. The authors found that dupilumab rapidly improved (vs. placebo) Peak Pruritus NRS scores by Day 2, anxiety and depression (HADS), and QoL (DLQI) by Week 2, and maintained through Week 16. At Week 16, more dupilumab-treated than placebo-treated patients reported improvement in SCORAD itch and sleep, and no pain/discomfort (EQ-5D). Dupilumab had a significant, positive impact on AD symptoms, including itch, sleep, pain, anxiety and depression, and QoL in adults with moderate-to-severe AD.