This week’s collection of the latest dermatologic studies covers aseptic facial granulomas, chronic spontaneous urticaria and IgE, a case review of crusted scabies, and the safety and tolerability of onabotulinumtoxinA.
In their retrospective case series, Lenders et al found that treatment with oral macrolides demonstrated efficacy and was well-tolerated in 12 children with aseptic facial granulomas (AFGs), which may present as a manifestation of pediatric rosacea. Children diagnosed with AFG from 2015 to 2022 were treated orally with either erythromycin 30–50 mg/kg or roxithromycin 7.5 mg/kg daily. Nine of out the 12 pediatric patients selected (75%) showed signs of rosacea, namely erythema, papules or pustules. Two of 12 (16%) patients had telangiectasias on the eyelids, and four out of 12 (33%) had associated recurrent blepharitis, conjunctivitis, or chalazia.
According to Su et al, IgE antibodies to various autoantigens like thyroperoxidase and interleukin 24 drive the occurrence of signs and symptoms in type I autoimmune chronic spontaneous urticaria (CSU). “Expression of tissue transglutaminase 2 (TG2), the autoantigen in celiac disease, was demonstrated to be increased in lesional skin mast cells of CSU patients,” the authors wrote. Su et al used a human IgE capture ELISA to quantify IgE-anti-TG2 levels in 160 CSU patients and 54 healthy control patients and found that a substantial subpopulation of CSU patients shows increased IgE-anti-TG2 levels.
Lause et al reviewed patient cases of crusted scabies in a tertiary care hospital to discuss risk factors and clinical presentations. In their first case, an elderly female patient with a history of advanced Alzheimer’s disease was transferred to the author’s medical center with a longstanding rash previously treated with topical corticosteroids and oral antihistamines. Hyperkeratotic and excoriated papules and plaques were found on the face, trunk, and extremities with extensive hyperkeratosis of the palms and interdigital web spaces. Dermoscopy revealed live scabies mites and the patient was treated with combined topical permethrin (5% cream with full-body application) and oral ivermectin (200µg/kg/dose).
Brin et al completed a meta-analysis of 5298 patients with glabellar lines (GL), crow’s feet lines (CFL), and forehead lines (FHL) who received either onabotulinumtoxinA or placebo across 18 studies. Out of the 14 selected double-blind, placebo-controlled studies, adverse events were reported in 1443 (42.1%) of patients in the onabotulinumtoxinA group (n=3431) and 486 (35.8%) of patients in the placebo group (n=1359). Serious adverse events were reported in 54 (1.6%) of the onabotulinumtoxinA group and 17 (1.3%) of the placebo group. According to the authors, “This meta-analysis confirms the onabotulinumtoxinA safety profile for GL, CFL, and FHL treatment, with no new onabotulinumtoxinA-associated AEs.”
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