Clinical and Quality of Life Outcomes among Ixekizumab Treated Psoriasis Patients in a Real-World Setting

Introduction: Psoriasis is a chronic immune-mediated inflammatory skin condition that has a significant negative impact on the physical, emotional, and psychosocial well-being of those affected. This study aimed to assess the speed of onset and long-term clinical and quality of life (QOL) outcomes among Ixekizumab (IXE) treated plaque psoriasis patients. Method: A retrospective cohort study was conducted at a single US dermatology referral center. Medical charts were reviewed for adult psoriasis patients starting IXE (index date) between March 22, 2016, and February 28, 2018.Disease severity and QOL data were collected up to one-year pre-IXE initiation and up to 35 months post-IXE initiation. Static Physician Global Assessment (sPGA), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) were summarized at 1-month post-index and at 3-month intervals. Logistic regressions were performed to evaluate the 1-month response in relation to long-term sPGA, BSA, and DLQI outcomes. Results: A total of 153 patients (median age at index: 47.7 years; 65.4% male; 93.5% Caucasian) were included in the study. Majority of patients (69%; n=106) were biologic-experienced prior to IXE initiation. At 1-month post-index 58.8% of patients achieved sPGA (0,1), 55.9% achieved DLQI (0,1), and 66.9% achieved BSA≤1%. Patients with sPGA (0,1) at 1-month post-index had greater odds of remaining sPGA (0,1) and BSA≤1% at 24-month (sPGA 0,1: OR=10.1; 95% CI: 2.1-47.9; BSA≤1%: OR=13.3; 95% CI: 2.2-80.2). Among patients who achieved sPGA (0,1) at 1-month post-index, the observed proportion of patients with sPGA (0,1), DLQI (0,1), and BSA≤1% remained largely the same for the 24-month follow-up. Conclusion: This real-world study demonstrated that the majority of patients initiating IXE achieved sPGA (0, 1), DLQI (0, 1) and BSA ≤1% targets within the first month of treatment and were able to maintain treatment response for up to 24 months independent of prior biologic exposure.

Platelet Rich Plasma in the Treatment of Frontal Fibrosing Alopecia

Frontal Fibrosing Alopecia (FFA) represents a form of scaring alopecia more frequent in postmenopausal women that presents with frontal hairline recession. It is typically classified as a variant of lichen planopilaris. Treatment of FFA can be challenging with poor long-term outcomes. Platelet-Rich Plasma (PRP) consists of an autologous concentration of platelets in a small volume of plasma. Activated platelets secrete cytokines and growth factors and thus may have a potential role in the treatment of inflammatory scarring alopecia such as FFA. A 68-year-old female with multi-resistant FFA was treated with lesional PRP injections every 4 weeks for 16 weeks. Baseline LPPAI score and phototrichograms targeting a representative area of disease activity were compared at baseline and at 16 weeks. After 16 weeks, no significant change in follicular units or follicular density from baseline to week 16 was noted. Only a minimal improvement in inflammatory activity observed clinically and through the Lichen Planopilaris Activity Index was observed. The discordance between the follicular density count and observed inflammatory activity suggests a longer treatment and observational period is needed. Additionally, the frequency of PRP injections potentially may also need to be increased. Given the limited efficacy of current therapies for FFA, PRP injections may be an option in patients with refractory disease, as an adjunct to systemic therapy. Additional investigation is needed to optimize frequency of PRP injections in FFA and to better assess its true anti-inflammatory effect.

Giant malignant Chondroid Syringoma: Case Report and Literature Review

Chondroitin syringoma, also known as cutaneous mixed tumor, is a rare type of sweat gland tumor, accounting for 0.01% to 0.1% of all primary tumors of the skin. The malignant form is extremely rare, with 41 cases described so far. It predominates in the trunk and distal extremities and affects women more frequently, with a 3: 2 rate 6,7. Patients may reach the health service with large lesions due to the fact of being slow-growing lesions and have a high rate of recurrence, requiring surgical treatment that may lead to extensive defects making complex reconstructions necessary. We present a case of malignant chondroid syringoma in an 80 years old male patient, with 29 years of evolution and unusual size. A reconstruction was performed with a muscular dorsal flap of the latissimus dorsi with good aesthetic and functional results, with no signs of recurrence after 8 months of follow-up. It is concluded that because it is a late diagnosis neoplasia, the surgical treatment ends up generating expressive defects. There for musculocutaneous should be considered as an option for reconstruction, aiming optimal functional and aesthetic restoration.

