Dermatology

Moore, A.Y., Nguyen, M. and Moore, S. (2021). “Cyclic calcipotriene 0.005% foam and 1% 5-fluorouracil cream after cryotherapy in treatment of hyperkeratotic actinic keratosis: A retrospective study.” J Am Acad Dermatol 84(4): 1148-1150.

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Traditional treatments for actinic keratoses include cryotherapy, 5-fluorouracil cream, imiquimod, diclofenac, ingenol mebutate gel, and photodynamic therapy.1,2 Recent research suggests topical vitamin D3 as possibly efficacious by mounting a robust antitumor immunoresponse via T-cell recruitment.3 We hypothesized that these treatments may be synergistic and that vitamin D3 would enhance the efficacy of 5-fluorouracil cream in hyperkeratotic actinic keratoses treatment after cryotherapy. [No abstract; excerpt from article]

Menter, A., Krueger, G.G., Paek, S.Y., Kivelevitch, D., Adamopoulos, I.E. and Langley, R.G. (2021). “Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities.” Dermatol Ther (Heidelb) 11(2): 385-400.

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Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.

Fawaz, B., Chamseddin, B.H. and Griffin, J.R. (2021). “Defining the role of mirtazapine in the treatment of refractory pruritus.” J Dermatolog Treat 32(2): 132-136.

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BACKGROUND/OBJECTIVE: Mirtazapine has traditionally been used for the treatment of major depressive disorder, with an added benefit in patients who have comorbid insomnia or anxiety. Recent studies describe its usefulness in treating refractory pruritus of various causes as well. Our goal is to better define the use of mirtazapine in the treatment of refractory pruritus. METHOD: Through a thorough literature review of PubMed, we identified all reports of the use of mirtazapine for pruritus. RESULTS: Upon examination of 8 supporting articles, we found mirtazapine has quality evidence for the treatment of intra-thecal morphine-induced pruritus. Mirtazapine may also be effective in treating pruritus related to various other conditions, including psoriasis, atopic dermatitis, cutaneous malignancies (primary or metastatic), hematologic malignancies (lymphomas and leukemias), liver failure, renal failure, cholestasis, as well as pruritus of unknown origin. CONCLUSIONS: Mirtazapine plays a role in treatment for intra-thecel morphine-induced pruritis yet high-quality trials are needed to confirm its efficacy in other dermatologic conditions.

Menter, A., Krueger, G.G., Paek, S.Y., Kivelevitch, D., Adamopoulos, I.E. and Langley, R.G. (2021). “Interleukin-17 and Interleukin-23: A Narrative Review of Mechanisms of Action in Psoriasis and Associated Comorbidities.” Dermatol Ther (Heidelb) Jan 29. [Epub ahead of print].

Full text of this article.

Psoriasis is an immune-mediated inflammatory skin disease associated with numerous inflammatory comorbidities, including increased cardiovascular risk. The interleukin (IL)-23/IL-17 axis plays a central role in the immunopathogenesis of psoriasis and related comorbidities by acting to stimulate keratinocyte hyperproliferation and feed-forwarding circuits of perpetual T cell-mediated inflammation. IL-17 plays an important role in the downstream portion of the psoriatic inflammatory cascade. This review discusses the distinct mechanisms of action of IL-17 and IL-23 in the immunopathogenesis of psoriasis and related comorbidities plus the significant therapeutic benefits of selectively inhibiting these cytokines in patients with moderate to severe plaque psoriasis.

Azhar, A., Zaayman, M., Silfvast-Kaiser, A., Kivelevitch, D., Menter, A. and Paek, S.Y. (2020). “Ixekizumab in the treatment of moderate-to-severe plaque psoriasis: Patient adherence, satisfaction, and preferences.” Dermatol Ther Nov 1;e14486. [Online ahead of print.].

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Ixekizumab is a humanized monoclonal antibody that exhibits its immunomodulatory effects by binding to interleukin 17A (IL-17A), a proinflammatory cytokine. It was approved for the treatment of plaque psoriasis by the Food and Drug Administration in 2016. Ixekizumab has demonstrated superiority in clinical trials against etanercept, with no significant difference in the side effect profile. The chronicity of psoriasis requires continual treatment to achieve disease clearance. Many factors may affect adherence to treatment including patient satisfaction, patient preferences, medication cost, and medication side effects. Limited data on patient adherence, satisfaction, and preference exists in formal literature. Often, surrogate measures must be used to extrapolate information regarding these measures. In this narrative review, we describe patient adherence, satisfaction, and preferences via both direct and surrogate measures as they relate to ixekizumab treatment for moderate-to-severe plaque psoriasis.