Psoriasis is driven by elevated levels of cytokines in the skin and joints, stimulating inflammation. These cytokines also circulate in the blood, stimulating inflammation elsewhere in the body.

One study recently looked at the effect of systemic treatments for psoriasis on mortality in patients with moderate to severe psoriasis. The study was comprised of 12,099 adult patients with moderate to severe psoriasis who were followed followed for up to 10 years.

The study found that treatment with biologics and methotrexate was associated with lower risks of mortality. Systemic therapy appears to not only help with the skin and joints, but also may help reduce inflammation systemically.

Reference:

Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR): A nested case-control analysis. Langley RG, Poulin Y, Srivastava B, Lafferty KP, Fakharzadeh S, Langholff W, Augustin M. J Am Acad Dermatol. 2021 Jan;84(1):60-69.

Bullous pemphigoid is an autoimmune disorder characterized by the development of tense blisters on various areas of the body. Dupilumab (Dupixent) is a monoclonal antibody used initially in the management of atopic dermatitis, a type of eczema. Dupixent works on IL-4 and IL-31 receptors, effectively blocking them and this is how it helps control atopic dermatitis.

A recent multicenter trial demonstrated that 92.3% of patients treated with Dupixent achieved complete clearance or satisfactory response with no adverse effects. Typically, we have used either oral steroids or oral methotrexate, which are potent immunosuppressants, to control moderate to severe cases of bullous pemphigoid.

Dupixent may be a useful additional tool for the management of bullous pemphigoid.

Reference

Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series. Abdat R, Waldman RA, de Bedout V, Czernik A, Mcleod M, King B, Gordon S, Ahmed R, Nichols A, Rothe M, Rosmarin D. J Am Acad Dermatol. 2020 Jul;83(1):46-52.

Chronic nodular prurigo is a very difficult problem to treat. It is characterized by severely itchy papules and nodules scattered over the extremities and buttocks. It is a multi-factorial skin disease that is often refractory to treatment. Treatments include topical steroids, topical calcineurin inhibitors, phototherapy, antidepressants, and other medications.

A recent article in the Journal of the American Academy of Dermatology described a cohort of patients who were placed on dupilumab ( a monoclonal antibody that inhibits IL-4 and IL-13 and otherwise known as Dupixent) who responded extremely well after 16 weeks of therapy. IL-4 and IL-13 may help stimulate the itch-sensory neuronal pathways; consequently, inhibiting this pathway would be theoretically helpful. Further studies are required to substantiate this finding but this gives patients with this condition some hope that there is an effective treatment.

Reference:

Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. Chiricozzi A, Maurelli M, Gori N, Argenziano G, De Simone C, Calabrese G, Girolomoni G, Peris K. J Am Acad Dermatol. 2020 Jul;83(1):39-45.

At Nakatsui DermaSurgery, sebaceous hyperplasia are most commonly treated with the CO2 resurfacing laser. A recent study on a new treatment modality was published in Dermatologic Surgery on the use of nanosecond pulsed electric field therapy. Each sebaceous hyperplasia lesion was treated 1-2 times. Ninety percent of lesions cleared with electric field therapy. With respect to pain, 54% reported mild pain, whereas 15% reported moderate pain with treatment Patients did experience hyperpigmentation although this gradually faded with time. At day 60, 45% of lesions were hyperpigmented. Redness and swelling were noted initially but did nor persist. One of the persistent side effects was that of small depressions at 19% of treatment sites.

This is an interesting new technique for treatment of sebaceous hyperplasia. Whether it will replace the use of CO2 resurfacing remains to be seen. Find out more about sebaceous hyperplasia.

Reference

Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Munavalli GS, Zelickson BD, Selim MM, Kilmer SL, Rohrer TE, Newman J, Jauregui L, Knape WA, Ebbers E, Uecker D, Nuccitelli R. Dermatol Surg. 2020 Jun;46(6):803-809.

Hidradenitis suppurativa is a chronic, inflammatory, acne-like condition affecting the skin folds. It is a difficult condition to treat, and treatments range from oral and topical antibiotics to injectable biologic medications like Humira (adalimumab).

One of the common antibiotic regimens is a combination of clindamycin and rifampin. A recent study in the Journal of the American Academy of Dermatology suggests that clindamycin alone may be just as effective as clindamycin and rifampin.

In this study, 60 patients were treated with either clindamycin alone or with a combination of clindamycin and rifampin. At the end of 8 weeks of therapy, the benefits were found to be similar in both groups.

Although more studies need to be done, this study suggests we may be able to treat this condition with a single antibiotic rather than a combination.