Takeaways from the literature for clinical practice
The Maui Derm NP+PA Summer 2022 program kicked off with a specialty status update. A review of current literature provided a platform for a panel discussion on the most influential articles and how their findings will change the practice of dermatology in 2022 and beyond.1
Presenters Ted Rosen, MD, Professor of Dermatology at Baylor College of Medicine and Chief of Dermatology at Houston VA Medical Center in Houston, Texas, James Treat, MD, Clinical Professor of Pediatrics and Dermatology and Director of Education, Pediatric Dermatology at Children’s Hospital of Philadelphia, the HUB for Clinical Collaboration in Pennsylvania, and Matthew J. Zirwas, MD, associate professor at Ohio University Heritage College of Medicine in Athens, Ohio.
Zirwas was responsible for developing the Contact Allergen Management Program (CAMP) for the American Contact Dermatitis Society (ACDS) and specializes in allergy patch testing, psoriasis and eczema.
He began by reviewing the paper “The influence of sun exposure and sun protection behaviors on allergic outcomes in infancy,” a study in which infants associated with a family with atopy wore UV dosimeters for the first 3 months of their life. This research determined that total UV exposure was strongly associated with the risk of developing atopic dermatitis.2
“It makes a lot of pathophysiological and epidemiological sense,” he said. “We treat AD with UV light, and childhood UV exposure has decreased in concert with increasing rates of AD.”
Zirwas went on to discuss the rapid improvement in scrotal burning syndrome with indomethacin, noting that oral carvedilol was the most effective treatment in his opinion.
When faced with a patient with red scrotum syndrome, start with 3.125 mg bid and titrate until symptom control. Although he observed some bradycardia, there were no cases of hypotension or fatigue in his patients, he said.
“Indomethacin also helped as a short-term rescue when carvedilol was not adequate,” Zirwas said, adding that the maximum dose should be 50 mg tid and tapered as quickly as possible.
Another paper that caught his eye last year was one that revealed that flushing while taking dupilumab (Dupixent; Sanofi and Regeneron Pharmaceuticals) could lead to an emergent adverse event.3
The study began after people were placed on dupilumab for 24 weeks and found that 10 minutes after consuming alcohol, some patients developed periorbital and perioral erythema. However, the case report referenced in the article stated that the patient reported that these symptoms would “spontaneously resolve” within 20 minutes, “regardless of continued alcohol consumption,” the authors wrote. According to the patient, the reaction did not trigger every time she consumed alcohol, but “dark spirits would make the flushing worse,” she told investigators. According to the article, the patient’s reactions were less severe or less frequent if she consumed alcohol on consecutive days. adverse effects did not occur while taking tacrolimus, leading the authors to conclude that it was related to IL-4 inhibition.
The next study that Zir reviewed was a case study of 7 patients with contact dermatitis of the forearm following frequent surface cleaning. It was revealed that it could be irritant or allergic contact dermatitis and recommendations included cleaning surfaces with water at work or after cleaning at home.4
A cohort study of long-term oral corticosteroid use and associated harms in adults came next, and Zir was noted when he needs an anti-inflammatory he turns to dexamethasone for dermatitis. atopic, contact dermatitis and itching, while if he needs immunosuppression he uses prednisone medication to treat conditions such as lichen planus, pemphigus or pemphigoid.5
Turning his attention to a clinical trial that examined the effect of HNS cynatine on hair and nail parameters, he found that in a randomized, double-blind, controlled study when using keratin treated with From sheep’s wool, the nails saw a great reduction in breakage and significant increase in nail hardness. Hair luminosity has also increased significantly.6
Other publications he reviewed dealt with the impact of laboratory tests and supplementation on patients with alopecia; improving the lipid structure of the stratum corneum to improve skin barrier function and protect against irritation in adults with dry, eczema-prone skin; and 1ll examining localized systemic contact dermatitis, using the vulva as a clue to identify allergen ingestion.
This latest study involved two patients with vulvar itching and dermatitis – 1 clearly flared in relation to their ovulatory cycle. The patient tested positive for formaldehyde and improved but did not disappear with avoidance. Zirwas said it would be reasonable to empirically recommend a month-long trial of strict aspartame avoidance in patients with “strange” dermatitis.seven
Another study investigated the efficacy and safety of HAT1 versus calcipotriol in the treatment of patients with mild to moderate chronic plaque psoriasis, and Zirwas presented the results of the open-label, randomized, comparative pilot clinical study. He called the results “impressive”.
A mini review was done on the effectiveness of azithromycin in the treatment of acne vulgaris and Zirwas commented on many studies about it.
“In my opinion, azithromycin has a better safety profile than doxycycline or minocycline,” he said. “There is much less concern about resistance. He added that the 2 regiments that make the most sense to him are ‘500 mg po qd x 3 days a week’ and ‘500 mg po qd x 4 days, then 500 mg po qd once a day.” week.”
