Biologic Treatments In Dermatology Beyond Psoriasis

Here’s a very informative catalogue of the off-label use of biological drugs in Dermatology by Martinez Leborans et al. which was shared with the dermatological community as Poster at EADV Annual Meeting 2015 – Copenhagen, Denmark

The Off-Label Use Of Biological Drugs In Dermatology  - Our Experience In The Last 10 Years

Biologics have a targeted action against very specific molecules involved in the pathogenic mechanisms of the disease.

For instance, psoriasis treatments often target cytokines involved in the pathogenic pathway, such as Tumor-Necrosis Factor (TNF)

In this study from Spain spanning from 2002 to 2014, 45 different biologic drugs were given for off-label indications in 38 patients (25 male, mean age 41.7 years old)

In which indication were the biologics used ? (percentage of total)

-47% = hidradenitis suppurativa (HS; Verneuil’s disease)

-22% = pemphigus vulgaris (PV)

-11% = Pyoderma Gangrenosum

-9% = Atopic dermatitis (AD)

-3% = Behcet’s disease

-2% = Pityriasis Rubra Pilaris (PRP)

-2% = Psoriatic arthritis (PsA)

-2% = Eosinophilic Folliculitis (Ofuji’s disease)

-2% = Bullous Pemphigoid

Which biologics were used ? (percentage of total)

-44% = Infliximab (Remicade)

-24% = Rituximab (Mabtera, Rituxan)

–18% = Adalimumab (Humira)

-9% = Estekinumab (Stelara)

-5% = Etanercept (Enbrel)

What were the response rates ? (percentage of total)

-25% = total response

-37% = partial response

-20% = no response

-18% = loss of efficacy

Was it safe ?

1 patient had a severe adverse event (AE), and only 8 did not respond

Comments

-This study shows that biologics are given for off-label indications

-Although some biologics have shown indications for off-label treatments, there is no specific data shown in this study…it does however show that they are effective.

Spring Cleaning For Summer Affiliated Skin Afflictions

Summer is "officially" almost over and what we are dealing with right now is the after math —in the form of different skin afflictions. Yup we’ve all been there —you’re staring at that funny patch of skin and frantically Googling the possible causes. But before you diagnose yourself with a rare ailment, check to see if your symptoms match up to anything on this list of slightly embarrassing, but totally common —post summer skin issues.

Tinea Versicolor

Folks this ailment is particularly prevalent in places that are humid all year round like the tropics, but in the summer can be seen across the globe —roughly 1 in 1000 people are usually affected. Typically it manifests its self in the form of light and dark patches of blotchiness on the skin. (Fun fact: The name versicolor actually means varied color). They’re often mistaken for sunspots, but this uneven skin tone is actually caused by a fungus that normally lives on the surface of your skin. When people sweat a lot, the fungus can take over, which is why symptoms tend to crop up during the spring and end of summer.

Prevention And Treatment

This yeast bonanza can be prevented by staying clean. The best preventative measure is to rinse off after a particularly sweaty day. Hop into the shower ASAP after exercising in humid weather.

For mild cases of tinea versicolor, you can try applying Selsun Blue or Nizoral Shampoo to the affected areas, leaving for 10 minutes, and then rinsing. If you want a guaranteed fix, your dermatologist can prescribe an antifungal medicine, either a pill for more serious all-over cases, or a topical foam that you rub on smaller patches of affected areas. (Tip: make sure to put foam on the splotches as well as beyond the borders of it.) The unexpected last step is getting a dermatologist-approved tan, as the fungus produces enzymes that leave skin hyper or hypo pigmented. Your skin won’t even out in color until you venture back out into the sun.

Folliculitis

If you live in workout clothes or spandex, you could be at risk for developing folliculitis. It is particularly easy to contract this bacterial infection in the summer months. Bacteria, like yeast, love the warmth. They thrive in warm, moist dark conditions. Essentially summer sweat is bacteria’s dream but it’s definitely not ours. Folliculitis tends to look like red bumps or pustules and is commonly found on shoulders, thighs and bottoms. Folliculitis can be itchy or burn. It is especially common in patients that are wearing tight clothes, if you are wearing spandex on the upper thighs and that compresses the hair follicle bacteria is more likely to grow there. Folliculitis can also be contracted in hot tubs or hammam maghrabi (Morrocan or Turkish baths). It is important to be sure that your bath place uses good sanitary and hygiene measures and every hot tub you spend time in should be properly chlorinated.

Prevention And Treatment

After sweating exercise it’s important to change out of tight clothes after working out and try not to wear spandex all day in the summer months. Do your best to shower right after a work out. If you know you will be out for the whole day and it is very hot outside, bring a change of clothes. To nip the evil in the bud its wise to invest in an antibacterial cleanser that can prevent and treat folliculitis. If you notice something that looks like folliculitis contact your health practitioner, more severe cases require an oral antibacterial.

Molluscum Virus

It is seen most often in children, while not particularly dangerous, mollusum is annoying. It causes whitish translucent tan bumps anywhere on the body. These bumps can last for up to four years. Molluscum thrives in under chlorinated water, which is why it occurs so often over the summer. The virus can be passed from skin-to-skin contact. The reason why kids get it so commonly and adults don’t is because the immune system mounts a reaction to the virus. Eventually you can be exposed and not get the bump because your immune system knows how to fight it. When kids are first exposed to it, the body's immune system reacts, and this reaction leads to the bumps.

Prevention And Treatment

Preventing molluscum can be tricky. No one wants to avoid pools all summer, let alone stop kids from jumping into a pool. Check with the pool owner to make sure that they are properly chlorinating it. It is also important to wash off as soon as you get out of the pool. Maintaining good hygiene is a way to prevent molluscum (as well as many other viruses.)

Pesky Bug Bites

Ouch! They are downright annoying but can also lead to some more serious health issues like malaria, dengue fever, Lyme disease or West Nile virus. Scratching a bug bite until it bleeds can also lead to infection. Hot weather means fewer clothes, more bugs and more bug bites. Bug bites can range in size from barely there specks to massive welts. Bug bite size does not correlate to bug or bug size. The idea that the size of the bite is determined by the bug is a misleading urban myth, that’s why most of the times just by looking at the bitten area it is difficult for your dermatologists to determine the bug’s specific species.

Initially the “cause” of a bug bite seems pretty straightforward. However the bug’s decision-making process is more complicated than just easy access to human blood. There are two major reasons why people get bitten by bugs, one: Carbon dioxide production, and second: the lipid mix on the surface of the skin. Mosquitos find humans by determining where carbon dioxide is being produced. As humans, producing carbon dioxide is pretty much unavoidable (we can’t exactly stop breathing to prevent a mosquito bite). Each person’s lipid mixture is a bit more varied. Everyone has a different composition of lipids on the surface of the skin. This mixture is made up of cholesterol, triglycerides, ceramides and other fats and certain lipid mixtures are more appealing to bugs. This is why it is common for some people to get bitten more than others.

Prevention And Treatment

Unfortunately, your skin’s lipid mix is based on genetics. You can’t change your DNA, but there are some preventative measures that everyone can take to avoid summer bites. The CDC recommends using bug repellents that contain DEET, picardin or oil of lemon eucalyptus. If you are into all organic and natural repellant try Para’Kito a green and safe solution to repel bugs. In addition it is important, especially in the bug season to sleep inside or in a screened in area (like a tent). 

If you have a bug bite that is unusually itchy or feels painful, contact your doctor or dermatologist.