Clearance Of Lesions Research Articles

Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials

An out-of-office therapeutic agent indicated for molluscum contagiosum is needed. To assess the efficacy and safety of berdazimer gel, 10.3% (a topical, antiviral, nitric oxide-releasing medication) versus vehicle. Berdazimer gel, 10.3% or vehicle was applied once daily to all molluscum contagiosum lesions for 12weeks in patients ≥6months with 3-70 mollusca. Efficacy assessment: complete lesion clearance and partial clearance at week 12. Safety and tolerability assessment: adverse events through week 24 and local skin reactions through week 12. There were 1598 patients enrolled (n=917 berdazimer, n=681 vehicle). Berdazimer was superior to vehicle at week 12 in complete clearance rates, 30.0% versus 19.8% (odds ratio, 1.75; 95% CI, 1.38-2.23, P<.001). Subgroup analyses of primary efficacy showed consistent favorable efficacy for berdazimer across most subgroups, including age, sex, baseline lesion count, and disease duration. Berdazimer provided favorable outcome for partial clearance. Application-site pain (18.7% vs 4.8% in berdazimer vs vehicle) and erythema (11.7% vs 1.3%), mostly mild to moderate, were the most common local skin reactions. Berdazimer sodium in molluscum patients with lesions (B-SIMPLE) trials enrolled only US patients; no efficacy assessments beyond week 12. Berdazimer gel, 10.3% showed favorable efficacy and safety across subgroups.

Evaluation of the therapeutic efficacy of topical 50% hydrogen peroxide vs. 100% trichloroacetic acid vs. 5% 5-fluorouracil in the treatment of warts

ABSTRACT Background: Warts (verruca) are caused by human papilloma virus (HPV), which is known to affect the skin and mucosae. Over two hundred strains of HPV have been identified to date, among which few strains cause cutaneous lesions. Various treatment modalities have been elucidated in treating verruca lesions, yet the best therapeutic option is yet to be determined. Objectives: To evaluate the efficacy and safety of topical 50% hydrogen peroxide (H2O2), 100% trichloroacetic acid (TCA), and 5% 5-fluorouracil (5-FU) as a topical application in the treatment of warts. Methods: This was a prospective, interventional, clinical trial that included sixty patients with warts randomly allotted into three groups. Group A and group B were treated every week with topical 50% H2O2 and 100% TCA, respectively, and group C with 5% 5-FU under tape occlusion twice a day. The treatment was executed for a maximum period of eight weeks. The patients were evaluated with the Physician Wart Assessment (PWA) every two weeks of treatment and at three months after treatment completion. Results: At the end of the eight weeks of treatment, 13 patients (65%) in the H2O2 group, 11 patients (55%) in the TCA group, and 8 patients (40%) in the 5% 5-FU group displayed complete clearance of warts (PWA grade 0). In our study, side effects were significantly higher in the TCA group (70%) and in the 5% 5-FU group (60%), notably lower in the H2O2 group (30%) (p = 0.011). The most frequent side effect was irritation (25%), which was reported in all groups. No relapse was encountered at three months of treatment completion. Conclusion: According to our study, H2O2 and TCA have the advantage of earlier action over 5% 5-FU. However, H2O2 remarkably stands as a safer therapeutic option concerning the clearance of lesions, patient tolerability, and side effects. Key words: Warts, H2O2, TCA, 5%, 5-FU

Assessment of the efficacy of 595nm pulsed dye laser in the management of facial flat angiomas. Results of a case series.

