The efficacy and safety of lebrikizumab monotherapy for the management of moderate-to-severe atopic dermatitis: A systematic review and meta-analysis

BackgroundAtopic dermatitis (AD) is a chronically relapsing disease. Few biologics are approved for moderate-to-severe AD, and novel interventions are emerging. We aimed to evaluate the safety and efficacy of lebrikizumab, an IL-13 immunomodulator, as monotherapy vs. placebo in treating moderate-to-severe AD.MethodsCochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and ClinicalTrials.gov registry (CT.gov) databases were systematically searched. We evaluated lebrikizumab vs. placebo and measured efficacy using Eczema Area and Severity Index (EASI), Body Surface Area (BSA), and Investigator’s Global Assessment (IGA) change from baseline to week 16. Safety was evaluated by the incidence of serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality. The risk of bias was investigated using the Revised Cochrane risk of bias tool.ResultsThree RCTs (n = 1,149) included 543 (47.25%) men vs. 606 (52.75%) women. Meta-analysis showed statistically significant improvement in EASI, IGA, and BSA. EASI75 at week 16 for all regimens was (RR = 2.62, 95% CI [2.06, 3.34], p < 0.00001) with the first regimen (500 mg loading dose then 200 mg every 2 weeks) showing the most significant improvement (RR = 3.02, 95% CI [2.39, 3.82], p < 0.00001). The pooled analysis of safety outcomes concluded that lebrikizumab did not correlate significantly with the incidence of SAEs, NSAEs, and mortality.ConclusionOverall, lebrikizumab showed a significant improvement in all efficacy outcomes. Additionally, it did not contribute to any significant incidence of SAEs, NSAEs, or mortality. The risk of bias in included RCTs was minor except in the randomization domain. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of the outcomes ranged from low to high, but predominantly high certainty of evidence.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022362438

A Case of Multiple Spontaneous Keloid Scars

Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body

Giant cell lichenoid dermatitis within healed varicella zoster site

Key Clinical Message There are dermatoses that arise within healed zosteriform sites, such as granulomas annulare, acneiform eruptions, psoriasis, lichen planus, and giant cell lichenoid dermatitis “GCLD.” Nonetheless, graft‐versus‐host disease should be considered and ruled out, especially in patients post‐bone marrow transplant. Herein, we report a case of GCLD manifesting within healed zosteriform sites

Psoriasis: Correlation between severity index (PASI) and quality of life index (DLQI) based on the type of treatment

Background: Psoriasis vulgaris is a common chronic dermatological disease that has a negative impact on the psychological status and the social interaction of the patient. Objective: To correlate the quality of life and clinical severity of psoriasis vulgaris in patients using different types of treatment. Materials and methods: This is a prospective observational cross-sectional study that took place over a 4 month period, from January to April 2014, at the King Abdul Aziz Medical City, Jeddah, Saudi Arabia. All patients with psoriasis vulgaris attending the dermatology clinics during this period were included. Results: Of the total 41 Saudi patients, 25 were males and 16 were females. 21 were on combined (i.e. topical with either systemic or NB-UVB) and 20 were on topical treatments only. PASI score was moderate in the majority for both groups, that is, patients on topical (70%) and combined treatment (80%). DLQI score shows only a small effect on the patient’s quality of life for the majority (14/20) in the topical group and (16/21) for those on combined therapy. Conclusion: There is no significant difference in terms of the effect of the type of treatment between the two groups

Cutaneous Squamous Cell Carcinoma in Patients with Hidradenitis Suppurativa

Background: Cutaneous squamous cell carcinoma (cSCC) is a rare complication of hidradenitis suppurativa (HS). Objectives: To conduct a systematic review and an individual patient data (IPD) meta-analysis to describe the clinical characteristics of HS patients developing cSCC and determine predictors of poor outcome. Methods: Medline/PubMed, Embase, and Web of Science were searched for studies reporting cSCC arising in patients with HS from inception to December 2019. A routine descriptive analysis, statistical hypothesis testing, and Kaplan–Meier survival curves/Cox proportional hazards regression models were performed. Results: A total of 34 case reports and series including 138 patients were included in the study. The majority of patients were males (81.6%), White (83.3%), and smokers (n = 22/27 reported) with a mean age of 53.5 years. Most patients had gluteal (87.8%), Hurley stage 3 HS (88.6%). The mean time from the diagnosis of HS to the development of cSCC was 24.7 years. Human papillomavirus was identified in 12/38 patients tested. Almost 50% of individuals had nodal metastasis and 31.3% had distant metastases. Half of the patients succumbed to their disease. Conclusions: cSCC is a rare but life-threatening complication seen in HS patients, mainly occurring in White males who are smokers with severe, long-standing gluteal HS. Regular clinical examination and biopsy of any suspicious lesions in high-risk patients should be considered. The use of HPV vaccination as a preventive and possibly curative method needs to be explored

Papular Elastorrhexis: Case report

Papular Elastorrhexis (PE) is a very rare acquired skin disease of unknown etiology characterized by asymptomatic, discrete, hypo-pigmented, non-follicular, tiny skin papules. We report a 52-year-old Saudi female patient who is otherwise healthy presented with a history of asymptomatic persistent skin lesions on her neck that have been increasing in number since adolescence. There are no similar skin lesions in the family. Skin examination showed multiple tiny non-scaly hypo-pigmented-skin colored dome-shaped papules on her neck. Skin biopsy showed normal epidermis and dermis. The elastic stain showed reduced and fragmented elastic fibers in the reticular dermis