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VIDEO: IL-17 antagonists continue reshaping psoriasis therapy in 2016
WAIKOLOA, HAWAII – What’s going to be the biggest development in the field of psoriasis in 2016?
Hint: Look for a repeat of 2015.
The first of the interleukin-17 antagonists, secukinumab, was the biggest development of 2015, explained Dr. Craig L. Leonardi, associate clinical professor of dermatology at Saint Louis University, St. Louis. “It’s always good when we get another mechanism of action.”
2016 should see the debut of another IL-17 antagonist, ixekizumab, which “seems to be more efficacious than secukinumab,” Dr. Leonardi said in an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
WAIKOLOA, HAWAII – What’s going to be the biggest development in the field of psoriasis in 2016?
Hint: Look for a repeat of 2015.
The first of the interleukin-17 antagonists, secukinumab, was the biggest development of 2015, explained Dr. Craig L. Leonardi, associate clinical professor of dermatology at Saint Louis University, St. Louis. “It’s always good when we get another mechanism of action.”
2016 should see the debut of another IL-17 antagonist, ixekizumab, which “seems to be more efficacious than secukinumab,” Dr. Leonardi said in an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
WAIKOLOA, HAWAII – What’s going to be the biggest development in the field of psoriasis in 2016?
Hint: Look for a repeat of 2015.
The first of the interleukin-17 antagonists, secukinumab, was the biggest development of 2015, explained Dr. Craig L. Leonardi, associate clinical professor of dermatology at Saint Louis University, St. Louis. “It’s always good when we get another mechanism of action.”
2016 should see the debut of another IL-17 antagonist, ixekizumab, which “seems to be more efficacious than secukinumab,” Dr. Leonardi said in an interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT SDEF HAWAII DERMATOLOGY SEMINAR
SDEF: New, aggressive strategies show promise in alopecia areata
Alopecia areata’s mysterious appearances, regressions, and recurrences frustrate patients and stymie physicians, but new treatments may be around the corner.
Tofacitinib, along with other medications that target the autoimmune etiology of alopecia areata, have shown complete alopecia reversal in case studies, Dr. Maria Hordinsky said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. “There’s a lot of excitement bubbling up in hair disease research because of these new potential topical and oral treatments.”
Janus kinase (JAK) inhibitors, including tofacitinib, baricitinib, and ruxolitinib, have also been reported to reverse alopecia areata.
“There’s been a surge of enthusiasm for using more aggressive systemic therapies, including not only tobacitinib and ruxolitinib but also methotrexate and interleukin-2,” Dr. Hordinsky said, noting that these are still investigational uses.
The new treatment targets are welcome for physicians treating patients with alopecia areata, since currently there are no FDA-approved treatments, Dr. Hordinsky said.
A review by Dr. Hordinsky and colleague found a total of 29 trials investigating more than a dozen topical and oral treatments. Most trials were of moderate or lower quality, and most had major limitations. Treatments that were effective included topical and oral corticosteroids, as well as the sensitizing agents diphenylcyclopropenone and dinitrochlorobenzene (Am J Clin Dermatol. 2014;15:231-46).
In the absence of high-quality evidence for effective treatments, patient characteristics and preference, as well as disease activity and location, can guide treatment. In some cases, a scalp biopsy can give more information about follicle differentiation, inflammation, and the stage of the hair cycle at the time of assessment, Dr. Hordinsky said.
It’s important to set expectations for patients, so they know that treatments will take time, she said. Providers should be alert to the possibility that hair loss may also be associated with an underlying medical problem, so a thorough workup is indicated.
Patients should be given the opportunity to enroll in clinical trials, where available, and should also be directed to the National Alopecia Areata Foundation (NAAF). Their website provides information and resources for patients and families, information for local support groups, and information on a national registry.
Dr. Hordinsky reported receiving grant or research support from a number of pharmaceutical and consumer product companies in the dermatology space. She serves on the scientific advisory board of the National Alopecia Areata Foundation.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
Alopecia areata’s mysterious appearances, regressions, and recurrences frustrate patients and stymie physicians, but new treatments may be around the corner.
Tofacitinib, along with other medications that target the autoimmune etiology of alopecia areata, have shown complete alopecia reversal in case studies, Dr. Maria Hordinsky said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. “There’s a lot of excitement bubbling up in hair disease research because of these new potential topical and oral treatments.”
Janus kinase (JAK) inhibitors, including tofacitinib, baricitinib, and ruxolitinib, have also been reported to reverse alopecia areata.
