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Background: Alopecia areata (AA) is a hair loss disorder that can seriously impact quality of life. Janus kinase (JAK) inhibitors, including deuruxolitinib, have previously demonstrated significant hair regrowth in AA., Objective: The Phase 3 THRIVE-AA1 randomized, double-blinded, placebo-controlled trial (NCT04518995) evaluated the safety and efficacy of the oral JAK1/JAK2 inhibitor deuruxolitinib in adult patients with AA., Methods: Patients aged 18-65 years with ≥50% hair loss were randomized to deuruxolitinib 8 mg twice daily, deuruxolitinib 12 mg twice daily, or placebo for 24 weeks. The primary end point was the percentage of patients achieving a Severity of Alopecia Tool score ≤20. A key secondary end point was the percentage of satisfaction of hair patient-reported outcome responders., Results: Significantly higher proportions of patients taking deuruxolitinib met the primary end point (8 mg 29.6%; 12 mg 41.5% versus placebo 0.8%). Both deuruxolitinib doses achieved significant improvements in all secondary end points versus placebo, including satisfaction of hair patient-reported outcome (8 mg 42.1%; 12 mg 53.0% versus placebo 4.7%). Most treatment-emergent adverse events were mild or moderate, consistent with other oral JAK inhibitors., Limitations: Further studies are required to understand longer-term safety, efficacy, and impact of treatment cessation., Conclusion: Both doses of deuruxolitinib were effective for hair regrowth. Patient satisfaction aligned with hair growth., Competing Interests: Conflicts of interest Dr King has served on advisory boards and/or is a consultant and/or is a clinical trial investigator for AbbVie, AltruBio Inc, Almirall, AnaptysBio, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Equillium, Horizon Therapeutics, Eli Lilly, Incyte Corp., Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, TWi Biotechnology Inc, and Viela Bio Inc; also served on speaker bureaus for AbbVie, Incyte, Eli Lilly, Pfizer, Regeneron, and Sanofi Genzyme and is a scientific advisor for BiologicsMD. Dr Senna has been a speaker for Eli Lilly and Pfizer and a principal investigator and/or received research funding from Follica, Eli Lilly, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Santiste Medical, and LEO Pharma; has also served on scientific advisory boards and/or been a consultant for Eli Lilly, Follica, L'Oreal, Kintor, and Pfizer, and is on the board of directors/medical advisory board for the National Alopecia Areata Foundation, Scarring Alopecia Foundation, and the American Hair Research Society. Dr Mesinkovska has been an advisor for CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, and Pfizer, a principal investigator for AbbVie, Arcutis Biotherapeutics, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, and Pfizer and a speaker for Eli Lilly. Dr Lynde has been a speaker and/or consultant for AbbVie, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Dermavant, Devonian, Eli Lilly, Fresenius Kabi, Galderma, GSK, Incyte, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L'Oreal, Medexus, MedX, Merck, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharmaceutical Industries Limited, TEVA, Tribute, UCB, Viatris, and Volo Health; and has also been a principal investigator for AbbVie, Acelyrin, Akros, Altius, Amgen, Aralez, Arcutis, Avillion, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cipher, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, Devonian, Eli Lilly, Evelo, Galderma, GSK, Incyte, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L'Oreal, Medexus, MedX, Merck, MoonLake, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharmaceutical Industries Limited, TEVA, Tribute, UCB, Valeant, Viatris, and Volo Health. Dr Zirwas has been an investigator and/or speaker and/or consultant for AbbVie, Acrotech, Aldeyra, Advanced Derm Solutions, All Free Clear/Sun, Amgen, Anaptys Bio, Apogee, Arcutis, Bausch and Lomb, Biocon, Bristol Myers Squibb, Cara, Castle Biosciences, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Connect Biopharma, Dermavant, Edessa Biotech, EPI Health, Evelo, Galderma, Genentech/Novartis, Incyte, Janssen, L'Oreal, LEO Pharma, Level-Ex, Eli Lilly, LUUM, Nimbus, Oculus, Peloton, Pfizer, Regeneron/Sanofi, Trevi, Trifecta, and UCB; has also been an advisor for Vial and is part owner of AsepticMD. Dr Maari has served on advisory boards and/or is