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Kaitlyn Bader is the assistant managing editor of 

 and joined the MJH Life Sciences team in June 2022. She attended Otterbein University in Westerville, Ohio, and earned a Bachelor of Arts degree in literary studies with minors in creative writing and film studies. Prior to health care news, Kaitlyn worked in industrial marketing. She enjoys cooking, reading, and tending to her house plants.

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In case you missed it, we had news about benzene in benzoyl peroxide acne products tested at room temperature, the FDA's approved sNDA for 3 tubes of aminolevulinic acid hydrochloride, phase 2b trial data of zasocitinib, and more.

The Weekly Roundup: October 7-11

The novel drug demonstrated tolerability for AK treatment when applied to a field of 100 cm2 of the face or scalp.

Tirbanibulin Demonstrates Efficacy for Actinic Keratosis in Larger Field Treatment

Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

Significant reductions in itch scores and improved assessments of PN severity and quality of life were observed throughout the study.

Safe and Effective: Upadacitinib Shows Promise in PN Treatment

A recent review found clinical trials for HS lack diversity, limiting understanding of treatment efficacy for SOC populations.

Disparities in Hidradenitis Suppurativa: A Closer Look at Skin of Color Populations

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, MD, is director of the Laser & Skin Surgery Center of New York, New York.

Final Thoughts: The Importance of Comparative Studies in AD

Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

clinical

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Hyperhidrosis is not rare. According to the 

, approximately 385 million people worldwide live with hyperhidrosis.

In fact, they note that the amount of people living with chronic, excessive sweating is even higher than the amount of people living with other dermatologic conditions like psoriasis.

Just how common is hyperhidrosis in real-world comparisons?

The prevalence of hyperhidrosis is much higher in younger populations than in the general population, with 8.8% of individuals between the ages of 18 to 39 years old living with the condition. 

When comparing these statistics to everyday, common occurrences like hair color, the number of people with hyperhidrosis is greater than the 1% of individuals with natural red hair and 2% of individuals with natural blond hair. 

Despite how common hyperhidrosis is, it is estimated that 27% of those with the condition never receive a diagnosis.

 wants to hear from you. What percentage of the global population is estimated to have hyperhidrosis?

 to share your hyperhidrosis insights or research.

Albert. Fact check: Hyperhidrosis - International Hyperhidrosis Society: Official site. Home - International Hyperhidrosis Society. October 24, 1970. Accessed November 16, 2023. 

https://www.sweathelp.org/home/news-blog/542-fact-check-hyperhidrosis.html

Hyperhidrosis affects approximately 385 million people globally, surpassing the prevalence of other dermatologic conditions like psoriasis. It is notably more common in younger populations, with 8.8% of individuals aged 18 to 39 experiencing the condition. Comparatively, hyperhidrosis is more prevalent than natural red or blond hair, which affects 1% and 2% of the population, respectively. Despite its prevalence, 27% of those with hyperhidrosis remain undiagnosed. The article encourages engagement during Hyperhidrosis Awareness Month to share insights and research on the condition.

Click here to answer this week's poll for Hyperhidrosis Awareness Month.

Polls 

POLL: What Percent of the Global Population is Estimated to Have Hyperhidrosis?

, Jason Hawkes, MD, MS, provided insights into the key differences between atopic dermatitis and prurigo nodularis, including appearance, cytokine pathways associated with each condition, patient populations, biologics use, diagnostic tools, and the psychological effect of both conditions on patients.

Hawkes, a board-certified dermatologist, co-owner, chief scientific officer, and investigator at the Oregon Medical Research Center in Portland, Oregon, emphasized that biologic treatments are transforming the management of both prurigo nodularis and atopic dermatitis, as treatments are needed to address the intense impact of itch on patients’ quality of life.

: What are the key differences in the appearance and/or lesions of prurigo nodularis vs atopic dermatitis?

: Some of the distinctive clinical features of prurigo nodularis are the symmetric distribution of lesions on easy-to-reach skin, prominent complaints of itch or other nerve-related symptoms, and skin plaques or nodules that are prone to scarring and dyschromia. These clinical features of prurigo nodularis are less common in patients with atopic dermatitis. However, these two pruritic conditions can co-occur and may have overlapping clinical features in patients.

: What are the prominent cytokine pathways in prurigo nodularis?