Scar Sarcoidosis as Presenting Finding in Pembrolizumab Induced Systemic Sarcoidosis in Stage III Melanoma: A Case Report

Immune checkpoint blockade using inhibition of Programmed Cell Death-1 (PD-1) improves both progression-free and overall survival in patients with advanced melanoma, but is associated with a unique set of toxicities termed immune-related Adverse Events (irAEs). We present a case of a man with stage IIIc melanoma who was treated with pembrolizumab (anti PD-1). Two months after initiation of the therapy, the patient developed subcutaneous nodules on his upper lip and right knee, both in a pre-existing scar. Histological examination showed non-necrotising granuloma, most consistent with sarcoidosis. PET-CT showed hypermetabolic mediastinal and hilar adenopathies as well as lung lesions and some cutaneous and subcutaneous metabolic hot spots. Bronchoscopy with biopsy of a lymph node confirmed the diagnosis of sarcoidosis. Pembrolizumab was withheld, whereby a gradual decrease and near spontaneous resolution of all lesions was seen over a period of approximately 6 months. The patient is currently in follow up with no evidence of disease recurrence.Our case shows a unique presentation of sarcoidosis in old scar tissue as presenting symptom of pembrolizumab-related systemic sarcoidosis and demonstrates the importance of histological examination of new lesions occurring during checkpoint inhibitor therapy in order to avoid misdiagnosis of melanoma progression.

Propeller Flap: Surgical Option after Resection of Lower Limb Melanoma

Objective: To describe a series of cases of lower limb reconstruction using an axial reverse flow flap (propeller flap) after melanoma excision. Patients and methods: From August 2014 to December 2016, at the Plastic Surgery Service at UNIFESP, five patients with defects in the lower limbs after melanoma resection were reconstructed using propeller flap. In all cases, the perforating vessels were previously mapped using Doppler ultrasound. Results: The size of the defect ranged from 4 cm × 3 cm to 8 cm × 4.5 cm. One case had a 180º rotation. In all the others, a 90° rotation was sufficient. All patients had good aesthetic results. Conclusion: The propeller flap is a simple and low cost technique. It is indicated for reconstruction of the distal third of small and/or medium-sized lower limb. The aesthetic result is satisfactory with the thickness and color of the flap very similar to the excised area.

Efficacy of a Retinoid, Keratolytic, Anti-Inflammatory and Antibacterial Gel and Spray Formulations in Mild Common Acne

Background and Objectives: For the treatment of mild/moderate acne, topical retinoids and antibacterial molecules are used in monotherapy or in combination. An exfoliating and anti-inflammatory action can increase the clinical efficacy of this therapeutic approach. A topical product in Gel and Spray Formulations (GF and SF) with retinoids (hydroxypinacolone retinoate and encapsulated retinol), with anti-inflammatory (niacinamide), antibacterial (biopep15) and keratolytic (glycolic and salicylic acids) activity has recently been developed. Topical retinoids have anti-inflammatory, anti-seborrheic and anticomedone-formation properties. Biopep15 is an oligopeptide with antibacterial action that can interfere with lipoteichoic acid, a component of the wall of Cutibacterium acnes. In addition, Biopep15 can perform also an antagonistic action against the Toll-Like-Receptor 2, involved in the pathogenesis of acne. Niacinamide has a well-known anti-inflammatory action. Salicylic and glycolic explain keratolytic and exfoliating activities. In this study the objective was to determine the efficacy and tolerability of GF and SF in mild/ moderate comedogenic acne. Methods: In a 4-week, open-label, prospective trial, 32 patients between the ages of 15 and 30 have been evaluated. All participants gave their written consent. Treatment with gel (for facial lesions) and spray (for lesions located on thorax, back and shoulder) applied twice daily were used. To assess clinical efficacy, a count of comedogenic lesions (open and closed comedones; non-inflammatory lesions: NIL) and inflammatory lesions (IL; papules, and pustules) was performed and the reduction in the number of lesions after 2 and 4 weeks of treatment was evaluated. An evaluation of Total lesions count (TL; NIL+IL) was also performed.The lesion count data were analysed with a paired Student's t test.We evaluated also the exfoliating/keratolytic activity and the effect on sebum production assessed at baseline, after 2 and 4 weeks of treatment. Finally, to evaluate Cutibacterium acnes (C. acnes) skin colonization, we performed a fluorescence detection of skin porphyrin content at baseline and at day 28, by mean of Visiopor PP 34 camera. Results: All patients completed the trial. At baseline the NIL, IL and TL count were 14.3, 8.7 and23, respectively. After 2 weeks of GF/SF treatment, NIL, IL and TL significantly decreased to 9.7 (-32%), 6.8 (-22%) and 16.5 (-29%), respectively. At the end of the treatment, a significant reduction in comparison with baseline was observed for NIL (-49%) IL (-63%) and TL (-54%). The exfoliating index evaluated in comparison with baseline value improved not significantly by 13% at day 14, and significantly (p=0.05) by 18% at day 24. The Cutibacterium acnes skin colonization area was significantly (p=0.02) reduced by 28% in comparison with baseline. Treatment was well tolerated, and local tolerability was assessed as optimal by all patients. Conclusion: This new anti-acne combination formula based on retinoids, antibacterial oligopeptide, keratolytic and anti-inflammatory agents have shown high clinical efficacy and good tolerability in patients with mild to moderate acne. The treatment shows also a keratolytic effect and a significant reduction of C. acnes skin colonization.