“There’s been a surge of enthusiasm for using more aggressive systemic therapies, including not only tobacitinib and ruxolitinib but also methotrexate and interleukin-2,” Dr. Hordinsky said, noting that these are still investigational uses.
The new treatment targets are welcome for physicians treating patients with alopecia areata, since currently there are no FDA-approved treatments, Dr. Hordinsky said.
A review by Dr. Hordinsky and colleague found a total of 29 trials investigating more than a dozen topical and oral treatments. Most trials were of moderate or lower quality, and most had major limitations. Treatments that were effective included topical and oral corticosteroids, as well as the sensitizing agents diphenylcyclopropenone and dinitrochlorobenzene (Am J Clin Dermatol. 2014;15:231-46).
In the absence of high-quality evidence for effective treatments, patient characteristics and preference, as well as disease activity and location, can guide treatment. In some cases, a scalp biopsy can give more information about follicle differentiation, inflammation, and the stage of the hair cycle at the time of assessment, Dr. Hordinsky said.
It’s important to set expectations for patients, so they know that treatments will take time, she said. Providers should be alert to the possibility that hair loss may also be associated with an underlying medical problem, so a thorough workup is indicated.
Patients should be given the opportunity to enroll in clinical trials, where available, and should also be directed to the National Alopecia Areata Foundation (NAAF). Their website provides information and resources for patients and families, information for local support groups, and information on a national registry.
Dr. Hordinsky reported receiving grant or research support from a number of pharmaceutical and consumer product companies in the dermatology space. She serves on the scientific advisory board of the National Alopecia Areata Foundation.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
Alopecia areata’s mysterious appearances, regressions, and recurrences frustrate patients and stymie physicians, but new treatments may be around the corner.
Tofacitinib, along with other medications that target the autoimmune etiology of alopecia areata, have shown complete alopecia reversal in case studies, Dr. Maria Hordinsky said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. “There’s a lot of excitement bubbling up in hair disease research because of these new potential topical and oral treatments.”
Janus kinase (JAK) inhibitors, including tofacitinib, baricitinib, and ruxolitinib, have also been reported to reverse alopecia areata.
“There’s been a surge of enthusiasm for using more aggressive systemic therapies, including not only tobacitinib and ruxolitinib but also methotrexate and interleukin-2,” Dr. Hordinsky said, noting that these are still investigational uses.
The new treatment targets are welcome for physicians treating patients with alopecia areata, since currently there are no FDA-approved treatments, Dr. Hordinsky said.
A review by Dr. Hordinsky and colleague found a total of 29 trials investigating more than a dozen topical and oral treatments. Most trials were of moderate or lower quality, and most had major limitations. Treatments that were effective included topical and oral corticosteroids, as well as the sensitizing agents diphenylcyclopropenone and dinitrochlorobenzene (Am J Clin Dermatol. 2014;15:231-46).
In the absence of high-quality evidence for effective treatments, patient characteristics and preference, as well as disease activity and location, can guide treatment. In some cases, a scalp biopsy can give more information about follicle differentiation, inflammation, and the stage of the hair cycle at the time of assessment, Dr. Hordinsky said.
It’s important to set expectations for patients, so they know that treatments will take time, she said. Providers should be alert to the possibility that hair loss may also be associated with an underlying medical problem, so a thorough workup is indicated.
Patients should be given the opportunity to enroll in clinical trials, where available, and should also be directed to the National Alopecia Areata Foundation (NAAF). Their website provides information and resources for patients and families, information for local support groups, and information on a national registry.
Dr. Hordinsky reported receiving grant or research support from a number of pharmaceutical and consumer product companies in the dermatology space. She serves on the scientific advisory board of the National Alopecia Areata Foundation.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR
SDEF: New clues emerge in scarring alopecias
Some kinds of scarring alopecia may also be related to lipid metabolism, pointing the way to novel therapeutic targets for this class of hair diseases, Dr. Maria Hordinsky said at the Hawaii Dermatology Symposium.
While the scarring alopecias are broadly divided into lymphocytic and neutrophilic alopecias, clinically, they are a heterogeneous group, said Dr. Hordinsky, chair of the department of dermatology at the University of Minnesota, Minneapolis.