a consultant and/or is a clinical trial investigator for AbbVie, Almirall, AnaptysBio, Arena Pharmaceuticals, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Horizon Therapeutics, Eli Lilly, Incyte Corp., Janssen Pharmaceuticals, LEO Pharma, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, Valeant, Dermavant, Novartis, Amgen, and UCB. Dr Prajapati has been an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Aralez, Arcutis, Aspen, Bausch Health, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, Tribute, UCB, and Valeant; investigator for AbbVie, AnaptysBio, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, RAPT Therapeutics, Regeneron, Reistone, Sanofi Genzyme, Takeda, and UCB; received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Dr Sapra has been a principal investigator, consultant, or speaker for AbbVie, Amgen, Arcutis, Avillion, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, Eli Lilly, Galderma, GSK, Incyte, Innovaderm, Janssen, LEO Pharma, Merz, Novartis, Pfizer, Pulse Biosciences, Regeneron, Roche, Sanofi, UCB, and Valeant. Dr Brzewski has been a principal investigator and/or consultant for AbbVie, Acelyrin, Alvotech Swiss, Amgen, BenevolentAI, Bioeq GmbH, Biogen, Celltrion, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, Horizon Therapeutics, Janssen, LEO Pharma, Pfizer, Regeneron, and Samsung Bioepis. Dr Osman has been an advisor for AbbVie, Affibody, Allergan, Amgen, AnaptysBio, Arcutis, Aurigene, Botanix, Castle Biosciences, Chemocentryx, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, DS Biopharma, Eli Lilly, Foamix Pharmaceuticals, Galderma, Janssen, Incyte, LEO Pharma, Reistone, Sun Pharmaceutical Industries Limited, and Valeant. Dr Hanna has been an advisory board member, principal investigator, investigator, speaker, and/or consultant for AbbVie, Akros, Allergan, Altius Healthcare, Amgen, Aralez, Arcutis, Bausch Health, Biopharma, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Cutanea, Dermira, Galapagos, Galderma, Glenmark, Incyte, Janssen, LEO Pharma, Lilly, Lumenis, Merz, Novartis, Pediapharma, Pfizer, Prollenium, Regeneron, Revanesse, Reistone, Sandoz, Sanofi, Sun Pharma, and UCB. Dr Wiseman has been a principal investigator, consultant, advisor, or speaker for Acelyrin, AbbVie (previously Abbott), Akros, Amgen, Arcutis, Asana BioSciences, AstraZeneca, Bausch Health, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Celgene, Dermavant, Dermira, Dice, Eli Lilly, Evelo, Galderma, Glenmark, Incyte, Janssen, LEO Pharma A/S, L'Oreal, Merck Frosst Canada, Moonlake, Novartis, Pfizer, Principia, PRCL Research, Regeneron, Sanofi, Takeda, Timber. Drs Hamilton and Cassella are employees of Sun Pharmaceutical Industries, Inc., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Real-world knowledge of the burden of hidradenitis suppurativa (HS) on patients remains limited., Objectives: To measure the impact of adalimumab on moderate-to-severe HS patients' health-related quality of life (HRQoL) and work productivity., Methods: In 23 Canadian centres, 138 adults with moderate-to-severe HS requiring a change in ongoing therapy were treated with adalimumab for up to 52 weeks as per the physician's practice. Patient-reported outcome measures (PROMs) were obtained at baseline, weeks 24 and 52 to measure overall HRQoL, HS severity, levels of anxiety and depression, impact and symptoms of HS, work productivity and activity impairment. A post-hoc analysis further explored the PROMs by abscess and inflammatory nodule (AN) count at baseline (≤5, low; 6-10, medium; ≥11, high)., Results: From baseline to weeks 24 and 52, all PRO overall scores improved significantly ( P ≤ .0023). The number of patients reporting "good disease control" and "complete disease control" increased from 9.7% to 66.4% over 52 weeks. The score in Health Utility Index Mark 3 (HUI3) pain attribute meaningfully decreased over 52 weeks (mean difference ≥.05). The HS symptoms skin "tenderness" and "itchiness" improved the most. Work productivity loss and activity impairment improved by approximately 20% over 52 weeks. Disease burden improved more in 24 week responders with low and medium AN counts at baseline than in those with high AN count or in 24 week nonresponders., Conclusion: At week 24 and maintained at week 52 in a real-world setting, adalimumab meaningfully improved HRQoL, work productivity, and activity impairment in moderate-to-severe HS patients.