Studies on pulsed dye laser (PDL) have shown the best efficacy and safety data for treating vascular anomalies among the various lasers used and the 595-nm PDL has been used to treat cutaneous vascular anomalies for about 30 years. The purpose of this study was to assess the efficacy of 595nm Pulsed Dye Laser in the management of facial flat angiomas present in the form of Port-Wine Stain. Seven cases of PWS in Fitzpatrick skin type ranged from I to III and colour ranging from pink to purple, were treated with 595nm pulse Dye Laser. Patients underwent to 6-8 laser sessions at 20-30 days intervals. Results obtained were judged by dermatologist, by comparing pre-treatment and post-treatment photographs, 6 months after the last session and a quartile scale of lesion clearance (4-point Investigator Global Assessment scale): 1=no or low results (0%-25% of the lesion area improved), 2=slight improvement (25%-50% of the lesion area cleared), 3=moderate-good improvement (50%-75%), and 4=excellent improvement (75%-100%) was used. Possible side effects such as blisters, hyper/hypopigmentation, and scarring were monitored. All patients observed global improvements. 71% of patients achieved excellent clearance and 29% patients achieved good-moderate clearance of their angioma. Patients were asked for a subjective evaluation of the results: 57% of patients were very satisfied, 29% were satisfied, and 14% patients were not very satisfied with the results. No patients were dissatisfied. No significant side effects were noted. This research confirms the efficacy of the 595nm PDL for flat angioma management, without considerable side effects.

Limitations of ALA-PDT as a reliable therapy for AK in clinical practice

BackgroundNumerous clinical studies have demonstrated the effectiveness of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treating actinic keratosis (AK). This therapy has achieved an average lesion clearance rate of approximately 80 % and has also shown to produce satisfactory cosmetic outcomes. However, in our clinical practice, the utilization and adherence to ALA-PDT treatment among AK patients has been lower than anticipated, possibly due to various factors. ObjectiveThe objectives of this study are twofold: (1) To analyze the actual therapeutic effects of ALA-PDT treatment on AK lesions in clinical practice; and (2) To identify the factors that hinder acceptance of ALA-PDT therapy among AK patients with large area or multiple lesions situated on the head and face. MethodThis study included a group of 20 AK patients, comprising 15 females and 5 males, with an age range of 57–87 years. All patients received a complete course of ALA-PDT therapy, consisting of 3–6 treatments. The study analyzed various factors, including the cure rate, recurrence rate, cosmetic effects, and adverse reactions following treatment. To investigate the factors affecting the acceptance of ALA-PDT treatment among AK patients with large or multiple lesions on the head and face, we also examined a separate group of 43 AK patients. This group included individuals who either had incomplete courses of ALA-PDT treatment or declined the therapy for the first time. The factors potentially influencing patients’ acceptance of PDT were analyzed based on the outcomes of these investigations. ResultAmong the 20 patients who completed the full course of ALA-PDT treatment, the cure rate was 95 % (19/20). The recurrence rates at 1 month, 3 months, and 6 months were 0 %, 5 %, and 10 %, respectively. Out of the 19 cured patients, only 2 experienced heavy pigmentation, and no scarring was reported 1–3 months post-treatment. Based on the survey of 43 patients who either had an incomplete course of ALA-PDT treatment or declined the therapy initially, several factors were identified as limiting their choice of PDT therapy. These factors include: (1) Intolerable adverse effects of treatment. (2) Higher treatment cost than expected. (3) Inconvenient transportation. (4) Coexistence of other senile diseases. (5) Unsatisfactory clinical efficacy observed. (6) Inadequate understanding of AK. (7) Lost to follow-up. ConclusionThe study concludes that ALA-PDT is a beneficial and aesthetically pleasing treatment for AK patients, particularly those with extensive or multiple lesions on the head and face. However, various factors can impede the selection of ALA-PDT therapy, potentially depriving patients of the most suitable option. The study aims to assist dermatologists and AK patients in considering treatment plans and exploring alternative options. Overall, the findings of this study may provide valuable guidance for improving treatment outcomes and patient satisfaction.

Successful Treatment of Pityriasis Rubra Pilaris with Risankizumab in Children.

Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that affects men and women of all ages, including children. PRP is characterized by follicular and palmoplantar hyperkeratosis and salmon-colored scaling plaques. The exact pathogenesis of PRP is still unknown; most PRP cases are acquired, but some cases may show a familial occurrence, often associated with a mutation in the CARD14 gene. Due to the rarity of PRP, treatment recommendations are based mainly on case reports, small case series and expert opinions and still represent a major therapeutic challenge, especially in children. A growing number of reports on treatment with biologicals, particularly anti-TNFα, has been published. However, an involvement of the IL-23/Th17 axis in both psoriasis and PRP pathogenesis may suggest that this pathway may be a potential therapeutic target. Here, we present three pediatric patients with PRP successfully treated with risankizumab. All patients exhibited a severe course of PRP and lack of response to conventional therapy, including acitretin, cyclosporine and phototherapy. A single dose of 75 mg risankizumab resulted in almost complete clearance of skin lesions in case 1 and 2 at week 4. In patient 3, clear skin was achieved after the second administration of risankizumab (150 mg). All patients continue the treatment with risankizumab, and no adverse effects have been reported up to the present time. Our study demonstrates that risankizumab, an IL-23 blocker, shows good efficacy and safety among pediatric patients with PRP.

Intralesional bivalent and quadrivalent human papillomavirus vaccines didn't significantly enhance the response of multiple anogenital warts when co-administered with intralesional Candida antigen immunotherapy. A randomized controlled trial.

Treatment of anogenital warts (AGWs) is challenging. Candida antigen immunotherapy has been proven to be a safe and relatively effective therapeutic modality; nevertheless, some patients may experience a partial or no response. Combining Candida antigen with other immunotherapies has been proposed to improve the cure rate. Immunotherapy with human papillomavirus (HPV) vaccines has been tried with conflicting outcomes. This study aimedto assess the efficacy and safety of intralesional Candida antigen, either alone or in combination with intralesional bivalent or quadrivalent HPV vaccines, for treating multiple AGWs. Eighty patients with multiple AGWs were included and randomly assigned to four equal groups: group A treated with intralesional Candida antigen only; group B treated with intralesional bivalent HPV vaccine (Cervarix) and Candida; group C treated with intralesional quadrivalent HPV vaccine (Gardasil) and Candida; and group D (control) treated with intralesional saline. Complete clearance of lesions was detected in 40%, 20%, and 60% of patients in Candida monotherapy, Cervarix/Candida, and Gardasil/Candida groups, respectively, whereas 40%, 60%, and 20% of patients in the three groups, respectively, showed partial response. Only 10% of the control group had a partial response. Therapeutic outcomes were significantly better in the three treatment groups compared to the control group, with no statistically significant difference between the Candida monotherapy group and the combination groups, but the response was significantly better in the Gardasil/Candida group than in the Cervarix/Candida group. No statistically significant difference was found between the studied groups regarding the development of side effects. Moreover, no recurrence was detected in any of the groups throughout the 3-month follow-up period. Based on our results,combining intralesional HPV vaccines with Candida antigen immunotherapy may haveno significant benefit for treating multiple AGWs. Candida antigen may be recommended as a relatively effective and inexpensive therapeutic modality. The combination of Gardasil and Candida was also effective but very expensive. The results of the Cervarix/Candida combination were unsatisfactory. This clinical trial was registered and approved prospectively by the ethical review board at Faculty of Medicine, Zagazig University.

Open-Label Observational Study of a Topical Formulation of Calcium Spirulan Contained in a Defined Extract of the Microalga Spirulina platensis in the Treatment of Children with Molluscum Contagiosum.

Molluscum contagiosum (MC) is a common viral skin infection primarily affecting children which is difficult to treat using available therapeutic approaches. The sulfated polysaccharide named calcium spirulan (Ca-SP) has demonstrated antiviral effects against herpes simplex virus in keratinocytes in vitro, and a cream containing 1.5% Ca-SP and 1% of a defined microalgae extract (Spiralin®) effectively prevented herpes labialis in a trial with susceptible individuals. This observational study aimed to show antiviral effects of a similar formulation (Spirularin® VS) against MC in children. Children with active MC lesions were treated with Spirularin® VS cream twice daily on affected skin over several months and asked to return for follow-up visits after 1 to 3 months. Clinical status of MC infection was documented at baseline and follow-up visits. Of the 31 children enrolled in the study, 26 completed treatment and returned for control visits. Spirularin® VS cream was applied twice daily over a period of 1 to 9 months (mean treatment duration 3.9 months). 19/26 (73.1%) children achieved complete clearance of MC lesions with no clinical evidence of bacterial skin infection during treatment. No irritative skin reactions or unpleasant symptoms were observed or reported. This open-label observational study suggests that a cream formulation containing 1.5% Ca-SP and 1% Spiralin® may be an effective and safe treatment option for children with active MC lesions. The high rate of complete clearance of MC lesions and lack of adverse reactions warrant further investigation in larger, controlled trials.