Two lymphocytic cicatricial alopecias, lichen planopilaris and frontal fibrosing alopecia, have been associated with peroxisome proliferator-activated receptor gamma (PPARG) deficiency. This finding suggests that they may be a type of lipid metabolism disorder; the theory is bolstered by case reports of improvement with the use of pioglitazone, Dr. Hordinsky said at the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation.
In both of these cicatricial alopecias, patients may also have significant discomfort including scalp burning, pain, paresthesias, and itching. Patients may even say they feel as though their scalp is on fire.
Dr. Hordinsky and her collaborators are currently conducting a clinical trial of the efficacy of a compounded formulation of 6% topical gabapentin to address the scalp discomfort associated with the cicatricial alopecias. The study is ongoing and recruiting patients. “FFA has been described as an emerging disease, and participation of FFA patients in a national registry focused on improving our understanding of the epidemiology of this disease is highly recommended,” said Dr. Hordinsky.
Currently, stepwise treatment for the lymphocytic cicatricial alopecias can be divided into 3 tiers:
• Tier 1: Topical high potency corticosteroids and/or intralesional steroids, as well as non-steroidal topical anti-inflammatory medications, such as tacrolimus and pemicrolimus.
• Tier 2: Hydroxychloroquine and acetretin, as well as low-dose antibiotics, which are used for anti-inflammatory effect.
• Tier 3: Cyclosporin, mycophenolate mofetil, and prednisone.
Low-level light therapy – approved by the Food and Drug Administration to treat thinning hair in men and women – may also be of benefit for those with inflammatory scalp diseases, Dr. Hordinsky added.
Dr. Hordinsky reported financial relationships with a number of pharmaceutical and consumer product companies in the dermatologic space.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
Some kinds of scarring alopecia may also be related to lipid metabolism, pointing the way to novel therapeutic targets for this class of hair diseases, Dr. Maria Hordinsky said at the Hawaii Dermatology Symposium.
While the scarring alopecias are broadly divided into lymphocytic and neutrophilic alopecias, clinically, they are a heterogeneous group, said Dr. Hordinsky, chair of the department of dermatology at the University of Minnesota, Minneapolis.
Two lymphocytic cicatricial alopecias, lichen planopilaris and frontal fibrosing alopecia, have been associated with peroxisome proliferator-activated receptor gamma (PPARG) deficiency. This finding suggests that they may be a type of lipid metabolism disorder; the theory is bolstered by case reports of improvement with the use of pioglitazone, Dr. Hordinsky said at the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation.
In both of these cicatricial alopecias, patients may also have significant discomfort including scalp burning, pain, paresthesias, and itching. Patients may even say they feel as though their scalp is on fire.
Dr. Hordinsky and her collaborators are currently conducting a clinical trial of the efficacy of a compounded formulation of 6% topical gabapentin to address the scalp discomfort associated with the cicatricial alopecias. The study is ongoing and recruiting patients. “FFA has been described as an emerging disease, and participation of FFA patients in a national registry focused on improving our understanding of the epidemiology of this disease is highly recommended,” said Dr. Hordinsky.
Currently, stepwise treatment for the lymphocytic cicatricial alopecias can be divided into 3 tiers:
• Tier 1: Topical high potency corticosteroids and/or intralesional steroids, as well as non-steroidal topical anti-inflammatory medications, such as tacrolimus and pemicrolimus.
• Tier 2: Hydroxychloroquine and acetretin, as well as low-dose antibiotics, which are used for anti-inflammatory effect.
• Tier 3: Cyclosporin, mycophenolate mofetil, and prednisone.
Low-level light therapy – approved by the Food and Drug Administration to treat thinning hair in men and women – may also be of benefit for those with inflammatory scalp diseases, Dr. Hordinsky added.
Dr. Hordinsky reported financial relationships with a number of pharmaceutical and consumer product companies in the dermatologic space.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
Some kinds of scarring alopecia may also be related to lipid metabolism, pointing the way to novel therapeutic targets for this class of hair diseases, Dr. Maria Hordinsky said at the Hawaii Dermatology Symposium.
While the scarring alopecias are broadly divided into lymphocytic and neutrophilic alopecias, clinically, they are a heterogeneous group, said Dr. Hordinsky, chair of the department of dermatology at the University of Minnesota, Minneapolis.
Two lymphocytic cicatricial alopecias, lichen planopilaris and frontal fibrosing alopecia, have been associated with peroxisome proliferator-activated receptor gamma (PPARG) deficiency. This finding suggests that they may be a type of lipid metabolism disorder; the theory is bolstered by case reports of improvement with the use of pioglitazone, Dr. Hordinsky said at the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation.
