WHAT S NEW AND EXCITING FROM JAAD Bruce H. Thiers, MD, Editor, JAAD Professor, Medical University of South Carolina Department of Dermatology and Dermatologic Surgery DISCLOSURES PFIZER VALEANT EFFECT OF TONSILLECTOMY ON PSORIASIS RACHAKONDA T ET AL. JAAD 2015;72:261-75 SOMETIMES IT WORKS ASSOCIATION OF HLA-Cw6 WITH STREP INFECTION AND IMPROVED PSORIASIS AFTER TONSILLECTOMY THORLEIFSDOTTIR T ET AL. JAAD 2016;75:epub A PRACTICAL GUIDE TO HOME PHOTOTHERAPY FOR PSORIASIS ANDERSON K ET AL. JAAD 2015;72:868-78 THE APPROPRIATE PATIENT THE TYPE OF UNIT THE TREATMENT REGIMEN POTENTIAL OBSTACLES SECUKINUMAB VS USTEKINUMAB FOR PSORIASIS THACI D ET AL. JAAD 2015;73:400-9 676 PTS; 52 WEEK DB STUDY WEEK 4 PASI 75: 50%(S) VS 21%(U) WEEK 16 PASI 100: 44%(S) VS 28%(U) PASI 90: 79%(S) VS 58%(U) 1
NEW PSORIASIS THERAPIES SECUKINUMAB APPROVED TARGETS IL-17A MROWIETZ U ET AL. JAAD 2015;73:27-36 IXEKIZUMAB APPROVED TARGETS IL-17A GORDON K ET AL. JAAD 2014;71:1176-82 BRODALUMAB ADCOMM TARGETS IL-17 RECEPTOR APREMILAST FOR PSORIASIS PAPP K ET AL. JAAD 2015;73:37-49 AN ORAL PDE4 INHIBITOR 33% W/PASI 75 @ 16 WEEKS DIARRHEA MAIN ADR APREMILAST FOR NAIL/SCALP PSORIASIS RICH P ET AL. JAAD 2016;74:134-42 APREMILAST FOR PALMOPLANTAR PSORIASIS RICH P ET AL. JAAD 2016;75:99-105 APREMILAST VS METHOTREXATE FOR PSORIASIS ARMSTRONG A ET AL. JAAD 2016;75:epub DATA FROM 2 TRIALS APREMILAST VS PLACEBO ADALIMUMAB VS METHOTREXATE VS PLACEBO PASI 75 RATES USED FOR COMPARISON EFFICACY SIMILAR APREMILAST WITH SIGNIFICANTLY HIGHER COST COST EFFICACY OF SYSTEMIC TREATMENTS FOR PSORIASIS D SOUZA L ET AL. JAAD 2015;72:589-98 COSTS/NNT TO REACH PASI 75 METHOTREXATE ($794-$1503) CYCLOSPORINE ($1410-$1844) INFLIXIMAB ($8705-$15236) USTEKINUMAB 90 MG ($12505-$14257) TOFACITINIB FOR PSORIASIS PAPP K ET AL. JAAD 2016;74:841-50 TOFACITINIB, A JAK INHIBITOR (XELJANZ ) POOLED DATA FROM 2 RANDOMIZED PHASE III STUDIES AND 1 OPEN-LABEL LONG TERM STUDY > 1000 PTS; PASI 12; 5-10 MG BID PASI REDUCTION 75% @ WEEK 28: 56%/69% PGA CLEAR/ALMOST CLEAR: 55%/66% ADRs < 11% 2
GUIDELINES OF CARE FOR MANAGEMENT OF ATOPIC DERMATITIS EICHENFIELD L ET AL. JAAD 2014;70:338-51 PART 1- DIAGNOSIS AND ASSESSMENT OF ATOPIC DERMATITIS PART 2- TOPICAL THERAPY (7/14) PART 3- PHOTOTHERAPY AND SYSTEMIC THERAPY (8/14) PART 4- PREVENTIVE AND ADJUNCTIVE THERAPIES (12/14) DUPILUMAB FOR ATOPIC DERMATITIS BECK L ET AL. NEJM 2014;371:130-9 THACI D ET AL. LANCET 2016;387:40-52 SIMPSON