Skin of Color Update 2021 Poster Session

Efficacy Evaluation of a Topical Hyaluronic Acid Serum in Facial Photoaging

 Zoe Diana Draelos, MD; Isabel Diaz, BA; Jin Namkoong, PhD; Joanna Wu, PhD; Thomas Boyd, PhD

Author Contact Information:
Zoe Draelos
[email protected]

Purpose: Hyaluronic acid (HA) acts as a biologic humectant thus retaining water in the skin making it useful as a topical moisturizing ingredient. The goal of the research was to evaluate the ability of a HA facial serum to deliver skin benefits in all Fitzpafrick skin types I-VI.

Methods: 40 females 30-65 years exhibiting photoaging used the HA facial serum twice daily with sunscreen. The dermatologist investigator evaluated smoothness, plumping, hydration, fine lines/wrinkles, and global appearance issues on a 5-point ordinal scale.

The subjects assessed product tolerability in terms of stinging, itching, and burning. Comeometry was undertaken with assessments at baseline, immediately after application, and weeks 2, 4, and 6. Facial swabbing and photography were performed at the same intervals on a subset of 15 subjects.

Results: The HA serum demonstrated excellent tolerability and produced an increase in skin hydration measured by corneometry immediately after application of 134% (p<O.001) with a sustained increase of 55% (p<O.001) at week 6 in all Fitzpatrick skin types. At week 6, there was also improvement (psO.001) in all evaluated attributes: smoothness (64%), plumping (60%), hydration (63%), fine lines (31 %), wrinkles (14%), and overall global assessment (43%). Facial swabbing confirmed an increase in topical HA at week 6 @=0.04), accounting for the enhanced skin appearance, but there was no statistically significant increase in IL-la, indicating no product irritation.

Conclusion: Topical HA in a serum fonnulation provides excellent skin hydration as demonstrated through clinical, photographic, chemical, and instrumental assessments in all skin types, including skin of color.

Cutaneous pseudolymphoma secondary to influenza vaccination in skin of color

Abrahem Kazemi MD (1), Jia Gao BS (1), Kenneth Shulman MD (1,2), and Marian Russo MD (1)

(1) Department of Dermatology, New York Medical College, NYC, NY. (2) Dermpath Diagnostics, Port Chester, NY.

Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma (CPL), is a group of benign skin conditions which histologically resembles malignant lymphoma. Herein, the authors present a case of CLH secondary to influenza inoculation in a 38-year-old Mexican woman. The localized eruption developed one day after the injection and remained grossly unchanged over the ensuing two months. A double-trephine punch biopsy was performed and revealed a superficial and deep nodular and diffuse dermal lymphocytic infiltrate of predominantly small B-cells and small T-cells with a few small germinal centers and sparse plasma cells. The lymphoid infiltrate was composed of 60% small CD20+ B-cells, and 40% small CD3+ T-cells associated with remnants of non-infiltrated germinal centers. Sparse plasma cells were polyclonal for kappa and lambda. T-cell and B-cell gene rearrangement studies were negative for monoclonality and acid-fast and Fite stains were negative for mycobacteria. The lesion improved with excisional biopsy and intralesional corticosteroids. When CLH is suspected, a biopsy is necessary to distinguish benign CPL from similarly presenting extranodal marginal zone lymphomas (1). The clinical presentation can vary greatly among patients and few cases are available in the literature. It is often overlooked among the differential diagnoses when patients initially present with these eruptions after a history of recent vaccine injection. Given the ongoing global vaccination effort against COVID-19, the authors seek to bring awareness to and describe one of the rare cutaneous adverse events of vaccine injections, which follows a benign course.

1. May SA, Netto G, Domiati-Saad R, Kasper C. Cutaneous lymphoid hyperplasia and marginal zone B-cell lymphoma following vaccination. J Am Acad Dermatol. 2005;53(3):512-6.

Efficacy and Tolerability of a Double-Conjugated Retinoid-Containing Eye Cream in Subjects with Fine to Moderate Wrinkles of the Periorbital Region

Joely Kaufman, MD,¹ Valerie Callender, MD, FAAD², Cherie M. Young, MD², Patricia Jones,MD², Mitchell Wortzman, PhD³; Diane B. Nelson, RN, MPH³

¹Skin Research Institute, Coral Gables, FL; ²Callender Center for Clinical Research, Glenn Dale, MD; ³skinbetter science LLC, Phoenix, AZ

Author Contact Information:
Diane Nelson
[email protected]

Topic: Cosmeceuticals

PURPOSE: The periorbital region is susceptible to premature skin aging and among the first areas to manifest age-related changes. Retinoids are highly effective but can be irritating, limiting use in this vulnerable area. A hydrating formulation comprised of a double-conjugated retinoid/alpha hydroxy acid (lactic acid; AHARet-EM) has been developed to address photoaging of the periorbital area. This study evaluated the efficacy, tolerability, and subject satisfaction of nightly application of AHARet-EM, and a regimen that included application of a peptide-rich eye cream (InF-E; AM) and AHARet-EM (PM).

DESIGN: A 12-week, dual-center, open-label study evaluated nightly application of AHARet-EM in subjects 35-65 years of age with fine to moderate lines/wrinkles in the periorbital area (3-7 score based on the Fitzpatrick Classification Wrinkle Scale [FCWS]). A subset of subjects applied AHARet-EM (PM) and InF-E (AM). Investigator assessments at baseline, 4, 8, and 12 weeks were based on the 9-point FCWS for lines/wrinkles (1 [Fine Wrinkles] to 9 [Deep Wrinkles]) and a 6-point scale (0 [None] to 5 [Severe]) for texture, erythema, and under-eye darkness, puffiness, and dryness. Subject satisfaction and Adverse Events (AEs) were captured over 12-weeks.

FINDINGS: Twenty-six subjects, Fitzpatrick Skin Type III-VI, completed the study (n=16, AHARet-EM; n=10, AHARet-EM/InF-E). Subjects applying AHARet-EM demonstrated significant improvements from baseline at week 12 in the appearance of lines/wrinkles (33%; p<.0001), texture (37%, p<.0001), erythema (37%, p=.004), and under-eye darkness (41%; p<.001), puffiness (55%, p<.0001) and dryness (94%, p<.0001). Significant improvements from baseline were demonstrated in subjects using the AM/PM regimen at week 12 in the appearance of texture (33%; p=.002), erythema (68%; p=.001), and under-eye darkness (32%; p=.007), puffiness (64%; p=.01) and dryness (90%; p<.0001). No AEs occurred related/possibly related to use of the study products. High levels of subject satisfaction were reported over 12 weeks.