In both of these cicatricial alopecias, patients may also have significant discomfort including scalp burning, pain, paresthesias, and itching. Patients may even say they feel as though their scalp is on fire.
Dr. Hordinsky and her collaborators are currently conducting a clinical trial of the efficacy of a compounded formulation of 6% topical gabapentin to address the scalp discomfort associated with the cicatricial alopecias. The study is ongoing and recruiting patients. “FFA has been described as an emerging disease, and participation of FFA patients in a national registry focused on improving our understanding of the epidemiology of this disease is highly recommended,” said Dr. Hordinsky.
Currently, stepwise treatment for the lymphocytic cicatricial alopecias can be divided into 3 tiers:
• Tier 1: Topical high potency corticosteroids and/or intralesional steroids, as well as non-steroidal topical anti-inflammatory medications, such as tacrolimus and pemicrolimus.
• Tier 2: Hydroxychloroquine and acetretin, as well as low-dose antibiotics, which are used for anti-inflammatory effect.
• Tier 3: Cyclosporin, mycophenolate mofetil, and prednisone.
Low-level light therapy – approved by the Food and Drug Administration to treat thinning hair in men and women – may also be of benefit for those with inflammatory scalp diseases, Dr. Hordinsky added.
Dr. Hordinsky reported financial relationships with a number of pharmaceutical and consumer product companies in the dermatologic space.
This news organization and SDEF are owned by the same parent company.
On Twitter @karioakes
EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SYMPOSIUM
SDEF: For some HS patients, adalimumab is a life changer
Adalimumab has made a big difference in the lives of hidradenitis suppurativa patients at Dr. Jeffrey Sobell’s dermatology clinic, SkinCare Physicians in Chestnut Hill, Mass.
Hidradenitis suppurativa (HS) “is a nightmare, probably the most negatively life-impacting disease we see in all of dermatology. We finally have a therapy to address it.” Adalimumab “has been life changing for a number of my patients,” he said at the SDEF Hawaii Dermatology Seminar.
The tumor necrosis factor inhibitor is the first Food and Drug Administration–approved treatment for the condition; an indication for moderate to severe disease in adults was added to labeling in September 2015. Dr. Sobell estimates he’s used adalimumab in about 20 HS patients, with more successes than failures.
“It’s a disease that’s embarrassing, occurring in areas of the skin that nobody wants to show their doctor or talk to their friends or family about. It’s not just pain; there’s a lot of drainage from the lesions that can be very malodorous, and that’s just devastating for patients. It impacts all aspects of people’s lives. Socially, people become very isolated; with employment, people go on disability because of the pain. [Adalimumab] has really brought many of my patients back to life,” said Dr. Sobell, also an assistant professor of dermatology at Tufts University School of Medicine, Boston.
In two phase III trials, about 53% of patients, versus about a quarter of placebo patients, had a 50% or more reduction in inflammatory nodules and abscesses. Overall, “more than half of patients achieve a clinically meaningful improvement by week 12, which correlates with improvements in quality of life and work productivity, Dr. Sobell said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
“What I find with most patients is a reduction in the frequency, severity, and intensity of flare-ups, and a reduction in the amount of time someone has active lesions. It doesn’t completely put patients into remission, but it really improves their” lives, he added.
Dr. Sobell turns to adalimumab when standard treatments – typically oral antibiotics – aren’t working, or when there’s scarring, sinus tract formation, or poorly controlled pain.
The dose is the same as for inflammatory bowel disease and higher than what dermatologists are used to using for psoriasis. HS patients start out with a loading dose of 160 mg, followed by 80 mg at week 2, and a weekly 40 mg maintenance dose starting at week 4. When adalimumab works, patients can start responding in as early as 2 weeks, and results seem durable. Dr. Sobell said that he has not noticed any decline in response with time, including in one patient who’s going into the fourth year on the medication, after it was started off label.
Higher doses are needed because HS patients tend to be heavier than psoriasis patients, and their lesions have higher levels of tumor necrosis factors and other inflammatory cytokines.
Dr. Sobell said that he has not had a problem with side effects, despite the higher doses. None of his HS patients have developed serious infections or medication-associated cancers, the main concerns with adalimumab. In trials, safety was similar in HS and psoriasis patients, and that’s what he’s seen in his practice. “I haven’t had any more problems with my HS patients than with my psoriasis patients,” he said.