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide., Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics., Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience)., Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree., Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients., Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

Vandetanib is an oral tyrosine kinase inhibitor with cutaneous adverse effects that include the development of acne. We present a patient who underwent vandetanib therapy for stage IV medullary thyroid cancer in conjunction with the use of doxycycline for acne that developed. After vandetanib use, blue-grey pigmentation developed in the acne on his face, chest, back, and arms, which darkened after the use of doxycycline. We review the literature to report that this blue-grey hyperpigmentation was likely vandetanib-induced but may have been the result of both drugs being used in combination., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2022.)

The Iroquoian and Algonquian-speaking Peoples of North America discovered numerous natural treatments to dermatological conditions long prior to European settlement. Anthropological evidence suggests that treatments for atopic dermatitis, dermatophyte infections, and syphilitic lesions were derived from Sassafras albidum , genus Salix trees, and S assafras officinale . Literature suggests these medicinal properties are attributed to the naturally abundant safrole, salicylic acid, and ascorbic acid in these flora. Numerous instances of these natural medicinal discoveries later being implemented into European literature reaffirms the impact of Indigenous medicine on contemporary dermatology.

The severe acute respiratory syndrome coronavirus 2 pandemic has necessitated enhanced protection against viral transmission among healthcare professionals, particularly relating to handwashing and personal protective equipment. Some of these requirements may persist for years to come. They bring associated concerns around skin hygiene and general care, with damage to the face and hands now a well-documented consequence among healthcare professionals. This review assesses optimal skin care during the severe acute respiratory syndrome coronavirus 2 pandemic and in the "new normal" that will follow, identifies current knowledge gaps, and provides practical advice for the clinical setting. Regular, systematic hand cleaning with soap and water or an alcohol-based hand rub (containing 60%-90% ethanol or isopropyl alcohol) remains essential, although the optimal quantity and duration is unclear. Gloves are a useful additional barrier; further studies are needed on preferred materials. Moisturization is typically helpful and has proven benefits in mitigating damage from frequent handwashing. It may be best practiced using an alcohol-based hand rub with added moisturizer and could be particularly important among individuals with pre-existing hand dermatoses, such as psoriasis and eczema. Face moisturization immediately prior to donning a mask, and the use of dressings under the mask to reduce friction, can be helpful dermatologically, but more work is required to prove that these actions do not affect seal integrity. Nonetheless, such measures could play a role in institutional plans for mitigating the dermatologic impact of transmission control measures as we exit the pandemic., Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.K.R. has been a consultant, investigator, and speaker for AbbVie, Allergan, Galderma, Leo Pharma, and Pfizer; is a consultant for MetaOptima Technology Inc.; and is the founder and a shareholder of Riversol Skin Care Solutions Inc. J.P.A. reports no conflicts of interest to disclose. J.D. reports no conflicts of interest to disclose. L.C.G. has been a consultant, investigator, and speaker for AbbVie, Allergan, Janssen, and La Roche-Posay, and a speaker for Johnson & Johnson and Pierre Favre. C.M. reports no conflicts of interest to disclose. V.R. has been an investigator for AbbVie, Allergan, Galderma, Leo Pharma and Pfizer, and a speaker and consultant for AbbVie, Bausch Health, Celgene, Eli Lilly, Galderma, Janssen, Leo Pharma, L’Oréal (La Roche-Posay), Novartis, Pfizer, Proctor & Gamble, and Sanofi. N.R. reports no conflicts of interest to disclose. J.-F.T. reports no conflicts of interest to disclose. M.C.W. reports no conflicts of interest to disclose. C.Z. reports no conflicts of interest to disclose. D.Z. has been a consultant, investigator, and speaker for Genentech/Roche and Sanofi Genzyme., (© The Author(s) 2021.)

Background: Long-term, real-word data are needed to help manage patients with hidradenitis suppurativa (HS) through this recurrent, painful and debilitating disease., Objectives: To primarily measure real-world effectiveness of adalimumab in HS and to secondarily observe clinical course of HS in the light of patients' response., Methods: In SOLACE, adults with moderate-to-severe HS in need for change in ongoing therapy were treated with adalimumab for up to 52 weeks as per physician's medical practice. Treatment effectiveness was measured by Hidradenitis Suppurativa Clinical Response (HiSCR). Inflammatory nodules, abscesses and draining fistulas were counted, Hurley stage was assessed, and disease severity was rated using the International HS Severity Scoring System (IHS4). A post hoc analysis further explored the HiSCR response by abscess and inflammatory nodule (AN) count at baseline (low, medium and high) and gender. Spontaneously reported safety events were collected., Results: From 23 Canadian centres, 69% of the 138 patients achieved HiSCR at week 24, which increased to 82% and 75% at week 52 in patients with medium and high AN counts, respectively. Gender (4 times the odds for female) and age at HS onset (5% decrease with each additional year) had an effect on achieving HiSCR. Treatment with adalimumab led to an important decrease in number of lesions in responders, with most gains observed in inflammatory nodules, more frequently in the lower body area of patients in the high AN count group. The IHS4 scores of responders were substantially lowered, with a larger decrease in patients of the high AN count group. No new safety signal was detected., Conclusions: The effectiveness of adalimumab was maintained during this 1-year period, and an optimal gain was documented for patients with medium and high AN counts. These real-world data support a prompt treatment of HS patients and the use of IHS4 to monitor treatment., (© 2021 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Competing Interests: None disclosed.

