Dermatology

Cizenski, J. D., P. Michel, I. T. Watson, J. Frieder, E. G. Wilder, J. M. Wright and M. A. Menter (2017). “Spectrum of orocutaneous disease associations: Immune-mediated conditions.” J Am Acad Dermatol 77(5): 795-806.

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There are a number of diseases that manifest both on the skin and the oral mucosa, and therefore the importance for dermatologists in clinical practice to be aware of these associations is paramount. In the following continuing medical education series, we outline orocutaneous disease associations with both immunologic and inflammatory etiologies.

Michel, P., A. Menter and J. Griffin (2017). “A congenital naevus in a blaschkoid distribution.” Clin Exp Dermatol: 2017 Oct [Epub ahead of print].

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NC is a rare hamartomatous proliferation of the pilo-sebaceous unit, usually evident at birth or appearingin early childhood. Most NCs arise sporadically, with afew adult onset cases reported secondary to trauma orirritation.1Men and women are equally affected, andthere is no evidence of racial aggregation. Rare associ-ations with cataracts, skeletal defects or central ner-vous system abnormalities characterize NC syndrome.

Strober, B., M. Gooderham, E. de Jong, A. B. Kimball, R. G. Langley, N. Lakdawala, K. Goyal, F. Lawson, W. Langholff, L. Hopkins, S. Fakharzadeh, B. Srivastava and A. Menter (2017). “Depressive symptoms, depression, and the effect of biologic therapy among patients in psoriasis longitudinal assessment and registry (psolar).” J Am Acad Dermatol: 2017 Oct [Epub ahead of print].

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BACKGROUND: Patients with psoriasis are at an increased risk for depression. However, the impact of treatment on this risk is unclear. OBJECTIVE: Evaluate the incidence and impact of treatment on depression among patients with moderate-to-severe psoriasis. METHODS: We defined a study population within the Psoriasis Longitudinal Assessment and Registry and measured the incidence of depressive symptoms (Hospital Anxiety and Depression Scale-Depression score >/=8) and adverse events (AEs) of depression within cohorts receiving biologics, conventional systemic therapies, or phototherapy. Patients were evaluated at approximately 6-month intervals. Multivariate modeling determined the impact of treatment on risk. RESULTS: The incidence rates of depressive symptoms were 3.01 per 100 patient-years (PYs) (95% confidence interval [CI], 2.73-3.32), 5.85 per 100 PYs (95% CI, 4.29-7.97), and 5.70 per 100 PYs (95% CI, 4.58-7.10) for biologics, phototherapy, and conventional therapy, respectively. Compared with conventional therapy, biologics reduced the risk for depressive symptoms (hazard ratio, 0.76; 95% CI, 0.59-0.98), whereas phototherapy did not (hazard ratio, 1.05; 95% CI, 0.71-1.54). The incidence rates for AEs of depression were 0.21 per 100 PYs (95% CI, 0.15-0.31) for biologics, 0.55 per 100 PYs (95% CI, 0.21-1.47) for phototherapy, and 0.14 per 100 PYs (95% CI, 0.03-0.55) for conventional therapy; the fact that there were too few events (37 AEs) precluded modeling. LIMITATIONS: Incomplete capture of depression and confounders in the patients on registry. CONCLUSION: Compared with conventional therapy, biologics appear to be associated with a lower incidence of depressive symptoms among patients with psoriasis.

Strober, B. E., R. G. B. Langley, A. Menter, M. Magid, B. Porter, T. Fox, J. Safi, Jr. and C. Papavassilis (2017). “No elevated risk for depression, anxiety, or suicidality with secukinumab in a pooled analysis of data from 10 clinical studies in moderate-to-severe plaque psoriasis.” Br J Dermatol: 2017 Oct [Epub ahead of print].

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Concerns have emerged over the potential for brodalumab, a monoclonal antibody that binds to the human interleukin (IL)-17 receptor A and blocks the activity of multiple IL-17 isoforms, to increase risk of suicidal ideation and behaviour. Although the validity of this association has been questioned,1,2 brodalumab has a boxed warning regarding suicidality in its US label and is only available through a Risk Evaluation and Mitigation Strategy. Regardless of the true association between suicidality and brodalumab, the demonstrated adverse impact of psoriasis on mental health necessitates careful assessment for possible psychiatric adverse effects of psoriasis therapies, including those that inhibit the IL-17 pathway.

Roostaeyan, O., D. Kivelevitch and A. Menter (2017). “A review article on brodalumab in the treatment of moderate-to-severe plaque psoriasis.” Immunotherapy 9(12): 963-978.

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Psoriasis is a chronic immune-mediated skin disorder affecting approximately 2-3% of the worldwide population. Recent advances in our understanding of the immunopathogenesis of psoriasis have resulted in novel therapeutic agents. IL-17, a pro-inflammatory cytokine, plays a pivotal role in psoriasis. Therapeutic agents targeting this cytokine have shown clinical effectiveness in the treatment of moderate-to-severe plaque psoriasis. Brodalumab, a human antibody against IL-17 receptor A, has been approved by the US FDA in February 2017, by the Japanese Pharmaceuticals and Medical Devices Agency in July 2016 and by the EMA in July 2017 for the treatment of moderate-to-severe psoriasis. This article reviews the published data relating to brodalumab for the treatment of moderate-to-severe plaque psoriasis.