Dr. Sobell disclosed relationships with numerous pharmaceutical companies, including AbbVie, which markets adalimumab as Humira.
SDEF and this news organization are owned by the same parent company.
Adalimumab has made a big difference in the lives of hidradenitis suppurativa patients at Dr. Jeffrey Sobell’s dermatology clinic, SkinCare Physicians in Chestnut Hill, Mass.
Hidradenitis suppurativa (HS) “is a nightmare, probably the most negatively life-impacting disease we see in all of dermatology. We finally have a therapy to address it.” Adalimumab “has been life changing for a number of my patients,” he said at the SDEF Hawaii Dermatology Seminar.
The tumor necrosis factor inhibitor is the first Food and Drug Administration–approved treatment for the condition; an indication for moderate to severe disease in adults was added to labeling in September 2015. Dr. Sobell estimates he’s used adalimumab in about 20 HS patients, with more successes than failures.
“It’s a disease that’s embarrassing, occurring in areas of the skin that nobody wants to show their doctor or talk to their friends or family about. It’s not just pain; there’s a lot of drainage from the lesions that can be very malodorous, and that’s just devastating for patients. It impacts all aspects of people’s lives. Socially, people become very isolated; with employment, people go on disability because of the pain. [Adalimumab] has really brought many of my patients back to life,” said Dr. Sobell, also an assistant professor of dermatology at Tufts University School of Medicine, Boston.
In two phase III trials, about 53% of patients, versus about a quarter of placebo patients, had a 50% or more reduction in inflammatory nodules and abscesses. Overall, “more than half of patients achieve a clinically meaningful improvement by week 12, which correlates with improvements in quality of life and work productivity, Dr. Sobell said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
“What I find with most patients is a reduction in the frequency, severity, and intensity of flare-ups, and a reduction in the amount of time someone has active lesions. It doesn’t completely put patients into remission, but it really improves their” lives, he added.
Dr. Sobell turns to adalimumab when standard treatments – typically oral antibiotics – aren’t working, or when there’s scarring, sinus tract formation, or poorly controlled pain.
The dose is the same as for inflammatory bowel disease and higher than what dermatologists are used to using for psoriasis. HS patients start out with a loading dose of 160 mg, followed by 80 mg at week 2, and a weekly 40 mg maintenance dose starting at week 4. When adalimumab works, patients can start responding in as early as 2 weeks, and results seem durable. Dr. Sobell said that he has not noticed any decline in response with time, including in one patient who’s going into the fourth year on the medication, after it was started off label.
Higher doses are needed because HS patients tend to be heavier than psoriasis patients, and their lesions have higher levels of tumor necrosis factors and other inflammatory cytokines.
Dr. Sobell said that he has not had a problem with side effects, despite the higher doses. None of his HS patients have developed serious infections or medication-associated cancers, the main concerns with adalimumab. In trials, safety was similar in HS and psoriasis patients, and that’s what he’s seen in his practice. “I haven’t had any more problems with my HS patients than with my psoriasis patients,” he said.
Dr. Sobell disclosed relationships with numerous pharmaceutical companies, including AbbVie, which markets adalimumab as Humira.
SDEF and this news organization are owned by the same parent company.
Adalimumab has made a big difference in the lives of hidradenitis suppurativa patients at Dr. Jeffrey Sobell’s dermatology clinic, SkinCare Physicians in Chestnut Hill, Mass.
Hidradenitis suppurativa (HS) “is a nightmare, probably the most negatively life-impacting disease we see in all of dermatology. We finally have a therapy to address it.” Adalimumab “has been life changing for a number of my patients,” he said at the SDEF Hawaii Dermatology Seminar.
The tumor necrosis factor inhibitor is the first Food and Drug Administration–approved treatment for the condition; an indication for moderate to severe disease in adults was added to labeling in September 2015. Dr. Sobell estimates he’s used adalimumab in about 20 HS patients, with more successes than failures.
“It’s a disease that’s embarrassing, occurring in areas of the skin that nobody wants to show their doctor or talk to their friends or family about. It’s not just pain; there’s a lot of drainage from the lesions that can be very malodorous, and that’s just devastating for patients. It impacts all aspects of people’s lives. Socially, people become very isolated; with employment, people go on disability because of the pain. [Adalimumab] has really brought many of my patients back to life,” said Dr. Sobell, also an assistant professor of dermatology at Tufts University School of Medicine, Boston.