: Lesional skin biopsies in prurigo nodularis reveal significant increases in mixed immune cell and signaling pathways (eg. Th2, Th17, and Th22), similar to what is observed in atopic dermatitis. However, phase 3 clinical trials in PN suggest that type 2 inflammation is the predominant immune pathway driving the clinical manifestations of prurigo nodularis due to the dramatic skin and itch responses seen following blockade of IL-4, IL-13, and/or IL-31. In contrast, there are several reports of the development of prurigo nodularis following treatment with selective IL-17 inhibitors, such as secukinumab.

: What are the prominent cytokine pathways in atopic dermatitis?

: Robust translational research studies in humans support the predominant role of type 2 inflammation in the immunopathogenesis of atopic dermatitis, such as increased IFN, IL-4, IL-13, and IL-31 cytokine signaling. Other immune cell populations, such as Th17 and Th22, have been reported in atopic dermatitis and may play a more prominent role in special patient populations. Testing of novel immunotherapies that inhibit the upstream regulatory signals (eg. TSLP, OX40, and OX40L) driving T cell activation and the development of resident memory T cell populations is underway and quite promising.

Regarding epidemiology, are there specific patient populations more likely to develop prurigo nodularis vs atopic dermatitis?

: Both conditions are observed in a broad range and diverse set of patient groups. Neither condition has a clear male or female predilection when controlling for other disease comorbidities or underlying health conditions. Atopic dermatitis has an increased overall prevalence compared to prurigo nodularis and most commonly presents in childhood or early adulthood. In contrast, prurigo nodularis is primarily observed in middle-aged adults, has a stronger association with Black patients, and co-occurs in individuals with underlying health conditions that are not commonly seen with atopic dermatitis, such as liver disease, renal dysfunction, malignancy, and HIV infection.

: How does your treatment approach differ when managing prurigo nodularis compared to atopic dermatitis, particularly with the development of newer biologics?

: In general, the therapeutic goals are very similar for both conditions — to alleviate disease symptoms, promote healing of active skin lesions, and sustain adequate disease control with little or no disease activity with ongoing treatment. These goals are more achievable than ever due to the availability of several highly effective biologic agents that are approved for each individual condition. Our treatment approach, however, is still dependent on a variety of other factors, such as patient treatment preference, insurance approval and affordability, and disease severity (ie. mild or localized disease versus more severe or widespread disease). Further, not every atopic dermatitis or prurigo nodularis patient responds the same to a specific treatment, thus necessitating the need for multiple treatments with distinct mechanisms of action. Combination therapies, such as the use of topical treatments with systemic agents, is another way to optimize or maximize a patient's clinical response.

What diagnostic tools or criteria do you prefer when differentiating between the 2 conditions

: The diagnosis of atopic dermatitis and prurigo nodularis remains clinical. This is primarily due to the lack of specific, validated disease biomarkers or commercial clinical tests (including skin biopsies) that can consistently distinguish the two conditions and are readily accessible to practitioners. Rather, in cases where the diagnosis is clinically ambiguous, there is tremendous benefit to having access to a biologic therapy like dupilumab that is approved and effective for both conditions.

: How do the psychological and quality of life impact on patients compare in prurigo nodularis and atopic dermatitis, especially given the often severe itch in both?

: Both chronic inflammatory conditions have a tremendous negative impact on the quality of life and pyschosocial health of our patients. This is well-documented in the clinical trial programs for atopic dermatitis and prurigo nodularis where multiple patient reported outcomes and quality of life measures are administered. However, the predominant symptoms that patients attribute to their disease is slightly different. In many patients with atopic dermatitis, the visible skin manifestations and their associated secondary findings (eg. skin pain, fissures, bleeding, etc) tend to be at the forefront; itch is often, but not always, a primary complaint in these patients. My patients with prurigo nodularis, on the other hand, tend to heavily focus on their itch and tendency to scratch or pick at their skin which is an essential component of their papulonodular lesions.

Atopic dermatitis and prurigo nodularis, while sharing some clinical features, differ in lesion appearance, cytokine pathways, and patient demographics. Prurigo nodularis is characterized by symmetric lesions, intense itch, and is more prevalent in middle-aged adults, particularly Black patients. Both conditions are driven by type 2 inflammation, but prurigo nodularis also involves Th17 and Th22 pathways. Biologic treatments are transforming management, though treatment responses vary. Diagnosis remains clinical due to the lack of specific biomarkers. Both conditions significantly impact patients' quality of life, with itch being a predominant concern.

