In Press Articles

Commentary: Systemic Therapy for Mucosal Lichen Planus with a Focus on Oral Lichen Planus: Update and Review of Challenges and Successes

Roy S. Rogers¹, Suha Zawawi¹, Thais Pincelli²*, Markéta Janovská², Alison Bruce¹

¹Department of Dermatology– Mayo Clinic Florida –Jacksonville, FL, USA

²Department of Oral Medicine, Institute of Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University - Prague, Czech Republic

Indications for Adjuvant (Chemo) Radiotherapy in Vulvar Cancer with Groin Lymph Node Metastases

Jacobus van der Velden^*, Ming Tjiong

Amsterdam UMC, location University of Amsterdam, Gynecologic Oncology, Meibergdreef 9, Amsterdam, the Netherlands

Guidelines recommend adjuvant treatment when positive lymph nodes are found after surgical treatment for squamous cell cancer of the vulva except for cases with a single occult intranodal metastasis. Recent studies questioned these recommendations and showed benefit of adjuvant radiotherapy for all patients with positive nodes irrespective of number of nodes. However, these studies did not take into account important nodal characteristics, such as clinical node status, extranodal spread or size of the metastasis. When these variables are taken into account, adjuvant radiotherapy does not seem to result in a better survival for patients with a single occult intranodal metastasis. Whether the addition of chemotherapy to the radiotherapy for patients with more than one positive node or extracapsular spread results in a better survival remains uncertain. Only a few studies have been published on this subject and come to the conclusion that adding chemotherapy results in a better survival. The conclusion is that adjuvant radiotherapy improves survival of patients with positive groin nodes, with the exception of patients with a single intranodal metastasis. The beneficial effect of chemo radiotherapy for subgroups of patients with positive nodes seems likely, although more data are needed before a definite conclusion can be made.

The Dawning of a New Enterprise: RNA Therapeutics for the Skin

Rachel E. Kieser^1,2,5#, Shaheerah Khan^1,2,5#, Nada Bejar^1,2,5#, Daniel L. Kiss^1,2,3,4,5*

¹Center for RNA Therapeutics,

²Department of Cardiovascular Sciences,

³Weill Cornell Medical College, New York, NY, USA

⁴Houston Methodist Cancer Center, Houston, TX, USA

⁵Houston Methodist Academic Institute, Houston Methodist Research Institute, 6670 Bertner Ave, R10‑113, Houston 77030, TX, USA

^#These authors have contributed equally

Despite being under development for decades, RNA therapeutics have only recently emerged as viable drug platforms. The COVID-19 mRNA vaccines have demonstrated the promise and power of the platform technology. In response, novel RNA drugs are entering clinical trials at an accelerating rate. As the skin is the largest and most accessible organ, it has always been a preferred target for drug discovery. This holds true for RNA therapies as well, and multiple candidate RNA-based drugs are currently in development for an array of skin conditions. In this mini review, we catalog the RNA therapies currently in clinical trials for different dermatological diseases. We summarize the main types of RNA-related drugs and use examples of drugs currently in development to illustrate their key mechanism of action.

Periodontitis and the Impact of Oral Health on the Quality of Life of Psoriatic Individuals: A Case-Control Study ‑ Commentary

Amanda Costa; Fernando Costa^*

Department of Dental Clinics, Oral Pathology and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Commentary: Sunscreen Compliance with American Academy of Dermatology Recommendations: A 2022 Update and Cross-Sectional Study

Stephanie V Shimon^1,2, BS; Loren E Hernandez, BS²; Keyvan Nouri, MD, MBA²

¹Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL.

²Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL.

The 2022 Global Monkeypox Outbreak: A Focused Review

Yasmine Oprea¹, Patricia Cerri-Droz², Urmi Khanna¹

¹ Albert Einstein College of Medicine/Montefiore Medical Center

² Renaissance School of Medicine at Stony Brook University

The first human infection with monkeypox virus was reported in 1970, and infections have subsequently been recorded in endemic areas such as Central and West Africa or linked to international travel to these regions. However, the emergence of the 2022 monkeypox outbreak has involved multiple non-endemic countries and continents without links to travel to endemic areas. The first cases in the current outbreak were reported in May of 2022. The primary mode of transmission is atypical and is thought to occur through direct contact with infected skin lesions. The rapid increase in case numbers prompted the World Health Organization to declare this disease outbreak as a public health emergency of international concern. Robust efforts are being made by global public health authorities to develop effective antiviral treatment options and vaccination strategies to reduce the spread of this disease. The objective of this manuscript is to provide a comprehensive review of the 2022 mpox outbreak with respect to its unique epidemiology, clinical features, complications, and management options.

Racial and Ethnic Disparities in Androgenetic Alopecia Clinical Trials in the United States

Ishita Aggarwal BA; Carolina Puyana MD, MSPH^*; Neha Chandan MD, MPH; Roger Haber, MD

University of Illinois at Chicago, Department of Dermatology, 1801 W. Taylor St., Chicago, IL 60612-7307

Introduction: Androgenetic alopecia (AGA) is the most common type of hair loss worldwide and is estimated to affect about 80 million people in the United States. Recent trends suggest that incidence and severity of the disease are increasing across all genders and races. Randomized controlled trials (RCTs) involving diverse patient populations are necessary to individualize treatment.