The literature review continued with a remarkable study on the pruritus-reducing effects of omega-3 fatty acids in hemodialysis patients, where the results reduced itching by more than 50%.8
A more recent clinical trial was an evaluation of hand hygiene strategies on skin barrier function during COVID-19, with key takeaways being to use alcohol hand sanitizer instead of soap, and the idea that it was better to use cold water to wash your hands.9
Zirwas ended his talk by reviewing the efficacy and safety of lotion, cream, gel and ointment emollients for childhood eczema that excelled in a randomized phase 4 superiority trial. While families strongly preferred lotions or gels, there were no marked differences in AD severity or steroid use between the study groups.
Clearly there is a lot of interesting and innovative research in dermatology, he said. “[Based on that]you will never practice the same way again,” Zirwas noted.
Zirwas is a speaker for Genentech, Novartis, Sanofi and Regeneron Pharmaceuticals. He is a consultant for Sanofi/Regeneron Pharmaceuticals, FitBit, L’Oréal, LEO Pharma, Pfizer, Eli Lilly and Company, Arcutis Biotherapeutics, Ortho Dermatologics, Sol-Gel, Bausch Health and EPI Health. He is a researcher for Sanofi/Regeneron Pharmaceuticals, LEO Pharma, Janssen Pharmaceuticals, Incyte, Vyne Therapeutics, UCB, Pfizer, Eli Lilly and Company, Asana Biosciences, Avillion, AbbVie, Edesa Biotech, Galderma, Dermavant, Arcutis Biotherapeutics, EPI Health, and Concert Pharmaceuticals. He is co-owner of AspeticMD.
- Rosen T, Treat J, Zirwas M. Dermatology update 2022. Presented at Maui Derm NP+PA. Held June 23-25, 2022, Colorado Springs, Colorado, and virtual.
- Rueter K, Jones AP, Siafarikas A et al. The influence of sun exposure and sun protection behaviors on allergic outcomes in early childhood. Int J Environ Res Public Health. 2021 May 19;18(10):5429. doi: 10.3390/ijerph18105429. PMID: 34069576; PMCID: PMC8161152.
- Igelman SJ, Na C, Simpson EL. Alcohol-induced flushing in a patient with atopic dermatitis treated with dupilumab. JAAD Case Representative. 2020 Jan 25;6(2):139-140. doi: 10.1016/j.jdcr.2019.12.002. PMID: 32021896; PMCID: PMC6994276.
- Hamann CR, Duprat G, Dagrosa AT, Mann JA. “Office dermatitis”: a case series of 7 patients with contact dermatitis of the forearm due to frequent cleaning of the surface. Dermatitis. 2021 Nov-Dec 01;32(6):e104-e107. doi: 10.1097/DER.0000000000000766. PMID: 34115668.
- Yasir M, Goyal A, Sonthalia S. Adverse effects of corticosteroids. [Updated 2021 Jul 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Edition; 2022 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK531462/
- Beer C, Wood S, Veghte RH. A clinical trial to investigate the effect of cynatine HNS on hair and nail parameters. ScientificWorldJournal. 2014;2014:641723. doi: 10.1155/2014/641723. Published online October 16, 2014. PMID: 25386609; PMCID: PMC4214097.
- Admani S, Maghfour J, Jacob SE. Localized systemic contact dermatitis: The vulva as a clue to identify allergen ingestion. Int J Dermatol Woman. 2021 Mar 3;7(5Part B):843-844. doi: 10.1016/j.ijwd.2021.02.009. PMID: 35028397; PMCID: PMC8714567.
- Forouhari A, Moghtaderi M, Raeisi S et al. Pruritus-reducing effects of omega-3 fatty acids in hemodialysis patients: a randomized crossover clinical trial. Hemodiale Int. 2022 Feb 3. doi:10.1111/hdi.13007. Epub ahead of print. PMID: 35112475.
- Montero-Vilchez T, Martinez-Lopez A, Cuenca-Barrales C et al. Evaluation of hand hygiene strategies on skin barrier function during the COVID-19 pandemic: a randomized clinical trial. Contact dermatitis. 2022 Apr;86(4):276-285. doi: 10.1111/cod.14034. Epub 13 Jan 2022. PMID: 34954837.
- Ridd MJ, Santer M, MacNeill SJ et al. Efficacy and safety of emollient lotions, creams, gels and ointments for childhood eczema: a pragmatic, randomized, phase 4 superiority trial. Lancet Child Adolesc Health. May 23, 2022: S2352-4642(22)00146-8. doi: 10.1016/S2352-4642(22)00146-8. Epub ahead of print. PMID: 35617974.