SUMMARY: Nightly application of a hydrating, double-conjugated retinoid eye cream demonstrated significant improvements in the appearance of lines/wrinkles, under-eye darkness, puffiness and dryness of the periorbital area at 12 weeks. Morning application of a peptide-rich eye cream afforded additional benefits. The study products were non-irritating, and subjects reported high levels of satisfaction throughout the study.

Gender approach in pemphigus patients: a comparative study in the Dermatology Department of Rabat (Morocco)

Farah El Hadadi¹, Line Mezni¹, Mariame Meziane¹, Nadia Ismaili¹, Laila Benzekri¹, Karima Senouci¹.

(1) Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco.

Author Contact Information: 
Farah El Hadadi
[email protected]

Background: Pemphigus is the most frequent chronic autoimmune bullous condition in the eastern European Jewish and Mediterranean descent. The disease involves the skin and mucous membranes of the stratified squamous epithelium. It is the first leading cause of hospitalization in our department with 15 newly diagnosed cases per year. Few studies have been published to see whether there is a significant gender influence on disease presentation, severity activity score and evolution.

Materials and methods: we performed a comparative analysis of 129 male and 173 Moroccan female pemphigus patients seen at the Dermatology Department of Ibn Sina University of Rabat between 19902020. Files were retrospectively analyzed, and the following epidemiological and clinical data were retrieved from the medical records: age at diagnosis, mean duration of disease, history of autoimmune conditions, clinical subtypes, cutaneous and oral involvement and the evolution. The Softwares Excel and Statistical Package for the Social Sciences (SPSS Inc, version 15.0 for Windows) were used for data entry and analysis. Normally distributed numerical data was summarized by its mean values and standard deviation.

Results: There was no significant difference in terms of age of disease’s onset (52,24±14 in women VS 54,05±15 in men), the mean duration of the disease before diagnosis in both cases was (13 months). The association with autoimmune diseases was more frequent in women (9 patients with thyroid dysfunction, 5 cases with diabetes type 1, 5 rheumatoid polyarthritis, 2 systemic lupus, 1 autoimmune hepatitis, 1 Gougerot-Sjogren, 1 vitiligo, 1 autoimmune sclerosing cholangitis) VS 2 males with diabetes type 1 and 1 vitiligo. As for the clinical subtypes we noticed that pemphigus herpetiformis was more frequent in women (8 cases VS 1 men), but also pemphigus vegetans (17 female VS 10 male) and pemphigus vulgaris (75 women VS 50 men), the mucosal involvement with no cutaneous lesions was more frequent in women (12 cases) VS 3 male, the PDAI was more severe in women (135 cases) VS men (96 cases). In both cases, the main protocol used was oral steroids in 55%, a combination of steroids and other sparing agents in 45%, the most immunosuppressive therapy used was the azathioprine in 91.6% the use of rituximab as a first line therapy in 8%. In terms of evolution: a complete remission was noticed in: 48% female VS 38% men, there was no difference in term of time of recovery (80 days in women VS

73 days in men). Relapses and mortality weren’t statically different in women (30% for relapses and 16 case’s death) VS men (28% relapses and 17 case’s death). Females tend to relapse 49 months after a complete remission while males after 52 months.

Discussion: the mechanism of acantholysis (loss of keratinocyte cell adhesion) in pemphigus is increasingly decoded and is mainly due to an autoimmune mechanism (production of antibodies against desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1), desmocollins (Dsc) and plakins) [1]. However, several studies suggested that environmental factors may play a crucial role in the pathogenesis such as: exposure to pesticides, excessive intake of allium group (Garlic, onion…), Herpes simplex virus infection and a prevalence bias toward females [2]. In fact, it was found that females have a higher absolute number of CD4+ T lymphocytes than men and produce more Th1 cytokines; for example, after vaccination [3].  The gender specific auto immunity can be explained by hormonal, immunological, microbiome, and genetic theories (specific genes encoded on the X chromosome). Sex hormones (estrogens, progesterone) are reported to affect antigen presentation, lymphocyte activation, cytokine gene expression, and/or homing of immune cells with a severe activity disease during pregnancy and relapses in the postpartum period while testosterone has a protective effect on the immune system [4] [5].

Conclusion: We conclude that gender can influence the clinical phenotype of pemphigus patients: Pemphigus herpetiformis, vegetans and mucosal involvement are more frequent in women. The association of multiple autoimmune disease are also more frequent in females. Our data shows that there is no difference in terms of evolution or prognosis. The main limitations of our study are the “one center study”, the retrospective design, the absence of dosage of the Desmoglein antibodies and the genetic analysis (HLA type). Further multicenter studies are therefore necessary to explain the role of genetic and hormonal factors in the immune dysregulation among pemphigus patients.

References:

• Witte M, Zillikens D, Schmidt E. Diagnosis of Autoimmune Blistering Diseases. Front Med. 2018; 2;5:296.
• Brenner S, Tur E, Shapiro J, Ruocco V etal. Pemphigus vulgaris: environmental factors. Occupational, behavioral, medical, and qualitative food frequency questionnaire. Int J Dermatol. 2001;40(9):562-9.
• Amadori A, Zamarchi R, De Silvestro G et al. Genetic control of the CD4/CD8 T-cell ratio in humans. Nat Med. 1995; 1(12):1279-83.
• Ahmed SA, Penhale WJ. The influence of testosterone on the development of autoimmune thyroiditis in thymectomized and irradiated rats. Clin Exp Immunol, 1982;48(2):367–374.
• Whitacre CC. Sex differences in autoimmune disease. Nat Immunol. 2001 Sep;2(9):777-80.

Spectrum of skin neglected tropical diseases in the Department of Dermatology at the IBN SINA University Hospital of Rabat (Morocco)

Farah El Hadadi¹, Line Mezni¹, Mariame Meziane¹, Nadia Ismaili¹, Laila Benzekri¹, Karima Senouci¹.

(1) Department of Dermatology, Mohammed V University in Rabat, Ibn Sina University Hospital, Rabat, Morocco.

Author Contact Information: 
Farah El Hadadi
[email protected]

Background: Neglected tropical diseases (NTDs) are defined by the WHO as a diverse group of acute and chronic conditions that include several parasitic, viral, and bacterial diseases that cause substantial illness and death for approximately 350 000–500 000 persons around the globe [1].