Objective: Evaluate enrollment and subgroup analysis of people falling in racial/ethnic minority groups in phase II and III RCTs for AGA published in the United States within the past 10 years.

Methods: We examined completed published phase II and III randomized, double-blind, placebo-controlled trials investigating AGA. Race/ethnicity data was extracted for each RCT using US Census Bureau guidelines.

Results: 20 total RCTs with a total of 1855 participants were included in the analysis. 8 (40%) of RCTs included race/ethnicity data. Among these, 3 (15%) studies included only race and 5 (25%) included both. The majority of study patients were white (n= 862/1063, 81.1%) followed by African American (n=127/1063, 11.9%) and Asian (n=33/1063, 3.1%). Six (0.56%) patients identified as American Indian/Alaska Natives, 5 (0.47%) as Hawaiian/Pacific Islander, and 16 (1.5%) as another race or race was unknown. Ethnicity was reported in 5 (25%) of trials, totaling 317 participants; 60 (18.9%) patients identified as Hispanic.

Conclusions: Non-Caucasian patients remain underrepresented in RCTs despite AGA being a highly prevalent condition, reducing the generalizability of trial outcomes to the general population. Future RCTs should update definitions of race/ethnicity and include more diversity among AGA patients.

Old Solutions May Be the New Answer: How the Use of Modern Superficial Radiation Therapy Might Address Disparities in Dermatologic Care

Alison Tran, M.D., M.A., Ed.M.^1* and Lio Yu, M.D., DABR²

¹Menter Dermatology Research Institute, Baylor University Medical Center; Heights Dermatology, Dallas, TX

²Director of Radiation Oncology, Laserderm Dermatology, Smithtown, NY

Superficial Radiotherapy: Long Term Follow-Up of Highly Selected Basal and Squamous Cell Carcinomas in Skin Cancer Patients

Simon J. Madorsky, MD^*, Orr A. Meltzer, BS, Alexander Miller, MD

Skin Cancer and Reconstructive Surgery Center (SCARS Center) at 180 Newport Center Drive, Suite 158, Newport Beach, CA 92660

Superficial radiotherapy (SRT) treatment for non-melanoma skin cancer has been reported to yield variable cure rates. When patients are highly selected, adequate margins of treatment are chosen, and hypofractionation is avoided, cure rates of SRT can approach that of Mohs surgery.

The objective of this study is to evaluate long term results of our center’s SRT selection criteria and define proper decision-making parameters of optimal candidates for treatment, and to review the literature. A retrospective chart analysis was done of all SRT cases from 2012-2018. Location, size, type and depth of the treated tumors were defined. Treatment energy, fractionation, and radiation field size were documented. Recurrences and complications were analyzed. Of 131 treated lesions treated, head and neck lesions (105, 80%) were the most common location, primarily on the lower nose (60, 46%). Of 122 lesions analyzed for recurrence, 2 (1.6%) recurred, with a mean follow-up time of 5 years. Acute ulcerations in 29 (28%) head and neck lesions, 5 (63%) trunk lesions, and 9 (50%) leg lesions occurred. Delayed ulcerations occurred in 5 (28%) leg lesions. In conclusion, when patients are highly selected, long-term SRT cure rates up to 98% can be achieved.

Successful Use of Brentuximab Vedotin for Treatment of CD30-positive Primary Cutaneous Extranodal Natural Killer/T-Cell Lymphoma

Denise Ann Tsang^1*, Chee Leong Cheng², Laura Hui¹

¹Singapore General Hospital, Department of Dermatology

²Singapore General Hospital, Department of Pathology

Commentary: Addressing the Challenges in Antisepsis: Focus on Povidone Iodine

Stan J. Monstrey

Ghent University Hospital, Ghent, Belgium

Commentary: Laser Tattoo Removal: Laser Principles and an Updated Guide for Clinicians

Samantha D. Verling^*, Noreen Mohsin^#, Loren E Hernandez, Teresa Ju, Keyvan Nouri

Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA

Effects of Obesity on Infections with Emphasis on Skin Infections and Wound Healing

Daniela Frasca^1,2*, Natasa Strbo^1,2

¹Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL USA

²Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL USA

Obesity represents a serious health problem as it is rapidly increasing worldwide. Obesity is associated with reduced health span and life span, decreased responses to infections and vaccination and increased frequency of inflammatory conditions. In this review, we summarize published data showing that obesity increases the risk of different types of infections, with a special focus on skin infections. Obesity also induces skin changes and conditions (inflammation-based and hypertrophic) which are often associated with fungi or bacteria overgrowth. The association of obesity with the skin microbiome has been established in both mice and humans. Balance of commensal microbes controls skin homeostasis and the host immune response, while changes in normal physiologic skin microbiome composition and pathologic bacteria contribute to skin diseases. We also summarize the major steps in wound healing and how obesity affects each of them. The role that immune cells have in this process is also described. Although the studies summarized in this review clearly demonstrate the deleterious effects of obesity on wound healing, additional studies are needed to better characterize the cellular and molecular mechanisms involved and identify specific targets of intervention.