E ET AL. JAAD 2016;75:506-15 MONOCLONAL AB AGAINST IL-4/IL-13 DRIVES Th2-MEDIATED INFLAMMATION 5 SEPARATE STUDIES; > 500 PTS; MODERATE TO SEVERE ATOPIC DERMATITS VARYING DOSAGE COMBINATIONS x 4-12 WKS MARKED AND RAPID IMPROVEMENT ADRs SIMILAR TO PLACEBO TOPICAL CALCINEURIN INHIBITORS VS TOPICAL STEROIDS FOR ATOPIC DERMATITIS BROEDERS J ET AL. JAAD 2015;75:410-9 SYSTEMATIC REVIEW AND META-ANALYSIS 12 COMPARATIVE TRIALS SIMILAR EFFICACY CALCINEURIN INHIBITORS MORE EXPENSIVE CALCINEURIN INHIBITORS WITH MORE ADRs TOPICAL PDE-4 INHIBITORS FOR ATOPIC DERMATITIS OPA-15406 HANIFIN J ET AL. JAAD 2016;75:336-9 CRISABOROLE PALLER A ET AL. JAAD 2016;75:494-503 TREATMENT OF ATOPIC DERMATITIS WITH AN ORAL JANUS KINASE (JAK) INHIBITOR LEVY L ET AL. JAAD 2015;73:395-9 TOFACITINIB, A JAK INHIBITOR 6 PATIENTS; OPEN STUDY MODERATE TO SEVERE ATOPIC DERMATITIS ALL IMPROVED; 66% DECREASE IN SCORAD NO ADRs 3
REPIGMENTATION OF VITILIGO WITH ORAL RUXOLITINIB HARRIS J ET AL. JAAD 2016;74:370-1 RUXOLITINIB (JAKAFI ), A JAK INHIBITOR PATIENT ON RUXOLITINIB FOR COINCIDENT ALOPECIA AREATA AND VITILIGO BOTH CONDITIONS RESPONDED HAIR GROWTH MAINTAINED, BUT PIGMENTATION LOST, WHEN TREATMENT DISCONTINUED ALTERNATIVE TREATMENTS FOR ALOPECIA AREATA SIMVASTATIN/EZETIMIBE LATTOUF C ET AL. JAAD 2015;72:359-61 PULSE ORAL DEXAMETHASONE VANO-GALVAN ET AL. JAAD 2016;74:1005-7 ORAL AZATHIOPRINE VANO-GALVAN ET AL. JAAD 2016;74:1007-8 GUIDELINES OF CARE FOR THE MANAGEMENT OF ACNE VULGARIS ZAENGLEIN A ET AL. JAAD 2016;74:945-73 EVIDENCE-BASED GUIDELINE REVIEWS GRADING, TOPICAL AND SYSTEMIC MANAGEMENT 4
TREATMENT OF RECALCITRANT PEMPHIGUS, PEMPHIGOID & MMP AHMED A ET AL. JAAD 2016; 74:700-8 HUANG A ET AL. JAAD 2016; 74:746-53 MALEY A ET AL. JAAD 2016;74:835-40 IMMUNOSUPPRESSANTS, RITUXIMAB +/- IVIg, AND FUTURE ANTI-B CELL BIOLOGICS STEROIDS VS CYCLOSPORINE FOR PYODERMA GANGRENOSUM ORMEROD A ET AL. BMJ 2015;350:h2958 121 PATIENTS PREDNISOLONE 0.75 MG/KG/DAY (MAX = 75 MG/DAY) VS CYCLOSPORINE 4 MG/KG/DAY (MAX = 400 MG/DAY) EQUALLY EFFECTIVE TOPICAL THERAPY FOR PYODERMA GANGRENOSUM THOMAS K ET AL. JAAD 2016:75:epub TREATMENT OF GRANULOMA ANNULARE WITH ADALIMUMAB MIN M ET AL. JAAD 2016;74:127-33 7 ADULTS; RECALCITRANT DISEASE PSORIASIS DOSING SOME REQUIRED WEEKLY DOSING ALL IMPROVED SOME RECURRED AFTER TREATMENT D/C D NO SIGNIFICANT ADRs 5