Materials and methods: We performed a retrospective and a descriptive study covering a period from January 2017 to January 2021, we included patients with severe, multifocal forms of NTDs that required systemic treatments, patient’s files were retrospectively analyzed, the epidemiological and clinical data were retrieved from the medical records. The aim of our study was to evaluate the significant impact of NTDs, the number and features of patients diagnosed with NTDs in our center. The diagnosis was made clinically, histologically and required bacterial, parasitic and/or fungal samples for microscopic species confirmation.

Results: 41 cases of NTD were diagnosed of all hospitalized patients, the distribution of NTDs was as follow: 15 cases of leishmaniasis (2 leishmaniasis in HIV patient, 2 sporotrichoid leishmaniasis, 3 verrucous subtype,4 ulcerated 2 erysipeloide like  and 2 forms of multiple disseminated leishmaniasis), 11 mycetoma (4 actinomycetoma, 7 eumycetoma), 10 cutaneous tuberculosis  (including 2 bone and 2 lymph nodes involvement), 4 cases of leprosy (2 tuberculoid leprosy, 1 lepromatous leprosy, 1 borderline leprosy) and one fatal case of a disseminated strongyloidiasis in a pemphigus patient. The duration of disease before diagnostic was variable (3 months to 12 years). The mean age of our patients was 47.7 years old. All of our cases were autochthonous infections expect for 2 patients (1 leprosy and 1 mycetoma both from Mali). All of our patients had a low socio-economic background with no social security. 5 patients died due a severe disseminated disease (2 cases of leprosy, 1

leishmaniasis, 1 tuberculosis, 1 actinomycetoma).

Discussion:
The term ‘neglected tropical diseases’ was first introduced by the author Peter Hotez in his book “Forgotten People, Forgotten Diseases”, where he describes the common characteristics and social impact of the NTD on patients around the world [2]. Indeed, NTDs are largely present in rural and poor urban settings with lower socioeconomic status especially in low middle income tropical and subtropical countries but also in some population of Southern Europe, due to high immigration rate and climate change. A list of 17 NTDs has been established by the WHO and include: Buruli ulcer, human African trypanosomiasis, cysticercosis, rabies, dengue, Chagas disease, echinococcosis, endemic treponematoses, leprosy, dracunculiasis, foodborne trematode infections, onchocerciasis, leishmaniasis, filariasis, schistosomiasis, helminthiases and trachoma. All these diseases share the same clinical features:

Cutaneous manifestations with variable degree of pain and itching, anemia, acute or chronic pain, diarrhea, visceral involvement, psychiatric and neurological condition (depression, low self-esteem, seizure), malnutrition, cognitive impairment leading to compromised education and loss of productivity in adults,  stigma and discrimination due to disability and disfigurement [3].

Due to its geographic location at the north-west corner of Africa and its typical Mediterranean subtropical climate, Morocco is a bridge between the European and the African continent and a great melting pot country with mixed skin phototypes and various infectious diseases. These NTDs continue to cause a massive burden of morbidity and mortality in our country. Raising awareness among health care professionals and education of the patients and their family are a cornerstone for a quick and effective treatments to avoid any social stigmatization. References 

1. World Health Organization. Fourth Report on NTDs – Integrating neglected tropical diseases in global health and development. Geneva: WHO, 2017. http://apps.who.int/iris/bitstream/10665/255011/1/9789241565448-eng.pdf?ua=1 (20.7.2017).
2. Beard C. Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development. Emerg Infect Dis. 2009;15(3):510-511.
3. Winkler AS, Klohe K, Schmidt V, et al. Neglected tropical diseases – the present and the future. Tidsskr Nor Laegeforen. 2018;138(3):10.4045/tidsskr.17.0678.

IGA x BSA: An Alternative to EASI in Assessing Disease Severity and Responsiveness in Pediatric Patients With Moderate-to-Severe Atopic Dermatitis

Jerry K. L. Tan¹, Jerry Bagel², Haixin Zhang³, Ainara Rodríguez Marco⁴

¹Windsor Clinical Research, Windsor, ON, Canada; ²Eczema Treatment Center of New Jersey,

East Windsor, NJ, USA; ³Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA; ⁴Sanofi Genzyme, Madrid, Spain

Author Contact Information: 
Ainara Rodriguez Marco
[email protected]

Background: Eczema Area and Severity Index (EASI) and Investigator’s Global Assessment (IGA) are validated, widely used instruments for assessing atopic dermatitis (AD) severity. However, EASI is complex and time consuming, while IGA does not include body surface area (BSA) affected by AD. An initial study assessed only vIGA (validated IGA) xBSA taken at a single time point. Here, we evaluate IGAxBSA at multiple time points and report validity as well as responsiveness in pediatric patients with AD.

Methods: We included pooled data from patients enrolled in 3 dupilumab trials: LIBERTY AD

ADOL (NCT03054428, ≥12–<18 years, moderate-to-severe AD, 16-week treatment); LIBERTY AD PEDS (NCT03345914, ≥6–<12 years, severe AD, 16-week treatment); and an open-label extension trial (NCT02612454, pediatric patients who previously participated in dupilumab trials, 52-week treatment). We compared IGAxBSA with other severity measures (IGA, BSA affected, EASI, SCORing Atopic Dermatitis [SCORAD], Patient-Oriented Eczema Measure [POEM], Children’s Dermatology Life Quality Index [CDLQI], Peak Pruritus Numerical Rating Scale [PP-NRS]) using Spearman’s correlations and assessed IGAxBSA responsiveness to change.

Results: 205/775 patients were treated with placebo/dupilumab. Spearman correlations showed strong correlation of IGAxBSA with EASI: 0.9282/0.9487 for placebo/dupilumab (both P<0.0001). Similar strong correlations were observed regardless of race (White, Asian, Black/African American). IGAxBSA correlated better with objective measures (EASI, BSA, IGA) and SCORAD, than with patient/caregiver-reported measures (POEM, CDLQI, PP-NRS). Further, there was a strong correlation between change from baseline in IGAxBSA and EASI at the end of treatment (responsiveness): 0.8482/0.8354 for placebo/dupilumab (both P<0.0001).

Conclusion: IGAxBSA is a valid alternative to EASI for rapid assessment of disease severity and response in pediatric patients with moderate-to-severe AD.

