Biologics in the Management of Sever Atopic Dermatitis

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, it is presented with heterogeneous clinical phenotypes that can alter by severity, age, and ethnic background. The chronic nature of AD necessitates safer, and newer treatment that is effective in improving quality of life [1]. A new era of therapeutics is in innovation phase including Biologic treatment and it is essential to provide a comprehensive understanding of this modality of treatment. Hence, this review presents an overview of up to date biologics that are approved or are in development for the treatment of AD

Management of Adult Chronic Urticaria: Practical Approach

Chronic urticaria is an itchy inflammatory skin condition, also known as hives, weal’s, welts or nettle rash. The main symptom is raised blotchy rash which can be intensely itchy. Its cause is unknown, although it can be triggered by an allergen, physical triggers, underlying health conditions or drugs. Several serious conditions can lead to anaphylaxis which is a medical emergency. Chronic urticaria can be difficult to manage hence there are different approaches for its management. Many still use unlicensed medications to control the condition. We are putting forward a practical approach in the management of this challenging medical problem

Pathogenesis and A Practical Guide to the Management of Steven-Johnson Syndrome & Toxic Epidermal Necrolysis

Steven Johnson Syndrome (SJS) and Toxic Epidermal necrolysis are rare dermatological emergencies that are associated with a high degree of morbidity and mortality [1]. They are considered to be severe blistering conditions that portray an image of diffuse epidermal necrolysis in association with sloughing of the skin. SJS and TEN are effectively the same disease with the main difference being the percentage of body surface area involved. It is widely accepted that SJS belongs to the below 10% body surface area category and TEN to the more than 30% category. A Steven Johnson syndrome and Toxic Epidermal Necrolysis overlap exists when the body surface area affected is between 10 percent and 30 percent [2]. The causes of both conditions within this spectrum are most likely drug related, however certain infections can also trigger SJS/TEN but this is less likely. In a substantial number of cases the cause is idiopathic [3]. The main grading system is the SCORTEN criteria, which can also provide more information regarding prognosis and mortality [4]. Management of this condition is highly controversial with no clear guidelines but there is a wide agreement that patients should be managed in a burns unit with intravenous fluids and protection from secondary infections. Stopping all medications and investigating for the cause is important unless there is clear benefit from any single medication

Drug induced dermatological reaction of the 100 most commonly prescribed medications in UK hospitals

Objective: It is commonly reported that medicines have side effects related to dermatological practice. However, it is extremely difficult to establish how commonly, or rarely skin-related medication side effects occur. Common dermatological side effects include rash, pruritus, and photosensitivity. Objective: To demonstrate the dermatological side-effects of the most commonly prescribed medications in the United Kingdom. Methods: This paper discusses dermatological side-effects of the commonly prescribed medications, including uncommon or rare manifestations such as angioedema and Stevens - Johnson syndrome (SJS). The list used for the most frequently prescribed drugs in the United Kingdom was created by nurses. This list was compared to the British National Formulary to demonstrate the reported frequency of occurrence of dermatological side-effects or complications. Conclusion: The top 100 prescribed medication cause a number of dermatological side effects that need to be considered when they are prescribed to patients who have pre-existing skin conditions. Additionally, when confronted with a common dermatological problem in any patient, clinicians should always consider the possibility of a drug adverse reaction.Published onlin

VITAMIN A DERIVATIVES USE IN THE TREATMENT OF SKIN CONDITIONS

Retinoids are used to treat various skin diseases. They add valuable impact of when used early in the treatment of dermatological conditions. Overall vitamin A derivatives are underused, with isotretinoin is the most used. This paper aims to develop prescribers’ knowledge about their benefits, to improve their usability and aids in alleviating patient concerns to improve therapeutic outcomes in dermatological conditions. In acne vulgaris, adapalene gel and tretinoin cream showed equal efficacy. In psoriasis the combination of acitretin and PUVA was superior to PUVA alone. Acitretin showed a reduction of 41% in the Nail Psoriasis Severity Index and similar efficacy to potent steroids and calcipotriol. In chronic hand eczema, alitretinoin showed 50% improvement in patient’s refractory to steroid treatment. In photoaging and aging, retinoids were shown to increase the synthesis and decrease the degradation rate of collagen and hyaluronate, reducing the impact of aging. In rosacea, topical and systemic isotretinoin showed complete remission in 24% of the patients compared to only 14 % with antibiotics (metronidazole and doxycycline). In lichen planus, isotretinoin demonstrated clinical and histopathological efficacy. In cutaneous T-cell lymphoma, bexarotene used alone or with PUVA or narrow band UVB, showed a response between 80.0% to 84.0%. Lastly in Kaposi sarcoma alitretinoin gel showed superiority to all other agents and better tolerance. This review highlights the benefit of timely use of vitamin A derivatives to encourage wider use

Surgical Treatment of Vitiligo

Vitiligo is an acquired, idiopathic disorder characterized by depigmented macules and patches with absence of functional melanocytes. Numerous treatment strategies exist, but lesions may be resistant to traditional therapies. Many treatments can help including topical including mainly topical steroids, calcineurine inhibitors and more recent biological therapy, ultraviolet light, laser including needling and surgical with various techniques. In this paper we highlight the various surgical techniques which can be helpful in the treatment of Vitiligo

Tanning Melanotan Jabs and Nasal Spray: Safe or Not?

Cultural values among young population are focused on the concept of skin tanning as a perception of health and attractiveness. This has populated the development of using synthetic tanning agents especially with the advertisement coming from the social media. Synthetic tanning agents in forms of nasal spray or injections have gained publicity of use within society through the web and other uncontrolled sourcing routes. Warnings have been issued by UK Medicines and Healthcare products Regulatory Agency, and Irish Medicines Board against the use of subcutaneous injections labelled as Melanotan, after the upsurge in consuming tanning injections that has noticed in recent years

Vitamin A derivatives use in the treatment of skin conditions

Retinoids are used to treat various skin diseases. They add valuable impact of when used early in the treatment of dermatological conditions. Overall vitamin A derivatives are underused, with isotretinoin is the most used. This paper aims to develop prescribers’ knowledge about their benefits, to improve their usability and aids in alleviating patient concerns to improve therapeutic outcomes in dermatological conditions. In acne vulgaris, adapalene gel and tretinoin cream showed equal efficacy. In psoriasis the combination of acitretin and PUVA was superior to PUVA alone. Acitretin showed a reduction of 41% in the Nail Psoriasis Severity Index and similar efficacy to potent steroids and calcipotriol. In chronic hand eczema, alitretinoin showed 50% improvement in patient’s refractory to steroid treatment. In photoaging and aging, retinoids were shown to increase the synthesis and decrease the degradation rate of collagen and hyaluronate, reducing the impact of aging. In rosacea, topical and systemic isotretinoin showed complete remission in 24% of the patients compared to only 14 % with antibiotics (metronidazole and doxycycline). In lichen planus, isotretinoin demonstrated clinical and histopathological efficacy. In cutaneous T-cell lymphoma, bexarotene used alone or with PUVA or narrow band UVB, showed a response between 80.0% to 84.0%. Lastly in Kaposi sarcoma alitretinoin gel showed superiority to all other agents and better tolerance. This review highlights the benefit of timely use of vitamin A derivatives to encourage wider use

Hyperhidrosis: Pathophysiology and Treatment

Hyperhidrosis is the process of dysregulated sweating beyond homeostatic regulation. It is often classified by aetiology (primary or secondary) and location (focal or generalised). Sweating is essential for thermoregulation but it is thought that failure within the negative-feedback loop, driven by acetylcholine, causes disproportionate sweating. Often this impacts patient’s emotional, mental, and physical wellbeing. Personalization of therapy and education is paramount to improving outcomes. Hyperhidrosis can be managed using topical or oral agents, iontophoresis, botulinum toxin injection and with local and endoscopic surgical techniques

A literature review of the Janus kinase inhibitors used in the treatment of auto-immune dermatological conditions

© 2022 The Authors. Published by Archives of Pharmacy Practice. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.51847/RHmIzdv54FThe signal transducer and activator of transcription (STAT) families and Janus kinase group (JAK) are important intracellular signalling components that affect more than 50 cytokines and growth elements. JAK inhibitors target distinct receptor-associated kinases, inhibiting the activation of inflammatory signals. With the expanding body of evidence supporting the use of targeted medicines, numerous JAK inhibitors, both topical and systemic, have been tested in the treatment of atopic dermatitis, with varying mechanisms of action, effectiveness, and safety. The efficacy and safety of JAK inhibitors used to treat inflammatory and atopic skin diseases are examined in this review study. Their application in the mentioned fields has been characterized by some excellent clinical responses, but wide variability in responses and some serious and even life-threatening side effects. While JAK inhibitors are now beneficial to many patients, further study is needed to better understand this complicated mechanism to improve treatment outcomes and minimize side effects.Published versio