Background: Atopic dermatitis is a chronic, relapsing and remitting disease that can be difficult to treat despite a recently approved biologic therapy targeting IL-4/IL-13 receptor. Oral janus kinase inhibitors (JAKi) represent a novel therapeutic class of targeted therapy to treat moderate-to-severe atopic dermatitis (AD). Objective: To review the efficacy, safety, and pharmacokinetic characteristics of oral JAKi in the treatment of AD. Methods: A PRISMA systematic review was conducted using MEDLINE, EMBASE (Ovid), and PubMed databases for studies assessing the efficacy, safety, and/or pharmacokinetic properties of oral forms of JAKi in the treatment of AD in pediatric or adult populations from inception to June 2021. Results: 496 papers were reviewed. Of 28 articles that underwent full text screening, 11 met our inclusion criteria for final qualitative review. Four studies examined abrocitinib; three studies examined baricitinib; three examined upadacitinib and one examined gusacitinib (ASN002). Significant clinical efficacy and a reassuring safety profile was reported for all JAKi agents reviewed. Rapid symptom control was reported for abrocitinib, baricitinib and upadacitinib. Limitations: Given the relatively limited evidence for each JAKi and the differences in patient eligibility criteria between studies, the data was not deemed suitable for a meta-analysis at this time. Conclusion: Given their ability to achieve rapid symptom control with a reassuring safety profile, we recommend considering the use of JAKi as a reliable systemic treatment option for adult patients with moderate-to-severe AD, who are unresponsive to topical or skin directed treatments., Competing Interests: MB an advisory board member and speaker for AbbVie, Amgen, Leo Pharma, and Janssen; a speaker for Astellas and Merck; and an investigator for AbbVie, Astellas, Amgen, Leo Pharma, Novartis, Janssen, Sun Pharma, Lilly, Pfizer, and Celgene; LF an investigator for Pfizer, Amgen, Leo, and received honoraria as speaker and participant of advisory boards from the same companies. She is also a speaker for Pierre Fabre and Galderma; MG has been an investigator, speaker or advisory board member for Abbvie, Akros, Amgen, Arcutis, Boehringer Ingelheim, BMS, Celgene, Dermira, Dermavant, Galderma, GSK, Eli Lilly, Incyte, Janssen, Kyowa Kirin, Leo Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharmaceuticals, UCB, Valeant/Bausch; LG has been a consultant, advisory board member, speaker and clinical trials principal investigator for AbbVie, Eli Lilly, LaRoche Posay, Leo Pharma, Pfizer and Roche, and a consultant, advisory board member and speaker for Bausch Health, Johnson & Johnson, and Sanofi Aventis. SH has been a consultant and/or advisor and/or investigator for or received honoraria from Abbvie, Akros, Altius Healthcare, Amgen, Aralez, Arcutis, Bausch Health, Biopharma, BMS, Boehringer-Ingelheim, Celgene, Coherus, Concert Pharma, Cutanea, Dermira, Galderma, Glenmark, Incyte, Janssen, Leo, Lilly, Novartis, Pedia-Pharm, Pfizer, Regeneron, Sandoz, Sanofi, Sun Pharma, UCB; HH has been a consultant and/or advisor and/or investigator for or received honoraria from Abbvie, Amgen, Arcutis, Bausch Health, Boerhinger Ingelheim, Bristol Meyers Squibb, Celgene, Dermavant, Dermira, DS Biopharma, Eli Lilly, Galderma, GlaxoSmithKline, Incyte, Janssen, Leo Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma, and UCB; PL has been a consultant and/or advisor and/or investigator for or received honoraria from Abbvie, Amgen, Aralez, Bausch Health, Boehringer-Ingelheim, Celgene, Dermira, Galderma, Janssen, Leo, Lilly, Novartis, Pfizer, Regeneron, Sanofi, Sun Pharma; DM has been a consultant and/or investigator and/or speaker for Abbvie, Celgene, Janssen, Leo Pharma, Lilly, Novartis, Pfizer, Regeneron, Sanofi, UCB; MW reports having received honoraria for ad board participation from Novartis, Sun Pharma and Pfizer; JY has been a speaker, consultant, and investigator for AbbVie, Allergan, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Meyers Squibb, Celgene, Centocor, Coherus, Dermavant, Dermira, Forward, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa, Leo Pharma, Lilly, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon. CL was a consultant, speaker, and advisory board member for Amgen, Pfizer, AbbVie, Janssen, Novartis, and Celgene, and was an investigator for Amgen, Pfizer, AbbVie, Janssen, Lilly, Novartis, and Celgene. Dr Poulin was a speaker and advisory board member for AbbVie, Amgen, and Janssen, and was an investigator for AbbVie, Amgen, Celgene, Centocor, Lilly, Galderma, Incyte, Sun Pharma, Janssen, Leo Pharma, Merck, Novartis, Pfizer, and Roche; IVL received grant funding from Novartis, Merck, AbbVie, and Bristol Myers Squibb and honoraria from Janssen, Bausch, Galderma, Novartis, Pfizer, Sun Pharmaceuticals, Johnson & Johnson, and Actelion. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Le, Berman-Rosa, Ghazawi, Bourcier, Fiorillo, Gooderham, Guenther, Hanna, Hong, Landells, Lansang, Marcoux, Wiseman, Yeung, Lynde and Litvinov.)

Psoriasis is a chronic and debilitating inflammatory immune-mediated skin disorder. Several cytokines including interleukin (IL)-23 were demonstrated to play a central role in the pathogenesis of this disease. Treatment options for psoriasis range from topical to systemic modalities, depending on the extent, anatomical locations involved and functional impairment level. Targeting cytokines or their cognate receptors that are involved in disease pathogenesis such as IL-12/23 (i.e., targeting the IL-12p40 subunit shared by these cytokines), IL-17A, IL-17F, IL-17RA, and TNF-α using biologic agents emerged in recent years as a highly effective therapeutic option for patients with moderate-to-severe disease. This review provides an overview of the important role of IL-23 signaling in the pathogenesis of psoriasis. We describe in detail the available IL-23 inhibitors for chronic plaque psoriasis. The efficacy, pharmacokinetic properties, and the safety profile of one of the most recent IL-23 biologic agents (tildrakizumab) are evaluated and reviewed in depth., Competing Interests: LK has received honoraria and research grants as a consultant, investigator, speaker, and/or advisory board member for Abbott, Acambis, Allergan, Amgen, Assos Pharma, Astellas Pharma US, Asubio, Berlex Laboratories (Bayer HealthCare Pharmaceuticals), Biogen Idec, Biolife, Biopelle, Breckinridge Pharma, Colbar, Celgene, Centocor, CollaGenex, Combinatrix, Connetics, Coria, Dermik Laboratories, Dow Pharmaceutical Sciences, Dusa, Embil Pharmaceuticals, EOS, Ferndale Laboratories, Galderma, Genentech, GlaxoSmithKline, Health Point, Intendis, Innovail, Johnson & Johnson, Laboratory Skin Care, LEO Pharma, 3M, Medical International Technologies, Merck, Medicis Pharmaceutical, Merz, Nano Bio, Novartis, Nucryst Pharmaceuticals, Obagi, Onset, OrthoNeutrogena, Promius, QLT, PharmaDerm, Pfizer, Quatrix, Serono (Merck Serono International SA), SkinMedica, Stiefel, Sun Pharmaceutical Industries, TolerRx, Triax, Valeant Pharmaceuticals Intl, Warner-Chilcott, and ZAGE. YP has received grant funding and honoraria for services as an investigator, speaker, and member of advisory boards from AbbVie, Amgen, Bausch, Janssen-Ortho, UCB Biopharma, and has received grant funding as an investigator from AnaptysBio, Arcutis biotherapeutics, Asana, Astrazeneca, Baxalta, Baxter, Boehringer Ingelheim, Bond Avillion, Bristol Myers Squibb, Celgene, Dermira, Devonian, Galderma, Genentech, Glaxo Smith Kline, Eli Lilly, Incyte, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sun Pharmaceutical Industries, Serono, Takeda. MB an advisory board member and speaker for AbbVie, Amgen, Leo Pharma, and Janssen; a speaker for Astellas and Merck; and an investigator for AbbVie, Astellas, Amgen, Leo Pharma, Novartis, Janssen, Sun Pharma, Lilly, Pfizer, and Celgene. RV was a speaker for AbbVie, Amgen, Celgene, Galderma, Janssen, Leo Pharma, Novartis, and Pfizer, and was an investigator for AbbVie, Amgen, Celgene, Galderma, Janssen, Leo Pharma, Novartis, Sun Pharmaceutical Industries, Pfizer, Lilly, and Merck. MW reports having received honoraria for ad board participation from Novartis, Sun Pharmaceutical Industries and Pfizer. CL was a consultant, speaker, and advisory board member for Amgen, Pfizer, AbbVie, Janssen, Novartis, and Celgene, and was an investigator for Amgen, Pfizer, AbbVie, Janssen, Lilly, Novartis, and Celgene. YP was a speaker and advisory board member for AbbVie, Amgen, and Janssen, and was an investigator for AbbVie, Amgen, Celgene, Centocor, Lilly, Galderma, Incyte, Sun Pharmaceutical Industries, Janssen, Leo Pharma, Merck, Novartis, Pfizer, and Roche. IL received research grant funding from Novartis, Merck, Abbvie, and Bristol Myers Squibb and honoraria from Janssen, Bausch, Galderma, Novartis, Pfizer, Sun Pharmaceutical Industries, Johnson & Johnson, and Actilion. Topics included in this article were based on, but not limited to, broad discussions at an advisory board meeting, which was sponsored and funded by Sun Pharma Canada, Inc. Consultancy fees were paid to meeting participants (LK, MB, YP, RV, MW, CL, and IL). Sun Pharma Canada, Inc., participated in developing the content for the meeting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ghazawi, Mahmood, Kircik, Poulin, Bourcier, Vender, Wiseman, Lynde and Litvinov.)

Background: Acne vulgaris (acne), a common inflammatory skin disorder, has its peak incidence between 14 and 19 years of age, with girls frequently developing acne earlier than boys. Over recent years, persistent acne is becoming more prevalent in adult women., Objectives: This review and panel discussion addresses challenges in acne management, particularly in adult women. The role which nonprescription acne treatment can play is explored when used as monotherapy or as an adjunctive treatment for acne of all severity., Methods: The best available evidence on nonprescription acne treatment was coupled with the opinion of an international expert panel of dermatologists to adopt statements and recommendations discussed in this review., Results: All severity of acne has a significant burden on patients. Addressing environmental factors that are important for the individual with acne may help to educate, prevent, effectively manage, and maintain acne, as per the panel. They agreed that the adult female acne population has unique needs because of their aging skin and social environment. Nonprescription acne treatment products may help to balance the efficacy and tolerability of prescription acne treatment. Currently, there are no specific guidelines for how to use nonprescription acne treatment products in these patients., Conclusion: The panel agreed that guidelines including nonprescription acne treatment either as monotherapy for mild acne or in combination with prescription treatments for more severe acne would address a significant unmet need., (© 2020 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Intravenous immunoglobulin is a recognized treatment in recalcitrant autoimmune bullous diseases. Infusions are administered monthly over 1-5 days in the hospital setting and associated with mild to severe infusion-related systemic effects, in part due to the high doses necessary to induce and achieve remission. We present a case series of four patients with bullous diseases treated successfully with low-dose subcutaneous IgG who achieved remission with maintenance therapy. Patient-administered smaller, more frequent doses of IgG into subcutaneous tissue more closely mimics the body's own antibody production and produces a more stable serum trough level. Subcutaneous IgG is a novel treatment approach in bullous diseases which can induce a state remission., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

A retrospective analysis on 587 patients with chronic lymphocytic leukemia (CLL) assessed risk factors for skin cancer and the influence of skin cancers on survival and incidence of solid tumors (STs). Patients underwent skin surveillance and were followed for a median of 6.65 years. The relative risk for skin cancer increased prior to CLL diagnosis rising 4-fold one-year post-diagnosis. Independent predictors for skin cancer were male gender ( p  = .0001), age ≥70 years ( p  = .0036) and prior chemotherapy ( p  = .0116). There was no increase in mortality from skin cancer and neither skin cancer nor chemotherapy increased the risk for a ST. The development of a ST was an independent predictor of survival ( p  < .0001) and 43% of deaths were related to STs. Thus, regular skin surveillance can prevent increased mortality from skin cancer, but not STs, in CLL. Close skin monitoring is required for elderly males who received chemotherapy.

Background: Basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer. There is a clear association between BCC development and ultraviolet (UV) radiation. Erythropoietic protoporphyria (EPP) is an inherited porphyria disorder that is a result of protoporphyrin accumulation, typically manifesting with phototoxicity., Case Summary: We report a case of a 24 year-old man with both EPP and BCC diagnoses. At the age of 4 years, the patient was diagnosed with EPP. The patient presented with a BCC on his nose at age 24 years, despite sun avoidance as the primary treatment for his EPP diagnosis., Conclusion: Consider the diagnosis of BCC in a patient with EPP, despite sun avoidance.

The Mozart Effect is a phenomenon whereby certain pieces of music induce temporary enhancement in "spatial temporal reasoning." To determine whether the Mozart Effect can improve surgical performance, 55 male volunteers (mean age = 20.6 years, range = 16-27), novice to surgery, were timed as they completed an activity course on a laparoscopic simulator. Subjects were then randomized for exposure to 1 of 2 musical pieces by Mozart (n = 21) and Dream Theater (n = 19), after which they repeated the course. Following a 15-minute exposure to a nonmusical piece, subjects were exposed to one of the pieces and performed the activity course a third time. An additional group (n = 15) that was not corandomized performed the tasks without any exposure to music. The percent improvements in completion time between 3 successive trials were calculated for each subject and group means compared. In 2 of the tasks, subjects exposed to the Dream Theater piece achieved approximately 30% more improvement (26.7 ± 8.3%) than those exposed to the Mozart piece (20.2 ± 7.8%, P = .021) or to no music (20.4 ± 9.1%, P = .049). Distinct patterns of covariance between baseline performance and subsequent improvement were observed for the different musical conditions and tasks. The data confirm the existence of a Mozart Effect and demonstrate for the first time its practical applicability. Prior exposure to certain pieces may enhance performance in practical skills requiring spatial temporal reasoning.

Background: Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes., Objective: The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM., Methods: A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM., Results: Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor (p  =  .86) nor treatment duration (p  =  .18) was related to resolution of the lesion., Conclusion: Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.

On the basis of integrating objectification theory research with research on body image and eating problems among sexual minority men, the present study examined relations among sociocultural and psychological correlates of eating disorder symptoms with a sample of 231 sexual minority men. Results of a path analysis supported tenets of objectification theory with the sample. Specifically, findings were consistent with relations posited in objectification theory among sexual objectification experiences, internalization of cultural standards of attractiveness, body surveillance, body shame, and eating disorder symptoms. Within this set of positive relations, internalization of cultural standards of attractiveness partially mediated the link of sexual objectification experiences with body surveillance; body surveillance partially mediated the relation of internalization with body shame; and body shame partially mediated the relation of body surveillance with eating disorder symptoms. In addition to these relations, internalized homophobia was related to greater eating disorder symptoms through body shame, and recalled childhood harassment for gender nonconformity was linked with eating disorder symptoms through a positive series of relations involving internalization of cultural standards of attractiveness, body surveillance, and body shame., (PsycINFO Database Record (c) 2010 APA, all rights reserved.)