Dupilumab and Live-Attenuated Vaccines: Experience With Prior Dupilumab Use and Yellow Fever Vaccine in Patients With Severe Asthma From Brazil

Michael E. Wechsler¹, Lisa Purcell², Adelmir Souza-Machado³, Christine Xu⁴, Xuezhou Mao⁴, Upender Kapoor⁴, Faisal A. Khokhar², John T. O’Malley⁵, Veronica Mas Casullo², Leda P. Mannent⁶, Elizabeth Laws⁴, Megan Hardin⁵

¹National Jewish Health, Denver, CO, USA; ²Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA; ³Universidade Federal da Bahia, Salvador, Brazil; ⁴Sanofi, Bridgewater, NJ, USA; ⁵Sanofi, Cambridge, MA, USA; ⁶Sanofi, Chilly-Mazarin, France

Author Contact Information: 
Ainara Rodriguez Marco
[email protected]

Background: Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4/IL-13, key and central drivers of type 2 inflammation in multiple diseases. The single-arm, open-label extension study LIBERTY ASTHMA TRAVERSE (NCT02134028) evaluated long-term safety, tolerability, and efficacy of dupilumab in adult and adolescent patients with moderate-to-severe asthma who had previously completed a dupilumab asthma study. The safety and tolerability of concomitant use of live-attenuated vaccines with dupilumab have not been previously evaluated. Due to a yellow fever outbreak in Brazil during TRAVERSE, enrolled patients requiring yellow fever vaccine (YFV) discontinued dupilumab to receive YFV and continued to be monitored for safety and efficacy endpoints. This post hoc analysis describes the experience of these patients, including the neutralizing antibody response and the safety profile and tolerability of the live-attenuated YFV in these patients.

Methods: Patients at risk discontinued dupilumab and were vaccinated with a single injection of the 17D live-attenuated YFV. Dupilumab serum concentrations, plaque reduction neutralization titers (PRNT), and safety signals before and after YFV were evaluated.

Results: 37 patients (mean [SD] age 46.5 years [12.0]; 32.4% male) discontinued dupilumab treatment to receive YFV. Dupilumab concentrations were assessed in most patients 1–25 days before (n = 16) and on the same day of (n = 19) vaccination. Pre- and post-YFV PRNT were obtained in 23/37 and 37/37 patients, respectively. Time from last dose of dupilumab to YFV administration was 7–51 days (mean [SD] 22.3 [11.9]). Of the 23 patients with pre- and post-YFV PRNT, 15 had dupilumab concentrations obtained on the day of YFV administration; mean dupilumab concentration (76.4 mg/L) exceeded the therapeutic threshold (37.4 mg/L). All patients were seropositive after receiving YFV, with the response appearing unaffected by pre-YFV dupilumab concentrations. No YFV-related adverse events were reported in 36/37 (97.3%) patients; 1 patient reported non-serious body ache, malaise, and dizziness 7 days after YFV and fully recovered. There were no reports of vaccine hypersensitivity.

Conclusions: These data suggest that dupilumab had no apparent impact on the immunologic response to the live-attenuated YFV. Further studies are warranted to investigate the effect of dupilumab on live-vaccine-induced immune responses.

An Open-label Study of Fixed-Combination Halobetasol Propionate and Tazarotene Lotion for Psoriasis in Patients With Skin of Color

Neal Bhatia, MD¹; Andrew Alexis, MD, MPH²; Seemal Desai, MD^3,4; Abby Jacobson⁵

¹Therapeutics Clinical Research, San Diego, CA; ²Weill Cornell Medical College, New York, NY; ³Innovative Dermatology, Plano, TX; ⁴University of Texas Southwestern Medical Center, Dallas,TX; ⁵Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, NJ

Author Contact Information:
Andrew Alexis
[email protected]

It is important to examine topical therapies for psoriasis in patients with skin of color. Oncedaily (QD), fixed-combination halobetasol propionate 0.01%/tazarotene 0.045% lotion (HP/TAZ) is approved for treatment of plaque psoriasis in adults. Here, we assessed the efficacy and safety of HP/TAZ QD in non-White (n=77) and White (n=473) participants in a 52-week openlabel study (NCT02462083). Participants received HP/TAZ QD for 8 weeks; those who achieved the primary endpoint of treatment success (investigator’s global assessment [IGA] score of clear

[0] or almost clear [1]) stopped treatment and were reevaluated monthly through 52 weeks.

Participants who did not achieve treatment success at week 8 continued to apply HP/TAZ. Participants were allowed 24 continuous weeks of HP/TAZ treatment if they achieved ≥1-grade improvement in IGA from baseline at week 12, and were reevaluated monthly for achievement of IGA 0/1. Subsequent decisions to continue or discontinue treatment at each monthly evaluation were repeated for 1 year. If at any point IGA ≥2 was achieved, HP/TAZ was resumed, and if IGA 0/1 was achieved, HP/TAZ was discontinued. In this post hoc analysis, at week 52, 33.3% of non-White and 40.3% of White participants achieved treatment success. Both groups had similar rates (~7%) of no disease relapse throughout the study, and time to disease recurrence (eg, first post-cessation evaluation in which treatment success was not achieved) was similar between non-White and White groups at <29, <57, and <85 days after cessation of HP/TAZ (42.9% vs 44.9%; 64.3% vs 72.7%; 75.0% vs 81.3%, respectively). The proportion of non-White and White participants maintaining ≤3% body surface area affected for Job #11922              9/2/2021

Bhatia, SOC Update ’21, HP/TAZ OLE

≥1 year was comparable (42.9% vs 50.0%, respectively). Rates of adverse events were also similar between groups. Non-White patients with psoriasis experienced prolonged skin clearance with HP/TAZ treatment, without new safety concerns.

A Case of Interstitial Keratitis in an African American Hidradenitis Suppurativa Patient

India Robinson, BA; Gabriella Santa Lucia, BS; Alex Ritter, BS; John Plante, MD, MSCR; Manuel Valdebran, MD

¹Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina

Author Contact Information:
India Robinsin
[email protected]

Introduction

Hidradenitis Suppurativa (HS) is a chronic, inflammatory disease resulting in panful abscesses in skin bearing apocrine glands. This disease more often affects women beginning in their second or

third decade of life.^1,2 Interstitial Keratitis (IK) is characterized by nonulcerative and nonsuppurative inflammation of the corneal stroma.³ While inflammatory disorders such as inflammatory bowel disease, spondyloarthropathy, and other autoimmune disease are commonly associated with HS, IK is described as an association that is uncommon in daily clinical practice.^1,4 Here we describe a patient with a history of Hidradenitis Suppurativa presenting with bilateral interstitial keratitis.

Case Report

A 34-year-old female with a 15-year history of Hurley Stage 3 Hidradenitis suppurativa (HS) with draining sinuses on her left buttock and right axilla presented to the clinic with bilateral eye pain, decreased vision, and redness. Her disease is severe with poor response to typical HS treatments. She began Adalimumab in November 2019 with relief but was discontinued. Nine months later, the patient presented to an acute care center with a white spot on her right eye with erythema, pain and pruritis that progressed over 10 days to include her left eye. She was prescribed prednisolone drops and showed improvement within a day.

