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2022 Fall Clinical Dermatology Conference Summary Day 4

A highly detailed look at the presentations and discussions from Day 4 of 2022 Fall Clinical.

Everything you need to know from Fall Clinical is right here: Day 1, Day 2, Day 3.

What’s New in JAMA Derm

VIDEO Highlight: What's New in JAMA Derm - YouTube

April Armstrong, M.D., MPH highlighted a few hard-hitting articles published in JAMA Dermatology within the past year. The first article presented efficacy data on combination intramarginal shaving and cryosurgery treatment for keloid scars. This single-center cohort study assessed 31 patients treated with intramarginal excision followed by immediate contact cryosurgery. Mean volume reduction across all scars was 81.9% with significant improvement in Vancouver scar scale scores.

Dr. Armstrong highlighted a case series of two patients treated with a topical combination of 5-fluorouracil cream 5% and calcipotriol 0.005% ointment in a 1:1 ratio for verruca plana. Both patients achieved complete lesion clearance at 3 weeks. A recent network meta-analysis evaluating the relative efficacy of minoxidil and 5-a reductase inhibitors for male androgenetic alopecia found that dutasteride 0.5 mg daily has the highest efficacy, followed by finasteride 5 mg daily. To conclude the session, Dr. Armstrong highlighted a few case studies using oral jak inhibitors to treat uncommon dermatologic diseases. Upadacitinib 15 mg daily was effective for oral erosive lichen planus, while various doses of baricitinib were used to treat livedoid vasculopathy, nail lichen planus, Darier disease, and progressive nodular histiocytosis.

What’s New in the JAAD

VIDEO Highlight: What's New in the JAAD - YouTube

Staying up to date on recently published literature can be a time-consuming task for busy dermatologists. During this session, Dirk Elston, M.D. reviewed interesting articles published in the JAAD over the past year. A review of treatments for actinic keratosis found that 5-FU is not superior to imiquimod at preventing SCC beginning one year post-treatment, despite previously demonstrated superiority. Pretreating with oral vitamin D prior to PDT therapy may increase overall efficacy for treatment of AKs. Combination therapy with TNFa-inhibitors and methylprednisolone decreases the duration of acute stage, hospitalization stay and time to skin re-epithelialization versus methylprednisolone alone for SJS/TEN.

Continuing the discussion of cutaneous malignancies, Dr. Elston reviewed a study showing superior outcomes for brentuximab vedotin compared to oral bexarotene for large-cell transformed mycosis fungoides. Peripheral blood neutrophil-to-lymphocyte ratio was an independent prognostic factor for poor-disease specific survival and a predictive factor for sentinel lymph node positivity in patients with SCC. Intralesional 5-FU appears to be effective for the treatment of squamous cell carcinoma, with 92% of lesions clinically resolved after one treatment.

Moving on to alopecia, ritlecitinib and brepocitinib were efficacious and well-tolerated in phase 2a studies for alopecia areata. Dutasteride appears to be more effective than hydroxychloroquine and oral retinoids for stabilizing frontal fibrosing alopecia. Spironolactone shows significant improvement in androgenetic alopecia after at least 12 months of use at 100 mg to 200 mg daily. Low-dose oral minoxidil at a dose of 0.25-5 mg daily for hair loss appears to be safe and well-tolerated with low rates of discontinuation.

To conclude the session, Dr. Elston reviewed a few studies pertinent to those with psoriasis. Biologic therapy for psoriasis was associated with reduced mortality regardless of treatment duration in a large retrospective cohort study. Other studies have found no increased hospitalization or mortality for psoriasis patients with COVID-19 who are on TNF inhibitors or methotrexate. Acitretin, apremilast, and methotrexate are safe and effective treatments for immune checkpoint-mediated psoriasis.

What’s New in Dermatologic Surgery

VIDEO Highlight: What's New in Dermatologic Surgery - YouTube

In this session, Brett Coldiron, M.D. presented a few interesting articles published in Dermatologic Surgery within the past year. Dr. Coldiron began with two articles focusing on basal cell carcinoma. Mohs micrographic surgery was found to be effective with higher cure rate for incompletely excised or recurrent basal cell carcinoma in high risk facial BCCs; while a review of curettage versus cryosurgery for superficial BCC showed less recurrence in the cryosurgery group. Moving on to squamous cell carcinoma, a review of 76 cases of SCC with bone invasion revealed that recurrent tumors and nonsurgical treatments were predictors of disease progression in univariable analysis, reinforcing the importance of complete surgical excision when possible.

Dr. Coldiron highlighted a large cohort study of 7,660 patients with invasive cutaneous melanoma looking at the time between diagnostic excision and sentinel lymph node biopsy. No significant association between time to SLNB and node positivity was observed. Moving on to primary prevention, mice studies have shown that mice treated with a fibroblast growth factor receptor inhibitor prior to UVB exposure had a decreased incidence of cutaneous SCC. Dr. Coldiron pointed out the potential for developing a sunscreen product based on this evidence, but further studies are needed. Dr. Coldiron concluded this session with a call for surgeons to create systems and processes in their practice to remain up to date with melanoma reporting.

What’s New in SKIN

VIDEO Highlight: What's New in SKIN - YouTube

To close out the What’s New in the Literature segment,  Roger I. Ceilley, M.D. reminded listeners about SKIN, a peer-reviewed, open access, online-only journal dedicated to providing free access globally to dermatologic knowledge. The journal does not charge fees to publish and is supported by the National Society for Cutaneous Medicine. SKIN recently celebrated its five year anniversary with a special 5th anniversary June 2022 edition. Other educational offerings from SKIN include SKIMages and Virtual Grand Rounds, which provides weekly free CME. Key articles published in SKIN over the past year include best practices for management of delusions of parasitosis, a cost-benefit analysis of the pigmented lesion assay, a diagnostic approach to chronic pruritus, and clinical management of actinic keratosis.

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