Jason Hawkes, MD, MS, emphasized the importance of biologic treatments transforming the management of both prurigo nodularis and atopic dermatitis. 

Clinical Features and Cytokine Pathways in Prurigo Nodularis vs Atopic Dermatitis

Yes, I diagnose and treat psoriasis through telehealth. 

Yes, I diagnose but will not treat psoriasis through telehealth.

Yes, I will treat psoriasis through telehealth but only established patients.

No, I do not diagnose or treat psoriasis through telehealth.

The use of telehealth in hospitals grew from 35% in 2010 to 76% in 2017

, and since the COVID-19 pandemic, that number has likely increased. Do you diagnose and/or treat psoriasis through telehealth appointments?

Fact Sheet: Telehealth. American Hospital Association. Accessed August 24, 2023. 

https://www.aha.org/factsheet/telehealth#:~:text=Telehealth%20connects%20patients%20to%20vital,place%2C%20at%20the%20right%20time

Telehealth adoption in hospitals surged from 35% in 2010 to 76% in 2017, with further increases likely post-COVID-19. This growth reflects the expanding role of telehealth in diagnosing and treating conditions like psoriasis. The pandemic has accelerated the integration of telehealth into routine healthcare delivery, offering patients timely access to care. The American Hospital Association provides resources and data supporting telehealth's efficacy and its potential to enhance patient outcomes by connecting them to necessary healthcare services efficiently and effectively.

POLL: Do You Diagnose and Treat Psoriasis Through Telehealth Appointments?

There can be significant crossover between dermatology and infectious disease, specifically for certain infections where skin presentation or involvement is a major hallmark. In other cases, the treatments for various viral, bacterial, fungal, and parasitic diseases can have skin manifestation, and so it is vital for dermatology providers to be aware of the potential implications of infectious disease.

Ted Rosen, MD, professor and vice-chair of the Dermatology Department at Baylor College of Medicine, and George Hightower, MD, PhD, associate clinical professor at UC San Diego and pediatric dermatologist at Rady Children’s Hospital, delivered an infectious disease update at 

, focusing on diagnostic and therapeutic challenges.

Rosen began the talk by covering some current COVID-19 statistics. Many like to declare that “COVID is over,” but there are still 100 to 200 Americans dying every say from the disease, although total cases have decreased. The emerging KP.1, KP.2, and KP.2 strains could be worrisome, Rosen said.

“[The KP strains] are not terribly aggressive in terms of their ability to cause mortality or even morbidity, but they're incredibly highly transmissible, and they present in a little different way, [with] fever, sore throat, runny nose, as opposed to cough, opposed to pneumonia,” he said.

In terms of dermatologic crossover with COVID, skin manifestations are polymorphic and have become increasingly more uncommon. Data from studies on hair loss and COVID have found a higher proportion of androgenetic alopecia but, because older people were more severely affected by COVID, the alopecia likely predated their disease, Rosen said.

Mpox is making a comeback, after a new clade emerged in countries like Burundi, Kenya, Rwanda, and Uganda. Data suggest it is more virulent an aggressive, causing the World Health Organization (WHO) to declare a public health emergency of international concern after ending the same designation just 10 months prior. Currently, it is estimated that there are > 32,000 US cases (58 deaths) and > 92,000 global cases (181 deaths). The deaths are most commonly associated with uncontrolled HIV co-infection.

Patients infected with Mpox present with lesions that are typically confined to the site of exposure. Because it is spread through sexual contact, providers will typically see the rash on the genitals, in the anorectal area, or in the mouth. There is a vaccine available but, even if a patient receives the necessary 2 doses, it is still only about 88% effective, Rosen said. Tecovirimat has been relied on as a treatment in the past, however there is data to suggest that resistance is growing.

In the United States, there are a growing number of Dengue virus infections, with 2241 cases reported as of mid-June, 1498 in Puerto Rico alone. There are currently isolated outbreaks in Florida, Arizona, Texas, and California. Dermatology providers are likely to encounter Dengue because the associated rash is non-descript; it could be any rash. However, when coupled with other symptoms — such as fever, nausea, vomiting, myalgia, arthralgia, bone pain, headache, or bleeding nose or gums, or even facial palsies — and travel history, Dengue should stay on the differential diagnosis list.