Ophthalmology diagnosed her with bilateral peripheral interstitial keratitis and continued prednisolone eye drops with oral steroids and cyclosporine on reserve. They gathered ANA titers, ANCA, RF, CCP, CMP, CBC, CRP/ESR and syphilis titers. She had an ANA titer of 1:160 with a negative reflex, positive c-ANCA, and slightly elevated CRP/ESR. Suspicion for Granulomatosis Polyangiitis was low due to a negative MPO/PR3, low ANA titers without negative reflex, and lack of other autoimmune symptoms. Coogan’s Syndrome was considered but ruled out due to no hearing loss. Her keratitis and elevated inflammatory markers were ultimately attributed to severe HS disease resulting in systemic inflammation. They recommended restarting Adalimumab, but she did not due to insurance reasons. Currently, her HS disease is stable without recent flares and her keratitis has resolved.

Discussion

Although bilateral interstitial keratitis is a rather rare complication of HS, it may be important to screen these patients for this complication along with other immune dysregulation phenomena such as acne conglobata, spondyloarthropathies, pyoderma gangrenosum, synovitis-acnepustulosis-hyperostosis-osteitis syndrome, Dowling-Degos disease, fox den disease, florid steatocystoma multiplex, pyoderma vegetans, and pityriasis rubra pilaris.³  Prevalence and incidence data is limited for the association of HS and keratitis, but there are at least 10 cases in which the two entities were linked to one another.⁴

One of these case reports is a similar presentation of another young Black female with severe HS that presented with bilateral interstitial keratitis that initially responded well to topical steroids, as our patient did.⁵ One month following discontinuation of topical steroids, she had a flare of her HS disease that coincided with another flare of keratitis. Both conditions responded to Adalimumab and remained in remission for 7 months. Although we cannot associate a response of our patient’s keratitis to Adalimumab, we also saw that there was a temporal association with the activity of our patient’s HS disease and her keratitis. Her keratitis initially presented when her HS disease was flaring and remained stable when her HS symptoms were minimal.

Another study investigated the associated of HS with any type of inflammatory eye disease (IED). They found 20 patients with concomitant HS and IED, though the association between the two could not be determined as causal.³ The majority were, similar to our patient, African American and female with 35% of patients without another autoimmune/inflammatory disease to explain the IED. Despite topical steroids being considered first line therapy, most patients with HS required systemic immunosuppression to alleviate symptoms.³

Despite this being a rare phenomenon, it is valuable to be watchful of any HS patients with any eye discomfort, pain, change in vision, or change in appearance of the eyes, and consider urgent referral to ophthalmology. Alongside referral, prompt escalation of therapy to systemic immunosuppressive agents is necessary in over 70% of HS cases complicated by inflammatory eye disease and results in significant improvement.^1,3   Although our patient did not require any systemic therapy, coordination between ophthalmology, rheumatology, and dermatology resulted in the appropriate ruling out of any other autoimmune conditions, and attribution of her keratitis symptoms to her HS disease.

References

1. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: A comprehensive review. Journal of the American Academy of Dermatology. 2009;60(4):539-561.

doi:10.1016/j.jaad.2008.11.911

2. Jemec GB. Hidradenitis Suppurativa. The New England journal of medicine.

2012;366(2):158-164. doi:10.1056/nejmcp1014163

3. Alzaga Fernandez AG, Demirci H, Darnley-Fisch DA, Steen DW. Interstitial keratitis secondary to severe hidradenitis suppurativa: a case report and literature review. Cornea.

2010;29(10):1189-1191. doi:10.1097/ICO.0b013e3181d4fd5c

4. Saygın D, Syed AU, Lowder CY, Srivastava S, Maya JJ, Hajj-Ali RA. Characteristics of inflammatory eye disease associated with hidradenitis suppurativa. European journal of rheumatology. 2018;5(3):1-168. doi:10.5152/eurjrheum.2018.17163
5. Knox CM, Holsclaw DS. Interstitial keratitis. International ophthalmology clinics. 1998;38(4):183-195. doi:10.1097/00004397-199803840-00017

Hidradenitis Suppurativa in Patients with Skin of Color: Do Management Differences Matter?

India Robinson, BA¹; Gabriella Santa Lucia, BS¹; Lara Wine Lee, MD, PhD^1,2; Colleen Cotton, MD1,2

¹Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina

²Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina

Author Contact Information:
India Robinsin
[email protected]

Background

Hidradenitis suppurativa (HS) is a chronic disease that causes inflammatory lesions typically found in the axillary, inguinal, and perineal regions that can result in permanent scarring, fibrosis, and sinus tract formation.(1) Although HS is more prevalent in patients with skin of color, research in HS has historically been performed in European and white populations.(2) Caucasian HS patients make up 68% of the patient population included in HS clinical trials while those of African descent comprise only 14%.(3) We aimed to explore management differences in skin of color HS patients compared to Caucasians.

Methods

We performed a cross-sectional retrospective study of HS-associated outpatient encounters in the Medical University of South Carolina’s Research Data Warehouse from January 2017 to December 2020. We performed descriptive statistics and chi-square analyses.

Results

The demographic breakdown had a slightly increased representation of skin of color patients when we compared overall patient count (59.6%) to HS-associated visit counts (67.6%) and procedural counts (65.5%), indicating that skin of color patients had more visits and procedures counts than expected. Caucasian HS patients were significantly more likely to be prescribed mood disorder agents (p=0.033) and thyroid replacement hormones (p=0.028). Skin of color HS patients were more likely to receive metformin (p=0.024) and nonsteroidal anti-inflammatory drugs (NSAIDs) (p=0.020) during HS-associated visits. We also found that skin of color patients were less likely to see dermatology (47.1% vs 57.1%) and primary care (14.6% vs 17.6%) and more likely to see surgery (29.0% vs 17.3%) for their HS-associated visits compared to

Caucasians. Lastly, skin of color HS patients were more likely to have a complex excision (11.6% vs 5.5%) compared to Whites who were more likely to have triamcinolone injections (60.9% vs 68.5%), p < 0.001. Discussion

Skin of color HS patients tend to receive more surgical treatments than Caucasian patients. This could be due to higher disease severity in HS patients with skin of color, delay in diagnosis leading to more severe scarring at the time of presentation to care, or differences in treatment strategies related to racial bias, socioeconomic status, and/or access to care. A limitation of our study is the lack of information concerning efficacy of treatment interventions and clinical outcomes. Future studies should include a representative population of HS patients with a higher proportion of skin of color HS patients, perform racial subgroup analyses in clinical trials, include race as a variable when investigating medical and surgical outcomes, and attempt to understand the different mechanisms that could explain differences in disease profiles across racial groups.

References

1. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105-
2. Published 2017 Apr 19. doi:10.2147/CCID.S111019
3. Kilgour JM, Li S, Sarin KY. Hidradenitis suppurativa in patients of color is associated with increased disease severity and healthcare utilization: A retrospective analysis of 2 U.S.

cohorts. JAAD International. 2021;3:42-52. https://doi.org/10.1016/j.jdin.2021.01.007

3. Price KN, Hsiao JL, Shi VY. Race and Ethnicity Gaps in Global Hidradenitis Suppurativa Clinical Trials. Dermatology. 2021;237(1):97-102. doi:10.1159/000504911
4. Lee DE, Clark AK, Shi VY. Hidradenitis Suppurativa: Disease Burden and Etiology in Skin of Color. Dermatology. 2017;233(6):456-461. doi:10.1159/000486741
5. Garg A, Neuren E, Cha D, Kirby JS, et. Al. Evaluating patients’ unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project. J Am Acad Dermatol. 2020 Feb;82(2):366-376. doi:

10.1016/j.jaad.2019.06.1301. Epub 2019 Jul 3. PMID: 31279015.

Care Gaps in Traction Alopecia: A Retrospective Review

Gabriella Santa Lucia, BS¹, India Robinson, BA¹, John Plante, MD, MSCR¹, Alexa DeMaio, BS¹, Richa Jaiswal, MBBS¹, Manuel Valdebran, MD^1,2

¹Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina

²Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina

Author Contact Information:
India Robinsin
[email protected]

Introduction: Traction alopecia (TA) is a condition that predominantly affects women and children of color that can significantly reduce quality of life.^1-3 Hairstyle modification through counseling remains the cornerstone of therapy.^1,4-5 However, we found that early intervention and sustained follow-ups for medication management, not counseling, to be the key factor in improving outcomes in patients with traction alopecia.

Methods: A retrospective chart review was conducted of patients from 5/2012 to 9/2020 with a clinical diagnosis of TA alone or TA plus androgenetic alopecia (AGA) at the Medical University of South Carolina (MUSC). Those with an additional alopecic diagnosis other than AGA were excluded.  An electronic health record query was performed using search terms “Traction Alopecia,” “Alopecia, Unspecified,” and “Nonscarring Hair Loss.” All charts were individually reviewed for accuracy. Descriptive statistics were used for data analysis. This study was approved by the Institutional Review Board at MUSC.

 Results: We originally identified 360 patients. Of these, 193 were excluded, yielding a final sample size of 167 patients. Most were female and black (Table 1). The mean age at diagnosis was 31.5 ± 20.0 years (range, 1.3 to 84), and approximately 33.5% of our cohort was pediatric. Most patients had a history of tight braid use and exhibited a frontotemporal distribution of hair loss. Of patients with a known prediagnostic disease duration, most (72 of 123, 58.5%) presented greater than one year after disease onset, with 17 presenting greater than five years after onset. Therapeutic counseling was given to most patients, and adjunctive pharmacotherapy was frequently prescribed (Table 2). About two thirds of patients did not return for follow-up after the initial visit. Of the 32% (54 of 113) that followed-up, 78% (38 of 54) were lost to follow-up within the first six months. All but two patients that followed-up (52 of 54, 96.3%) had unchanged/stabilized or improved disease per clinician assessment. The patients with improved outcomes (16 of 26, 61.5%) had a known pre-diagnostic duration of greater than a year. All received counseling, and most (26 of 34, 76.5%) received adjunctive therapies.

Discussion: Although most patients appropriately received counseling and other therapies, our study identified two gaps in care that warrant future discussion. Most patients were diagnosed in their fourth decade of life and greater than one year after disease onset, with many patients experiencing more severe diagnostic delay.  Since TA is typically reversible in early stages, a timely diagnosis is critical to maximize therapeutic potential.^1-3,5 Most patients also experienced brief or no follow-up. Limited clinician understanding concerning traumatic hairstyles’ cultural and societal significance is one potential reason.^2-4 Practitioners must appreciate the personal value of these hairstyles and provide detailed recommendations for low-risk alternatives instead of complete avoidance.^1,2,4 These culturally sensitive practices may lead to improved compliance, thereby increasing the likelihood of sustained, positive outcomes.^2,4

Future studies are needed to identify factors responsible for diagnostic delay and poor follow-up. Our study is primarily limited by its retrospective design. In addition, results were obtained from one institution, potentially limiting their generalizability.

Efficacy and Tolerability of a Comprehensive Brightening Serum Plus a Dual Antioxidant System in Skin of Color Patients with Moderate to Severe Facial Hyperpigmentation

Seemal R Desai, MDa; Shelly Manry, BAb; Elizabeth Makino, BS, CCRA, MBAb; Rahul Mehta,

PhDb a Department of Dermatology, The University of Texas Southwestern Medical Center, Innovative Dermatology, Dallas, Texas b Allergan Aesthetics, an AbbVie Company, Irvine, CA

Hyperpigmentation disorders disproportionately affect individuals with skin of color due to intrinsic differences in melanin biology.  Excess oxidative stress caused by environmental factors can further exacerbate hyperpigmentation in sensitive individuals.  Therefore, multitargeted approaches are required to adequately address the spectrum of hyperpigmentation conditions. A comprehensive HQ-free, retinol-free cosmetic topical brightener (LYT2) was previously shown to be effective at improving hyperpigmentation in dark skin types.  In addition, a dual serum providing broad antioxidant protection and skin repair support (LVS) was shown to protect from environmental damage and improve overall skin appearance.  In this study, the efficacy and tolerability of the combination of LYT2 and LVS was assessed in skin of color patients with moderate to severe facial hyperpigmentation.

Ten subjects aged 34-54 with Fitzpatrick Skin Types III-VI completed the open-label, singlecenter study.  The enrolled subject demographic was 23% Asian, 38.5% African American, and 38.5% Hispanic. Subjects applied each of the LVS day and night serums once daily, with LYT2 applied twice daily, in addition to a basic skincare routine (cleanser, moisturizer and sunscreen). Investigator assessments were made based on a 9-point scale for overall hyperpigmentation, skin tone evenness, and radiance.  Investigator assessments were made at baseline and at weeks 2,4,8 and 12. Standardized digital photographs (Canfield VISIA-CR) were taken at all visits and subjects completed a self-assessment questionnaire at all follow-up timepoints.

The combination regimen showed significant improvement against baseline for overall hyperpigmentation at week 12 (-23% mean change from baseline, p≤0.01).  Skin tone evenness and radiance showed progressive improvement, with a 33% and 51% mean change from baseline, respectively (p≤0.01).  The treatment was highly rated for perceived self-efficacy; 100% of subjects responded “agree” or “strongly agree” for improved evenness of skin tone and a more radiant complexion at weeks 8 and 12.  By week 8, 100% of subjects reported at least slight improvements in overall skin condition, and by week 12, 50% reported a marked improvement in skin condition. At week 12, 70% of subjects reported “good” or “excellent” overall satisfaction with the treatment. One subject experienced skin irritation and stinging that resolved once the regimen was discontinued and the subject withdrew from the study. No other treatment-related adverse events were reported.

Results from this study demonstrate the combination of LYT2 and LVS is well tolerated and suggests that it may be an efficacious treatment option for skin of color patients seeking to reduce the appearance of hyperpigmentation and improve skin quality.

Allergan Aesthetics, an AbbVie company sponsored and provided financial support for the study

Efficacy and Tolerability of a Comprehensive Brightening Serum Plus a Dual Antioxidant System in Ethnically Diverse Subjects with Moderate to Severe Facial Hyperpigmentation

Sachit Shah, MD, CCFP ^a; Shelly Manry,BA^b; Elizabeth Makino, BS, CCRA, MBA^b; Rahul Mehta, PhD^b

^aBC Laser and Skincare Clinic, Surrey, BC
^bAllergan Aesthetics, an AbbVie Company, Irvine, CA

Facial hyperpigmentation is a common concern in Asian populations.  Effective treatments should simultaneously target multiple pathways and processes that regulate pigmentation, due to physiological differences in melanin biology in ethnic skin. A comprehensive HQ-free, retinolfree cosmetic topical brightener (LYT2) was previously shown to be effective at improving hyperpigmentation in ethnically diverse skin types.  In addition, a dual serum providing broad antioxidant protection and skin repair support (LVS) was shown to protect from environmental damage and improve overall skin appearance in both Indian and Chinese populations.  It was hypothesized that LYT2 and LVS would complement each other to reduce the appearance of hyperpigmentation and improve skin quality in subjects of diverse skin types presenting with moderate to severe facial hyperpigmentation.

An open-label, single-center study was conducted to assess the efficacy and tolerability of the combination of LYT2 and LVS.  Fifteen female subjects aged 33-57 with Fitzpatrick Skin Types II-IV completed the study. The enrolled subject demographic was 50% Asian, 66% of whom identified as East Indian.  Of the remainder, 33% were Caucasian and 17% identified as “other”. Subjects applied each of the LVS day and night serums once daily along with LYT2 twice daily, in addition to a basic skincare routine (cleanser, moisturizer and sunscreen). Investigator assessments were made based on a 9-point scale for overall hyperpigmentation, skin tone evenness, and radiance at baseline and at weeks 2,4,8 and 12. Standardized digital photographs (Canfield VISIA-CR) were taken at all visits and subjects completed a selfassessment questionnaire at all follow-up timepoints.

The combination regimen provided progressive improvements against baseline at all follow-up visits for all investigator efficacy assessment parameters.  By week 12, there was a -45% mean change from baseline for overall hyperpigmentation, a 50% improvement in skin tone evenness, and a 58% increase in radiance (all p≤0.02).  By week 12, ≥80% of subjects rated “agreed” or “strongly agreed” to all attributes of perceived efficacy.  At week 4, 100% of subjects reported at least slight improvements in overall skin condition, and by week 12, 87% reported a either a moderate or marked improvement in skin condition. At week 12, 86% of subjects reported “good” or “excellent” overall satisfaction with the treatment. One subject developed a red rash on the face and experienced itchy eyes that resolved once the regimen was discontinued, and the subject withdrew from the study. No other treatment-related adverse events were reported.

Results from this study demonstrate the combination of LYT2 and LVS is well tolerated and suggests that it can be used to improve the appearance of facial hyperpigmentation and overall skin quality in subjects with diverse ethnicities.

Allergan Aesthetics, an AbbVie company sponsored and provided financial support for the study

Tofacitinib monotherapy in management of vitiligo

Brittany Feaster, MHS and Amy J. McMichael, MD

Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina

The case reported describes a 66 year old patient with vitiligo who received tofacitinib monotherapy following failing treatment with topical corticosteroids, protopic, fluocinonide, oral prednisone, and phototherapy. Tofacitinib is an oral, selective Janus kinase (JAK) inhibitor currently approved for use in rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis.  Recent studies suggest that tofacitinib may be an emerging treatment option for vitiligo particularly when used with concomitant phototherapy. In the case of the patient, tofacitinib monotherapy used over a six month period led to significant repigmentation in the affected sites with initial improvement noted at two month follow up with no side effects. These results suggest that tofacitinib may be effective in management of vitiligo.

DermaDiagnosis: A Smartphone interface for Efficiently diagnosing Melanoma in Clinical and Non-Clinical Settings

Name: Anurag Gottipati

Affiliation: Johns Hopkins University, USA

Author Contact Information:
Anurag Gottipati
[email protected]

Statement of the Problem: One of the greatest risks associated with indiscriminate amounts of UV light exposure is the chance of developing skin cancer. With 9,500 newly diagnosed cases of skin cancer appearing in the United States every day, skin cancer is the most common cancer in both the United States and across the globe. Unfortunately, the incidence rate of melanoma – the deadliest and most aggressive form of skin cancer – has annually increased at a 44% rate over the past decade. Despite the advent of new smartphone technologies for skin condition diagnosis, melanoma’s different forms (i.e. irregular pigmented lesions/abnormal moles) make it elusive to both experienced dermatologists and pathologists and existing diagnostic interfaces. The purpose of this study is to describe the development of the “DermaDiagnosis” system, a smartphone app melanoma diagnostic system, and its potential clinical applications. Methodology & Theoretical Orientation: Using MIT App Inventor’s framework, a deep learning convolutional neural network (CNN) with three 3×5 filters using the Adam optimizer (efficiently processes large datasets with noisy gradients) was developed. Model robustness was enhanced by using 20 epochs and a 75% training data fraction; the model was trained on 1440 benign and 1197 malignant melanoma images. Translated into an Android smartphone app, chances of malignancy are quantified by a percentage using the phone camera. Findings: Testing with 360 benign and 300 malignant melanoma images revealed the system had an 80% accuracy rate in accurately recognizing benign/malignant pigmented lesions. Despite melanoma’s various manifestations, DermaDiagnosis was able to differentiate between normal and abnormal lesions with significant confidence. Conclusion & Significance: As the incidence of melanoma continues to rise, medical technology must adapt to reducing disparities in skin care access and early diagnosis. As a means of achieving this goal, DermaDiagnosis offers clinicians a free and efficient solution.