In two phase III trials, about 53% of patients, versus about a quarter of placebo patients, had a 50% or more reduction in inflammatory nodules and abscesses. Overall, “more than half of patients achieve a clinically meaningful improvement by week 12, which correlates with improvements in quality of life and work productivity, Dr. Sobell said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
“What I find with most patients is a reduction in the frequency, severity, and intensity of flare-ups, and a reduction in the amount of time someone has active lesions. It doesn’t completely put patients into remission, but it really improves their” lives, he added.
Dr. Sobell turns to adalimumab when standard treatments – typically oral antibiotics – aren’t working, or when there’s scarring, sinus tract formation, or poorly controlled pain.
The dose is the same as for inflammatory bowel disease and higher than what dermatologists are used to using for psoriasis. HS patients start out with a loading dose of 160 mg, followed by 80 mg at week 2, and a weekly 40 mg maintenance dose starting at week 4. When adalimumab works, patients can start responding in as early as 2 weeks, and results seem durable. Dr. Sobell said that he has not noticed any decline in response with time, including in one patient who’s going into the fourth year on the medication, after it was started off label.
Higher doses are needed because HS patients tend to be heavier than psoriasis patients, and their lesions have higher levels of tumor necrosis factors and other inflammatory cytokines.
Dr. Sobell said that he has not had a problem with side effects, despite the higher doses. None of his HS patients have developed serious infections or medication-associated cancers, the main concerns with adalimumab. In trials, safety was similar in HS and psoriasis patients, and that’s what he’s seen in his practice. “I haven’t had any more problems with my HS patients than with my psoriasis patients,” he said.
Dr. Sobell disclosed relationships with numerous pharmaceutical companies, including AbbVie, which markets adalimumab as Humira.
SDEF and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM The SDEF HAWAII DERMATOLOGY SEMINAR
SDEF: Have higher degree of suspicion for pediatric allergic contact dermatitis
Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.
“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).
“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”
Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:
• Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.
• Localized or facial dermatitis, as this could indicate the point of contact with an allergen.
• Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.
• Dermatitis that worsens, despite otherwise adequate treatment regimen.
• Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.
“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.
In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.
“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”
Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.
On Twitter @whitneymcknight
Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.
“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).
“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”
Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:
• Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.
• Localized or facial dermatitis, as this could indicate the point of contact with an allergen.
• Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.
• Dermatitis that worsens, despite otherwise adequate treatment regimen.
• Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.
“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.
In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.
“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”
Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.
On Twitter @whitneymcknight
Allergic contact dermatitis is often missed in pediatric patients who present with eczema-like skin eruptions, in part because less is known about ACD in children than in adults.
“Often when we see a child with dermatitis, we automatically think of atopic dermatitis, but we should also consider the possibility of allergic contact dermatitis,” Dr. Joseph F. Fowler Jr. said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
A 2012 cohort study of 349 children between 0 and 15 years indicated that even very young children who were patch tested for common allergens had at least one positive result. Investigators found that nearly three-quarters of children studied tested positive for at least one allergen, typically nickel, other metals, fragrance, or preservatives (Dermatitis. 2012 Nov-Dec;23[6]:275-80).
“This is very similar to what we see in the adult population,” said Dr. Fowler, clinical professor of dermatology at the University of Louisville (Ky.). “Other studies in recent years have borne this out.”
Dr. Fowler suggested having a high degree of suspicion for ACD, especially when pediatric patients present with:
• Chronic, difficult to control atopic condition, as this could indicate a systemic reaction.
• Localized or facial dermatitis, as this could indicate the point of contact with an allergen.
• Scattered, generalized dermatitis, which also could represent systemic allergic contact dermatitis.
• Dermatitis that worsens, despite otherwise adequate treatment regimen.
• Reactions following contact with metals, fragrances, topical components, such as preservatives or neomycin.
“In these situations, patch testing will help determine that an allergen is implicated,” Dr. Fowler said.
In children with eczema, Dr. Fowler recommended patch testing when the eczema is not in the typical areas such as behind the knees or elbows, or if it started in typical areas and then spread elsewhere, especially in children around 5 years old.
“The moral of the story is that kids can be allergic to the same things as adults, even though we have less about this in the literature,” Dr. Fowler. “Skin testing or blood testing for food allergies, unless very strongly positive, usually aren’t helpful in the management of the atopic individual. Patch test more and prick test less.”
Dr. Fowler disclosed a number of relationships with companies in the dermatology space. SDEF and this news organization are owned by the same parent company.
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EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR
