This month’s highlights center on how systemic conditions can have cutaneous signs, using baricitinib to treat itch in moderate to severe AD, and what signs could predict successful treatment of actinic keratosis. Read my comments below, and the stories for further insights! Read my takeaways and the full stories below!
— Joe Gorelick
Systemic conditions that can affect skin
As Dermatology NPs and PAs it is essential that we are familiar with hallmark Cutaneous Signs of Systemic disease. Diseases such as Lupus, Dermatomyositis, Gastrointestinal Disease, or an Internal Malignancy may have cutaneous signs or signals that clue us in to a potential systemic process. Read on to learn more about specific cutaneous signs of the diseases listed above and register now for DERM2018 at www.DermNPPA.org to advance your dermatology knowledge and skills.
Less itch and more sleep with baricitinib
Rapid itch reduction was seen as early as one week in this phase 2 data studying Baricitinib for the treatment of Moderate to Severe Atopic Dermatitis (AD). Baricitinib is a once-daily oral Janus kinase (JAK) 1 and 2 inhibitor. The JAK’s will soon be coming to the world of Dermatology specifically in Psoriasis, Psoriatic Arthritis and Atopic Dermatitis. It is important that we become versed in the inflammatory pathways on which JAK inhibition will exert effects. In this article Dr. Silverberg provides a concise description of inflammatory cytokines important to AD such as IL-4, IL-13, IL-31, that are mediated by the JAK/STAT pathway. He suggests that baricitinib may have an added benefits because it directly targets inflammation as well as itch. In clinical studies, baricitinib has also shown to improve the objective signs of AD.
Predictors for successful actinic keratosis treatment
How do you approach the treatment of Actinic Keratoses (AK)? What we know is that we need to treat them because of their potential to become malignant yet we do not know which ones will progress- So we need to treat them all. This study identified key dermatoscopic findings that seem to predict a higher treatment success rate using ingenol mebutate 0.015% for the treatment of AKs on the face. Specifically on the face AKs dermascopically showing a red pseudonetwork, which lack structure and look like red areas intermingled with small roundish white areas, were nearly two times more likely to achieve complete dermoscopic clearance. Brush up on your Dermoscopy skills with a 2-Hour Dermoscopy session at DERM2018 this summer.