An Analysis of Skin of Color Representation in General Dermatology Hashtags on Instagram

Kathie Velez B.S.¹ , Desiree Morris B.S./B.A, ¹  Peterson Pierre MD ²

1. Kirk Kerkorian School of Medicine at UNLV
2. Pierre Skin Care Institute

Author Contact Information:
Kathie Velezk
[email protected]

Background: With the reach of social media, its influencing capabilities, and the potential for education, it is important to assess the representation of skin of color in general dermatology hashtags. Social media outlets are where a reported 42% of Americans search for health-related information. This study was performed to identify representation of Skin of Color in Dermatology hashtag usage in respect to general dermatology hashtags using the Fitzpatrick scale.

Methods: Cross-sectional epidemiologic study analyzing the content of Instagram posts associated with 43 general dermatology topics. The content of the top 9 posts was analyzed based on the Fitzpatrick scale representation of skin phototype with board-certified dermatologist evaluation, the posting entity, and the educational merit of the posting entity. The number of posts and likes associated with each hashtag were quantified.

Results: 43 general dermatology topics (such as #acne, #rosacea, #eczema, etc.) queried as

Instagram hashtags were analyzed. Fitzpatrick Skin Phototype II made up 51.3% of posts and Fitzpatrick Skin Type VI made up 1.4%. 83.8% of posts were non-educational and 16.2% were educational. 32.2% of posts were made by patients, 30.8% by non-dermatology medical professionals, 25.8% by non-dermatology non-medical professionals,and 11.2% by dermatologists.

Conclusions: The study supported the need for an increased presence of board-certified dermatologists to provide more accurate, evidence-based resources for dermatologic conditions and treatment options representative of all Fitzpatrick skin phototypes.

Effectiveness and safety of Resilient Hyaluronic Acid (RHA) dermal fillers for the correction of moderate-to-severe nasolabial folds in subjects with darker skin color: Post-hoc subgroup analyses of US pivotal clinical data

Jay Mashburn,¹ Kristie Kooken,¹ Yan Liu¹

1 Revance, Inc., Nashville, TN, USA

Author Contact Information:
Jay Mashburn
[email protected]

Background

• The latest 2020 US census showed increasing racial and ethnic diversity in the US¹
• People with darker skin types requesting aesthetic treatments represent an increasingly prominent patient base in aesthetic medicine²
• People of color (POC) are often underrepresented in clinical studies evaluating the safety and effectiveness of aesthetic products, and limited clinical data are currently available on the use of HA fillers in POC

Objective

Compare the safety and effectiveness of a new line of dynamic hyaluronic acid fillers (RHA®) for the treatment of moderate-to-severe nasolabial folds in POC and non-POC

• Post-hoc subgroup analyses compared POC versus non-POC for the pooled Per Protocol population of subjects treated with RHA, correcting for moderate-to-severe nasolabial folds in two pivotal US clinical trials (TEO-RHA-1302 and TEO-RHA-1402)^1,2 (N=217)

— By Fitzpatrick Skin Type (FST): High FST (IV + V + VI: POC) versus low FST (I + II + III: non-POC) — By subject-reported race: Non-White versus White

• Assessments included Wrinkle Severity Rating Scale (WSRS) scores, Global Assessment of Improvement (GAI), subject satisfaction, and adverse events

Adverse events in subjects treated with RHA

• Treatment-related adverse event (AE) rates were generally lower for subjects with high FST (35%) compared with low FST (56%)
• Treatment-related AE rates were similar for subjects of non-White (54%) and White (46%) race
• The most frequently reported treatment-related AEs for both POC and non-POC were injection site mass, induration, swelling, and tenderness

Summary

• POC consistently showed greater improvement in wrinkle severity compared to non-POC
• Responder rates (≥1-grade) among POC were higher than for non-POC across all visits
• Global aesthetic improvement scores assessed by the blinded live evaluator were similar for POC and non-POC across all time points
• Subject satisfaction remained high throughout the course of the study up to 15 months, with similar results between POC and non-POC when analyzed by FST
• The RHA line of dynamic fillers was well tolerated and effective for the correction of moderate-tosevere facial wrinkles and folds, such as nasolabial folds, in POC

Peels and Needles: Comparing Microneedling and Glycolic Acid Chemical Peel for Acne Scar Treatment

Rohan Shah, BA¹, Fatima Ishfaq, MD², Marielle Jamgochian, BA³, Shawana Sharif, MBBS², Nadia Waqas MBBS², Babar Rao MD³

¹Rutgers New Jersey Medical School, Newark, NJ
² Benazir Bhutto Hospital Rawalpindi Medical University, Rawalpindi, Pakistan
³ Rutgers Robert Wood Johnson Medical School, Piscataway, NJ

Author Contact Information:
Rohan Shah
[email protected]

Background: Acne vulgaris is a common skin disease frequently resulting in scarring. Scars secondary to acne can lead to physical disfigurements and a profound psychological impact. Early and effective treatment is the best means to minimize and prevent acne scarring. In patients with darker skin tones, current acne scar treatments pose complications including dyspigmentation, further scarring, and overall unsatisfactory clinical outcomes.

Objective: Compare the efficacy of microneedling and 35% glycolic acid chemical peels in the treatment of acne scars and determine whether either treatment provides a more satisfactory profile for patients with darker skin tones.

Methods/Materials: Sixty patients of Fitzpatrick skin phototype IV-VI with atrophic acne scars were randomized into Group A, receiving microneedling every two weeks for a total of 12 weeks, and Group B, receiving chemical peels every two weeks for a total of 12 weeks. Acne scar treatment efficacy was represented by a x >1 grade improvement from baseline measured two weeks after the completion of the last treatment session according to the Goodman and Baron Scarring Grading System.

Results: Group A demonstrated more improved outcomes in acne scar treatment compared to Group B. 73.33% (n=22) of Group A patients were treated effectively while 33.33% (n=10) in Group B were treated effectively. Additionally, 26.67% (n=8) in Group A showed no efficacy in improvement after treatment compared to 66.67% (n=20) in Group B.

Conclusion: Microneedling provided better efficacy and improvement outcomes than 35% glycolic acid peels for acne scar treatment in our patient population with Fitzpatrick skin phototype IV-VI.