Background: Incidence rates of cutaneous malignant melanoma (CMM) have increased worldwide. Long-term studies examining rates and anatomic site-specific incidence on a population-based level are infrequent., Objective: We sought to examine the historical changes in the incidence and anatomic site presentation of CMM during a 50-year period in Manitoba, Canada., Methods: Using population-based data, all first diagnoses of CMM reported between 1956 and 2005 were identified. Age-specific rates, age-standardized incidence rates, and anatomic sites were recorded., Results: Incidence rates of CMM slowed for each sex beginning in 1981 for female patients and 1992 for male patients. Annual percent change revealed decreasing rates among male patients younger than 40 years (1992-2005: -5.3% [P = .03]) and female patients younger than 40 years (1987-2005: -1.8% [P = .15]). Similarly, middle-aged individuals (age 40-59 years) also had diminished annual percent change (men 1992-2005: 0.6% [P = .65]; women 1983-2005: -0.3% [P = .68]). The annual percent change for older men and women (60-79 and > or =80 years) continued to increase. Anatomic site-specific analyses revealed that the trunk was the most frequent site of CMM for young male patients (<60 years) whereas the lower extremities were the most common among young female patients (<60 years). Incidence rates for each site, however, are slowing. Among those aged 60 years and older, the rates for each anatomic site increased., Limitations: Determining changes in tumor thickness would have been useful in determining whether the nature of tumors have changed over time; however, this is not recorded in our registry., Conclusion: The rates of CMM are slowing; however, this change is confined to younger individuals. Anatomic site-specific CMMs are changing; rates among older individuals continue to increase for both sexes.

Old world cutaneous leishmaniasis (CL) is caused by Leishmania major and Leishmania tropica, and is endemic to several Asian and Middle-Eastern countries where the rates of infection can be substantial. CL is one of the most common vector-transmitted parasitic infections in Afghanistan. Six cases of CL in Canadian soldiers returning from Afghanistan are reported in the present study. Their lesions did not improve with fluconazole therapy, and the organism demonstrated in vitro resistance. Oral miltefosine seemed effective.

Cancer-free patients diagnosed with a first primary nonmelanoma skin cancer (NMSC) offer an opportunity for studying the risk of a second primary cancer without the confounding effect of systemic treatment. The objective of the study was to estimate the risk of second primary cancer in people with a history of basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) and the risk of dying in cancer patients with a NMSC history. BCC and SCC cases diagnosed between 1956 and 2000 in Manitoba, Canada were followed-up for second primaries (other than NMSC). Standardized incidence and mortality ratios (SIR and SMR) were calculated. Men [SIR, 1.06; 95% confidence interval (95% CI), 1.02-1.10] and women (SIR, 1.07; 95% CI, 1.02-1.12) with a BCC history as well as men (SIR, 1.15; 95% CI, 1.08-1.22) with a SCC history were at greater risk of a second primary cancer. Overall, the increased risk was observed only in the first 4 years following a NMSC, although it remained increased for specific cancer sites. The risk remained higher in all age groups up to 75 years of age. People with a history of BCC (males: SMR, 1.09; 95% CI, 1.04-1.14; females: SMR, 1.24; 95% CI, 1.16-1.32) or SCC (males: SMR, 1.18; 95% CI, 1.09-1.27; females: SMR, 1.55; 95% CI, 1.35-1.79) had a greater risk of death following their second primaries. Even if NMSC patients are at greater risk of a second cancer, it is not recommended to follow them up beyond the generally accepted periodic examination of the skin.

Nonmelanoma skin cancer (NMSC) is the most common malignancy diagnosed in Caucasian populations, but little is known about its occurrence in Canada. We sought to determine the historical change of the occurrence and risk of NMSC. All first diagnoses of NMSC reported in Manitoba between 1960 and 2000 were identified. Rates were reported as well as lifetime risk of developing the disease. Basal cell carcinoma was the predominant form of NMSC, accounting for 79% of all NMSCs. The annual percentage change of basal cell and squamous cell carcinoma increased 2.4%, mainly in people older than 40 years of age from the early 1970s to 2000. The lifetime risk of being diagnosed with NMSC increased by two to three times in the 1990s compared to the 1960s. We concluded that because of the potentially high impact of NMSC on resource utilization and treatment-related costs as well as its easily preventable character, priority should be given to prophylactic measures.

Hidradenitis suppurativa is a recurrent disease involving apocrine-bearing skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to scarring, functional impairment, and rarely, squamous cell carcinoma. While genetic factors, patient characteristics, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited. Additionally, effective treatment is largely unknown. While the mainstay of therapy had been surgery, and topical or systemic antimicrobial agents, other therapeutic modalities such as retinoids, hormonal therapy and immunosuppresive medications may also hold some promise.

