What’s new in clinical dermatology?

Dr Tamar Nijsten (Erasmus University Medical Centre, the Netherlands) discussed remarkable clinical studies across various topics and diseases within dermatology that were published in 2023 or the first months of 2024 [1].

In a study among 180 participants with a peanut allergy and 2 other food allergies (NCT03881696), omalizumab treatment resulted in a better tolerance regarding ingesting the food allergens compared with the placebo treatment [2].

Next, the PALACE trial (NCT04454229) showed that in participants with low-risk penicillin allergy, as assessed by the PENFAST score, a direct oral penicillin challenge was non-inferior to the more complicated and time-consuming standard-of-care skin testing followed by an oral challenge [3].

Another interesting trial tested acupuncture versus a sham procedure and a close monitoring approach in participants with chronic spontaneous urticaria (n=330) [4]. Acupuncture was more efficacious than the other 2 arms concerning the weekly urticaria activity score.

In another trial (CTRI/2018/11/016448), oral acitretin plus topical triamcinolone was compared with topical triamcinolone monotherapy in 64 participants with symptomatic oral lichen planus [5]. The combination therapy was associated with better outcomes than the monotherapy across various efficacy endpoints.

Two large, randomised trials (SUNSHINE [NCT03713619] and SUNRISE [NCT03713632]) showed that secukinumab was more efficacious than placebo in improving signs and symptoms of moderate-to-severe hidradenitis suppurativa [6]. Furthermore, an IRAK4 degrader may be another efficacious therapy for the hidradenitis suppurativa population, according to a phase 1 study (NCT04772885) [7].

Dr Nijsten also presented the findings of a study (NCT04195698) on participants with moderate-to-severe atopic dermatitis. They were either started on dupilumab and switched to upadacitinib after 24 weeks or started and continued on upadacitinib. The switch group appeared to have better results concerning Eczema Area and Severity Index 90 (EASI90) scores than the non-switch group [8]. In another study among young participants with severe atopic dermatitis, methotrexate appeared to be more efficacious than ciclosporin and was well tolerated [9]. “This indicates that we do not have to be hesitant to use methotrexate in the young atopic dermatitis population,” said Dr Nijsten. Also, a trial revealed that online mindfulness plus self-compassion training improved patients' quality of life with atopic dermatitis [10]. “This illustrates that we do not always need expensive medicine to improve the situation for our patients,” commented Dr Nijsten.

In psoriasis, a large retrospective study (n=15,501) suggested that using ustekinumab could prevent inflammatory arthritis in patients with psoriasis, whereas other biological therapies were not associated with this preventive effect [11].

Also, a phase 3 trial (NCT04501679) in prurigo nodularis demonstrated that nemolizumab was more efficacious than placebo concerning the peak pruritus numerical rating scale (PP-NRS) [12].

Then, a small trial assessed mTOR inhibition in 16 participants with cutaneous sarcoidosis [13]. This study found that the mTOR inhibitor sirolimus may be an efficacious systemic treatment for this population.

The SAPTAP trial compared single ambulatory phlebectomy (SAP) with or without delayed endovenous truncal ablation to thermal endovenous ablation with concomitant phlebectomy (TAP) in patients with saphenous trunk and tributary incompetence (n=464) [14]. SAP was a non-inferior and cost-effective alternative to TAP.

Subsequently, Dr Nijsten discussed the phase 3 BRAVE-AA1 (NCT03570749) and BRAVE-AA2 (NCT03899259) trials that analysed response trajectories in participants with severe alopecia areata treated with baricitinib [15]. The results showed that some participants only started responding to baricitinib after 24 weeks, illustrating that it is advisable to try this therapy for a longer period. Another study in alopecia areata (n=718; NCT03732807) demonstrated that ritlecitinib was efficacious across various dosing levels compared with placebo [16].

Furthermore, a trial among 110 participants with scabies demonstrated that benzyl benzoate (25%) may be superior to topical permethrin (5%) if patients were treated for 3 consecutive days and 1 week later again for 3 consecutive days [17].

A study among 250 participants with Bowen’s disease showed that topical 5% 5-fluorouracil and photodynamic therapy was non-inferior to surgical excision [18]. Then, a study compared curettage to cryosurgery in participants with superficial basal cell carcinoma (n=228). The findings showed that both therapies were highly effective and that curettage reduced wound healing time [19]. Finally, nicotinamide appeared not as efficacious as skin-care chemoprevention therapy in a trial (ACTRN12617000599370) among transplant participants (n=158) [20].

1. Nijsten T. What’s new in clinical dermatology? Dutch Dermatology Days 2024, 11– 12 April, Amsterdam, the Netherlands.
2. Wood RA, et al. N Engl J Med 2024;390:889-899.
3. Copaescu A, et al. JAMA Internal Medicine. 2023;183(9):944-952.
4. Zheng H, et al. Ann Intern Med. 2023;176(12):1617-1624.
5. Vinay K, et al. JAMA Dermatol. 2024;160(1):80-87.
6. Kimball AB, et al. Lancet. 2023;401(10378):747-761.
7. Ackerman L, et al. Nature Medicine. 2023;29(12):3127-3136.
8. Blauvelt A, et al. J Am Acad Dermatol. 2023;89(3):478-485.
9. Flohr C, et al. Br J Dermatol. 2023;189(6):674-684.
10. Kishimoto S, et al. JAMA Dermatol. 2023;159(6):628-636.
11. Singla S, et al. Lancet Rheumatol. 2023;5:e200-e207.
12. Kwatra SG, et al. N Engl J Med 2023;389(17):1579-1589.
13. Redl A, et al. Lancet Rheumatol. 2024;6(2):e81-e91.
14. Scheerders ERY, et al. Br J Surg. 2023;110(3):333-342.
15. King B, et al. Br J Dermatol. 2023;189:666-673.
16. King B, et al. Lancet. 2023;401:1518-1529.
17. Meyersburg D, et al. Br J Dermatol. 2024;190(4):486-491.
18. Ahmady S, et al. J Am Acad Dermatol. 2024;90(1):58-65.
19. Backman EJ, et al. J Eur Acad Dermatol Venereol. 2022;36(10):1758-1765.
20. Allen NC, et al. N Engl J Med. 2023;388(9):804-812.

Copyright ©2024 Medicom Medical Publishers



Posted on 31 May 20244 June 2024