Drug Injections to Reduce Facial Fat

Facial aging involves not only the loss of volume, but also the ptosis of the fat compartments, leading to the emergence of deep folds and generating heterogeneous creases and depressions. Thus, this study aims to evaluate the drug injections of active principles in the subcutaneous tissue to reduce the puffiness in the jowl and nasolabial areas, and also the accumulation of fat in the submental area (“double chin”). Therefore, we describe the use of lipolytic and antioxidant substances to reduce facial fat in four patients who were very satisfied with the result of the treatment. Consequently, we conclude that the drug injections of active principles are a practical method with fast and promising results in the treatment of facial fat.

Dermatological Findings in COVID-19 Patients: A Review

Introduction: In the day 16th June 2020, the number of deaths is up to 430000 and the confirmed cases are more than 8 million in the world. The dermatology clinical findings on COVID-19 patients were cutaneous manifestations as pressure injury, contact dermatitis itch, pressure urticarial and exacerbation of pre-existing skin diseases, including seborrheic dermatitis and acne Objective: This work means to show the researches doing in dermatology about COVID-19 and the findings related to them Methodology: In this research article were founded in PubMed with free texts, clinical tests and published in the last 5 years Results: Were founded 13 articles published using the terms proposed: dermatology and coronavirus and COVID-19. Five of them were written about cutaneous manifestations of COVID-19 Conclusion: Although several cutaneous manifestations had been associated with COVID-19, none so far is specific to this disease. The dermatological approach has been valued and, in the future, It is expected that dermatologists can help both in the early diagnosis of the disease and in its prognosis

Relationship between Skin Microbiota and Skin Biophysical Parameters in Inflammatory Skin Disease: A Systematic Review

Many recent studies highlight the importance of skin microbiota for skin health. Alterations in the balance of bacterial flora cause the development of inflammatory skin diseases such as acne, atopic dermatitis, or psoriasis. This systematic review aims to investigate the relationship, in these skin diseases, between skin microbiota and skin biophysical parameters, such as pH, Transepidermal Water Loss (TEWL), Hydration (HI) and sebum levels. Google Scholar, Medline via Pubmed, and Web of Science were considered as scientific database to search studies about this topic. Research about acne and psoriasis did not produce any results. For this reason, in this review, only articles concerning atopic dermatitis were discussed. Therefore, a possible correlation between skin barrier functionality and microbial composition was also investigated. So, this could be a starting point for the diagnosis of atopic dermatitis or, more generally, for all inflammatory skin diseases.

Atopic Dermatitis and Breast Feeding/Weaning: Are they Related?

Background: Atopic Dermatitis (AD) is a very common polygenic chronic disease for which several environmental risk and protective factors have been considered, including breastfeeding and early weaning. Methods: To determine the influence of breastfeeding and early weaning in the development of AD in a sample of Mexican children, one hundred patients with AD were selected (group I) and compared with one hundred non-atopic children (group II). The subjects in these groups were matched according to age and gender. The mothers of both groups completed a questionnaire that collected information on the length of breastfeeding, and the child’s age at the time of weaning. Statistical analyses were performed and information was presented in percentages, X square, Odds Ratios (OR), and 95% Confidence Intervals (CI). Results: The relationship between breastfeeding and AD was not statistically significant; however, we were able to demonstrate a close relationship between early weaning (before four months of age) and AD (p<0.0001, OR=2.85, 95% CI: 1.15-5.3). Conclusion: In a sample of the indigent pediatric population with Mestizo ancestry, AD is significantly related with early weaning. Infants who are weaned before four months of age have an almost three times greater riskthan the general population of developing AD.