PREGNANCY AND DERMATOLOGIC THERAPY TYLER K ET AL. JAAD 2013;68:663-71 TOPICAL AND SYSTEMIC THERAPIES WHAT NOT TO USE, WHAT TO USE, AND WHEN TO USE IT SAFETY OF DERMATOLOGIC MEDICATIONS IN PREGNANCY MURASE J ET AL. JAAD 2014;70:401-14 SAFETY OF DERMATOLOGIC MEDICATIONS IN LACTATION MURASE J ET AL. JAAD 2014;70:417-26 WOUND HEALING AND TREATMENT MORTON L ET AL. JAAD 2016;74:589-605 VENOUS LEG ULCERS MARCH J ET AL. JAAD 2016;74:607-25 HAIR FOLLICLE-CONTAINING PUNCH GRAFTS MARTINEZ-MARTINEZ M ET AL. JAAD 2016:75:epub 6
TOPICAL TIMOLOL FOR ULCERATED INFANTILE HEMANGIOMAS BOOS M ET AL. JAAD 2016;74:567-70 RETROSPECTIVE ANALYSIS; 30 CHILDREN 1-2 DROPS BID X ~ 3 MONTHS ULCERATED LESIONS MOSTLY IN FOLDS 21 RESOLVED PROSPECTIVE, RANDOMIZED STUDIES NEEDED PHOTOTHERAPY OF CUTANEOUS T CELL LYMPHOMA OLSEN ET AL. JAAD 2016;74:27-58 GUIDELINES AND COMPREHENSIVE REVIEW APPROPRIATE USE CRITERIA FOR MOHS MICROGRAPHIC SURGERY AD HOC TASK FORCE. JAAD 2012;67:531-50 WHY APPROPRIATE USE CRITERIA FOR MOHS MICROGRAPHIC SURGERY? COLDIRON B ET AL. JAAD 2012;67:551 7
TREATMENT OF LOW RISK BCC AT THE END OF LIFE POINT: LINOS E ET AL. JAAD 2015;73:158-61 COUNTERPOINT: FOSKO S ET AL. JAAD 2015;73:162-4 NEW TECHNOLOGIES FOR MELANOMA DIAGNOSIS PART 1: NONINVASIVE APPROACHES MARCH J ET AL. JAAD 2015;72:929-41 NEW TECHNOLOGIES FOR MELANOMA DIAGNOSIS PART 2: MOLECULAR APPROACHES MARCH J ET AL. JAAD 2015;72:943-58 COMPUTER-AIDED CLASSIFICATION OF MELANOCYTIC LESIONS USING DERMOSCOPIC IMAGES FERRIS L ET AL. JAAD 2015;73:769-76 SENSITIVITY: 97.4% ( ) SPECIFICITY: 44.2% ( ) 1 CM VS 2 CM EXCISION MARGINS FOR MELANOMA 2 MM HUNGER R ET AL. JAAD 2015;72:1054-9 1 CM (228 PTS) VS 2 CM (97 PTS) MARGINS RETROSPECTIVE STUDY MEAN BRESLOW THICKNESS = 4.36 MM MEAN FOLLOW UP = 1852 DAYS NO DIFFERENCE IN LOCOREGIONAL OR DISTANT METASTASIS NO DIFFERENCE IN DISEASE-FREE OR OVERALL SURVIVAL 8
NEW THERAPIES FOR METASTATIC MELANOMA TARGETED THERAPIES KIT (IMATINIB) BRAF (VEMURAFENIB, DABRAFENIB) MEK (COBIMETINIB, TRAMETINIB) IMMUNOSTIMULATION ANTI-CTLA 4 (IPILIMUMAB) ANTI-PD 1 (LAMBROLIZUMAB, NIVOLUMAB, PEMBROLIZUMAB) SURGICAL TECHNIQUE FOR OPTIMIZING OUTCOMES MILLER C ET AL. JAAD 2015;72:377-87,389-402 PART 1: CUTTING TISSUE INCISING, EXCISING AND UNDERMINING PART 2: REPAIRING TISSUE SUTURING GUIDELINES FOR THE USE OF LOCAL ANESTHESIA IN OFFICE-BASED DERMATOLOGIC SURGERY KOUBA D ET AL. JAAD 2016;74:1201-19 EVIDENCE-BASED GUIDELINE REVIEWS USE, SAFETY, AND PATIENT PREFERENCES USING BICARBONATE BUFFERED LIDOCAINE ISEDEH P ET AL. JAAD 2016;75:454-5 9