Martin A. Menter M.D.

Cizenski, J., J. Griffin and A. Menter (2016). “Image gallery: Cutaneous t-cell lymphoma mimicking a gyrate erythema.” Br J Dermatol 174(5): e42.

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A 22-year-old white man was evaluated for a mildly pruritic scaly rash of 6 years’ duration, which began on his chest and recently spread to the axillae and back. He initially presented to his primary doctor, who provided him with topical steroids without benefit. The eruption never ulcerated. Examination revealed pink annular and polycyclic patches on the chest, axillae and flanks without nodules, tumours or adenopathy. There was very faint scale at the borders of the lesions. A potassium hydroxide stain was negative for dermatophytes. Two biopsies revealed a CD8 predominant epidermotropic infiltrate of atypical lymphocytes with a clonal T-cell receptor rearrangement. Complete staging revealed stage IA disease. The indolent behaviour is consistent with mycosis fungoides with aberrant CD8+ phenotype. Current treatment includes a potent topical corticosteroid and close follow-up.

Campa, M., C. Ryan and A. Menter (2016). “Developing more open and equitable relationships with industry to improve advancements in clinical research in dermatology.” Br J Dermatol 174(6): 1365-1369.

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Relationships between physicians, scientists, and the pharmaceutical industry can be complicated by conflicts of interest. Honest and equitable relationships, however, are essential to the advancement of dermatologic clinical research. Several factors can increase transparency in clinical trials including preregistration of clinical trials, reporting of all data produced from clinical trials, non-industry ownership of clinical trial data, clarity of statistical methods and publication of both positive and negative results. Through collaborative, scientifically rigorous studies, physicians and industry can achieve significant advances in dermatologic care.

Fawaz, B., L. Dickson and A. Menter (2016). “Pustular psoriasis eruption with dabrafenib, a braf inhibitor.” J Dermatolog Treat Apr 14 [Epub ahead of print]

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Targeted BRAF inhibition with vemurafenib and dabrafenib has dramatically improved the survival rate in metastatic melanoma. These agents are now being tested for their efficacy against other tumors with BRAF mutations, including lung adenocarcinoma. While cutaneous adverse events are prevalent with BRAF inhibition, our patient, to our knowledge, is the first to develop a psoriatic eruption with BRAF inhibitors. We postulate that the elevation of tumor necrosis factor-alpha (TNF-alpha) and the paradoxical activation of the mitogen-activated protein kinase (MAPK) pathway due to BRAF inhibition may be responsible for the eruption. More studies are needed to further elucidate the immunopathogenic mechanisms behind this adverse event. The response to MEK inhibitors and/or increased TNF-alpha inhibition may help support or debunk our hypothesis.

Campa, M., B. Mansouri, R. Warren and A. Menter (2016). “A review of biologic therapies targeting il-23 and il-17 for use in moderate-to-severe plaque psoriasis.” Dermatology and therapy 6(1): 1-12.

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The development of several highly effective biologic drugs in the past decade has revolutionized the treatment of moderate-to-severe plaque psoriasis. With increased understanding of the immunopathogenesis of psoriasis, the emphasis has turned toward more specific targets for psoriasis drugs. Although the complex immunological pathway of psoriasis is not yet completely understood, current models emphasize the significant importance of interleukin (IL)-23 and IL-17. Several biologic drugs targeting these cytokines are now in various stages of drug development. Drugs targeting IL-23 include BI-655066, briakinumab, guselkumab, tildrakizumab, and ustekinumab. Drugs targeting IL-17 include brodalumab, ixekizumab, and secukinumab. While many of these have shown safety and good efficacy in clinical trials of moderate-to-severe plaque psoriasis, long-term safety is still to be established.

Blome, C., A. Costanzo, E. Dauden, C. Ferrandiz, G. Girolomoni, R. Gniadecki, L. Iversen, A. Menter, K. Michaelis-Wittern, A. Morita, H. Nakagawa, K. Reich and M. Augustin (2016). “Patient-relevant needs and treatment goals in nail psoriasis.” Qual Life Res 25(5): 1179-1188.

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PURPOSE: Patient-centered health care implies that medical decisions are made jointly by physician and patient, based on patient needs. Aims were to (a) identify treatment goals for a new questionnaire on patient needs and benefits in nail psoriasis treatment; (b) analyze the importance of treatment goals in patients with nail psoriasis in general and in defined subgroups; and (c) determine the association between overall treatment goal importance and quality of life. METHODS: The study comprised the following steps: qualitative survey on needs and burdens in 120 patients; development of items by an interdisciplinary expert group; item testing in 55 patients in four countries; revision of the questionnaire and assessment in 203 patients in six countries (Germany, Denmark, Italy, Spain, USA, Japan). The percentage of patients rating the goals as ‘quite/very important’ was compared between various patient subgroups. RESULTS: Based on 692 free-text statements, 26 items were developed which were reduced to 24 items after pilot testing. Each of these treatment goals applied to the majority of patients in the multi-center study. Goal importance increased with severity of nail psoriasis, but not with age or disease duration. Manual dexterity and social interaction were of particular importance. Goal importance and quality of life were associated, but not redundant (r = 0.612, p < 0.001). CONCLUSIONS: Patients with nail psoriasis have manifold and specific treatment goals. Goal importance is a construct different from disease-specific quality of life and should be assessed separately. The new questionnaire can support goal setting in clinical practice.