Tinea faciei is an uncommon dermatophyte infection. Clinically, it may resemble other dermatoses such as cutaneous lupus erythematosus (CLE), polymorphous light eruption, and contact dermatitis. Histopathology is highly variable, demonstrating a spectrum from mild focal spongiosis to a chronic spongiotic psoriasiform dermatitis with a mixed dermal inflammatory infiltrate and fungi in the cornified layer. We report a case of tinea faciei with histopathology that is characteristic of CLE.

Background and Objective: No complete review of the cutaneous manifestations of eating disorders exists. We therefore, set out to review and systematically describe the clinical and histopathologic features of dermatologic conditions associated with anorexia nervosa, bulimia nervosa, and obesity. Differential diagnosis, pathophysiology, laboratory studies, and treatment are also reviewed., Methods: Index Medicus review (1966 to present) using Ovid-MEDLINE. Search terms included eating disorders, anorexia nervosa, bulimia nervosa, eating disorders not otherwise specified (ED-NOS), and obesity, as well as the terms dermatology skin and cutaneous manifestations, with cross-referencing sources. These were combined with our own clinical experience. All relevant publications, including case reports, case series, cohort studies, and histopathologic studies giving at least Level II-3 evidence (evidence from comparisons between times or places with or without the intervention, including dramatic results in uncontrolled experiments), were selected., Conclusion: Forty dermatological signs have been reported in eating disorder patients. Eating disorders have many cutaneous manifestations and cutaneous signs may lead to the diagnosis of an occult eating disorder. The resolution of skin eruptions in eating disorder patients often depends on treatment of the underlying disorder.

Background: Immunotherapy with diphencyprone (diphenylcyclopropenone) is used in the treatment of alopecia areata (AA). Response rates have varied in the literature., Objectives: To determine the efficacy of diphencyprone therapy for AA in the largest reported cohort of patients; to identify patient and treatment factors predictive of therapeutic success; and to develop a practical model for predicting patient response., Methods: The medical records of 148 consecutive patients treated with diphencyprone were reviewed. A clinically significant response to diphencyprone therapy was defined as a cosmetically acceptable response or greater than 75% terminal hair regrowth. Survival analyses using the Kaplan-Meier method and the Cox proportional hazards model were performed to determine significant factors predictive of regrowth and relapse., Results: Using a survival analysis model, the cumulative patient response at 32 months was 77.9% (95% confidence interval, 56.8%-98.9%). Variables independently associated with clinically significant regrowth were age at onset of disease and baseline extent of AA. Older age at onset of AA portended a better prognosis. A cosmetically acceptable end point was obtained in 17.4% of patients with alopecia totalis/universalis, 60.3% with 75% to 99% AA, 88.1% with 50% to 74% AA, and 100% with 25% to 49% AA. A lag of 3 months was present between initiation of therapy and development of significant hair regrowth in the first responders. Relapse after achieving significant regrowth developed in 62.6% of patients., Conclusions: Response to diphencyprone treatment in AA is affected by baseline extent of AA and age at disease onset. A prolonged treatment course might be necessary. A predictive model has been developed to assist with patient prognostication and counseling.

Background: Actinic prurigo (AP) is an idiopathic familial photodermatitis. AP of the Inuit is rarely reported and poorly characterized., Objective: Our purpose was to examine the clinical features and HLA associations of AP in an Inuit population., Methods: Thirty-seven Inuit subjects with AP were administered a questionnaire and underwent a cutaneous examination. Other causes of photosensitivity were excluded. HLA class I typing was performed by polymerase chain reaction and sequence-specific primers and class II typing by polymerase chain reaction and sequence-specific oligonucleotide probes., Results: Subjects were 81.1% female, 67.6% had a family history of photosensitivity, and all experienced seasonal variation. The average age at onset of photosensitivity was 29 years, and only 27% had a trend toward improvement in photosensitivity. Involvement of eyes and nonexposed skin was reported in 62.2% and 18.9% of subjects, respectively. Physical examination revealed involvement of the face (64.9%), lip (32.4%), ear (13.5%), and dorsal aspect of the hand (24.3%). HLA-DRB1*14 was present in 51.2% of subjects and 26.2% of controls (P =.022, odds ratio = 2.975). This is a previously unreported HLA association., Conclusion: AP in the Inuit is a seasonal, pruritic photodermatitis, often commencing in adulthood and worsening over time. A novel association with HLA-DRB1*14 has been discovered. Overall, this novel HLA association, the absence of HLA associations previously reported in non-Inuit populations, and clinical distinguishing features support the concept that AP in the Inuit may have a distinct immunopathogenic basis that translates into a different phenotype. It also raises the question of whether AP in the Inuit is a distinct photosensitivity disorder specific to this group that has been genetically isolated because of geographic and cultural seclusion.