When it comes to non-HIV sexually transmitted diseases, syphilis is front and center right now because we are experiencing the highest rates of syphilis since World War II, with 17.7 cases per 100,000 adults. People with skin of color are disproportionality affected and, in the United States, cases are most prevalent in South Dakota and New Mexico. These are both states with federally recognized Indian tribes, which is a group currently experiencing a surge in syphilis diagnoses. Cases in women are also on the rise.

“Syphilis does not respect ethnicity, syphilis does not respect age, and syphilis does not respect gender in any way, shape, or form,” Rosen said.

Compounding the rise in cases is the global shortage of penicillin, the most common treatment for the infection. There are also data that support the use of doxycycline as post-exposure prophylaxis.

Tuberculosis (TB) is currently an emerging threat, with cases ticking upward in California, Texas, New York, and Florida. Globally, according to the WHO, there are hot spots in Bangladesh, China, the DRC, India, Indonesia, Nigeria, Pakistan, and the Philippines. A summary of 2023 TB data published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report found that 1 in 50 migrants carry TB.

On the skin, TB can look very bad, with chancres and ulcers. Or it can appear as miliary TB, which happens when it gets into the bloodstream.

is a new dermatophyte gaining attention. It’s a widespread, resistant fungus that originated in India but has now been recorded in southeast Asia, the Middle East, Africa, Europe, Australia, and Canada. It is highly resistant to terbinafide and itraconazole and may be associated with the use of steroids. It is thought to spread via close contact or shared fomites, so familial spread is likely. It causes multiple lesions, lots of inflammation, and a double ring of scale.

The United States saw its first case in March 2023 in New York, with others sure to follow, Rosen said.Because it is so resistant to existing antifungals, treatment can be tricky.

“The best thing that's worked for me is Whitfield's ointment,” Rosen said. “That is an old, old product, but it doesn't rely on enzymes. It just basically sucks the skin off. It's great. It's $10 on Amazon.”

Hightower closed the presentation with a few case studies. One involved a case of tinea incognito where a topical corticosteroid actually altered the appearance of the underlying infection. The patient received a corticosteroid for an eczematous rash, which seemed to initially improve with use of the topical. The patient continued use of the corticosteroid but the rash never seemed to clear completely, and the curved or circular edges were still visible. The takeaway here for providers if to make sure you give a time course of when to discontinue use of a topical corticosteroid.

The second case involved an infant with respiratory syncytial virus and a rash, which turned out to be scabies. Rosen and Hightower encouraged providers to make sure everyone in the immediate family, including caregivers, receive treatment.

Lastly, a case of eczema herpeticum. With this viral co-infection, the patient experiences a sometimes widespread cutaneous vesicular eruption that can be life-threatening in infants and small children. Secondary infections are common, and empiric acyclovir is usually step 1 for treatment.

Rosen T, Hightower G. Infectious disease update. Presented at: Maui Derm NP+PA Fall; September 15-18, 2024; Nashville, Tennessee.

Infectious diseases often intersect with dermatology, as skin manifestations can be a hallmark of infections or their treatments. COVID-19, despite reduced cases, still poses a threat with new strains. Mpox is resurging, with a new virulent clade causing concern. Dengue virus cases are rising in the U.S., with dermatologists likely encountering its non-descript rash. Syphilis rates are at a historic high, compounded by a penicillin shortage. Tuberculosis cases are increasing globally. A new resistant fungus, Trichophyton indotineae, is spreading, challenging existing antifungal treatments.

At Maui Derm NP+PA Fall 2024, Ted Rosen, MD, and George Hightower, MD, PhD, review the landscape of infectious diseases that can have dermatologic involvement, including viral, bacterial, fungal, and parasitic illnesses.

Infectious Disease and Dermatology Crossover: What Providers Need to Know

As the 4th of July approaches, the risk of accidental burns increases with fireworks, firepits, and outdoor grilling. We want to know, as a dermatology provider, do you treat burns, or do you refer patients elsewhere?

If you have additional thoughts about the dermatologist's or advanced practice provider's role in burn care, email us at 

The 4th of July brings an elevated risk of accidental burns due to fireworks, firepits, and outdoor grilling. Dermatology providers face the decision of whether to treat burns themselves or refer patients to specialists. The role of dermatologists and advanced practice providers in burn care is a topic of interest, with considerations for their involvement in initial assessment, treatment, and follow-up care. The discussion extends to the potential need for collaboration with burn specialists to ensure comprehensive patient care.

Roy Geronemus, MD

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