Postinflammatory hyperpigmentation: protocol for development of a core outcome set for clinical trials

Postinflammatory hyperpigmentation (PIH) is a disorder of pigmentation that is a common presenting complaint, especially in individuals with skin of color. It is associated with a significant psychological burden and decrement of quality of life. Management options include photoprotection, topical lightening agents, and lasers and energy devices. Clinical trials of melasma report a diversity of outcomes, which often impedes synthesis of results across trials, or comparison of results associated with different treatment modalities. This protocol describes the design of a consensus process that would culminate in the development of a core set of outcomes to be assessed in all clinical trials for PIH. A long list of candidate outcomes will be developed through a systematic review, combined with semi-structured interviews with various stakeholders, including patients, scientists, regulators, and health care professionals. This long list of outcomes will be reviewed and refined by a steering committee. Then two rounds of Delphi surveys of patient and physician groups, respectively, will be used to cull the list, with provisional inclusion of those items deemed "important" by 70% of the respondents. A consensus meeting will be held virtually or in person to vote on these items, and also to consider any changes necessary before acceptance of a final core outcome set. Development of a core outcome set for PIH is expected to improve and standardize outcomes reporting in current and future clinical trials. This, in turn, may facilitate aggregation of research results and permit comparison of outcomes across multiple studies.

Update on new drugs in dermatology

Medications in dermatology are used in a variety of different methods and dosages and for numerous different diseases entities that are not approved by the US Food and Drug Administration (FDA); however, there are medications that have only recently hit the market that require our attention, as they are either FDA approved for the intended dermatologic use or could be effective in treating conditions that previously have been poorly managed.

Influence of diet in acne vulgaris and atopic dermatitis

Diet has been considered as an influence in dermatology for several years. Unfortunately, although correlation has been breached, causation is yet to be determined. Over the last couple years, a few reviews of the literature have been published regarding the influence of diet in acne vulgaris and atopic dermatitis. This article reviews some dietary restrictions and supplements that may have beneficial effects in managing patients with acne vulgaris and atopic dermatitis.

Cognitive biases in dermatology training

Cognitive biases are patterns that physicians develop based on predetermined judgments that can influence their decisions regarding patient care. Unfortunately, they are usually encountered on a daily basis in clinics. A few examples include affective, anchoring, availability, confirmation, zebra, and Sutton's biases.

Management of vitiligo patients with surgical interventions

Vitiligo is an acquired depigmentation disorder of unknown etiology. Medical treatments are usually reasonably effective for nonstable vitiligo patches; however, for vitiligo patches that have been stable for a substantial period of time, surgical intervention should be considered. In this article, surgical interventions for vitiligo are reviewed, including split-thickness skin grafting, suction blister grafting, miniature punch grafting, and cultured melanocyte transplantation.

Cyclosporine in SJS/TEN management: a brief review

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered to be among the most severe dermatologic emergencies with high risk for morbidity and mortality if managed poorly. These disease processes usually are the result of a reaction to antipsychotic or antibiotic medications, though the complete list of potential causative drugs is extensive. Despite the life-threatening nature of these conditions, studies evaluating systemic immunomodulating agents that would be effective in halting the poor overall outcome are limited. Over the last several years, reports advocating the benefits of cyclosporine, corticosteroids, and intravenous immunoglobulin (IVIG) have shown variable responses in their treatment of SJS/TEN. In this article, cyclosporine and its potential as an emerging therapeutic option for SJS/TEN patients is discussed.

Postinflammatory hyperpigmentation in patients with skin of color

Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.

Are topical keratolytic agents needed in the treatment of scalp psoriasis?

BACKGROUND

Topical corticosteroids are the primary treatment for scalp psoriasis. Keratolytic agents are promoted as adjunctive treatments. However, complex treatment regimens may result in poor adherence and outcomes.

OBJECTIVE

To evaluate the evidence for the need for use of topical keratolytic agents as opposed to topical corticosteroid monotherapy in the treatment of scalp psoriasis.

METHODS

A review of the literature was performed seeking clinical trials using topical keratolytics, topical corticosteroids or the combination for treatment of scalp psoriasis.

RESULTS

Complete clearance of scalp psoriasis can be achieved in 10-78% of patients using topical corticosteroids alone, in 3% of patients using topical keratolytics alone, and in up to 84% using a combination of topical keratolytics and topical steroids. Clinical trials comparing the combination of keratolytics and topical corticosteroids versus topical corticosteroids alone found marginally more efficacy using combination regimens.

LIMITATIONS

We could not find any long term study evaluating the efficacy of combination therapy in scalp psoriasis and its effect on the patients' adherence.

CONCLUSION

High potency topical corticosteroids are usually effective in treating scalp psoriasis in clinical trials. Poor efficacy in clinical practice may be owing to poor adherence to the treatment regimen. Using a keratolytic agent in conjunction with a topical corticosteroid may provide marginal additional benefit in clinical trials, but that benefit is likely outweighed by the downside of complicating treatment and reducing adherence in the clinical setting, unless a single product containing both medications were used.