Brodalumab in the Treatment of Plaque Psoriasis Localized in Difficult-to-Treat Areas: A Narrative Review.

Psoriasis is a common chronic, immune-mediated, inflammatory skin disease that in certain localization results difficult to treat. Psoriatic lesions in difficult-to-treat areas might be hardly managed as no standardized therapeutic approach and the application of topical treatments might have great limitations. Systemic agents, including biologic therapies, have been proven effective in treating this subgroup of patients. In particular, current evidence has shown beneficial effects with the use of brodalumab, a fully human IgG2 monoclonal antibody antagonizing the IL-17 receptor A subunit (IL-17RA). The aim of this narrative review was to collect published data about efficacy and safety of brodalumab in the treatment of psoriasis occurring in difficult-to-treat areas. Data on brodalumab effectiveness and safety deriving from both trials and real-world setting that had been published in the last 15 years were collected for this review, together with clinical findings issued during international meetings. In phase 3 trials, brodalumab demonstrated to be effective in promoting a rapid response in scalp psoriasis as well as in generalized pustular psoriasis and erythrodermic psoriasis. Nail psoriasis demonstrated marked clinical improvement after treatment with brodalumab. Amelioration of palmoplantar psoriasis was also described in brodalumab-treated patients. Various retrospective real-world studies reported a complete clearance of psoriatic lesions in difficult-to-treat areas, including genitalia, through short-term brodalumab treatment. Brodalumab, combining rapid and sustained efficacy with a favorable safety profile, may be a valid therapeutic option for severe variants of psoriasis as well as for psoriasis localized in difficult-to-treat areas.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&amp;RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. Aimof The Study:To study the different clinical presentations and etiological factors of the fissure in ano&amp; different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &amp;to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment &amp; with Lords Anal Dilatation. Materials &amp; Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital &amp; Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients &amp; each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation &amp; C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, &amp; adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

CLINICAL STUDY OF CHRONIC FISSURE-IN-ANO AND COMPARATIVE STUDY OF DIFFERENTMODALITIESOF ITS TREATMENT IN NMCH&amp;RC

Anal fissure is a most common painful condition whichcauses considerable morbidity and affects the patients quality of life to a greater extent. The majority of acute anal fissures heal spontaneously. However, some of the acute anal fissures do not resolve but become chronic. Thiswarrantsprompttreatmentof the condition with appropriatemethods.Selecting a better method of treating this condition that can achieve optimal clinical results and getting the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This has led to the innovation of a number of surgical and pharmacological methods that relaxes the anal sphincter. AimofThe Study:To study the different clinical presentations and etiological factors of the fissure in ano&amp; different modalities of treatment of fissure in ano i.e., application of 2% Diltiazem ointment, Lords Anal Dilatation and Subcutaneous Lateral Internal Sphincterotomy. &amp;to evaluate the efficacy Subcutaneous Lateral Internal Sphincterotomyas a treatment modality in the management of chronic anal fissure in comparison with application of 2% Diltiazem ointment &amp; with Lords Anal Dilatation. Materials &amp; Methods: The material for the study was taken from the cases attending thesurgery OPD and admitted In-patients of all the units of the Department of General Surgery, Navodaya Medical College Hospital &amp; Research Centre,whowerediagnosed to haveChronicanal fissure. This study was a prospective study which included 90 patients presenting with chronic anal fissure over a period of 18 months from November 2019 to May 2021.Thesepatientswererandomly selectedandclassifiedintothree groups(A,B,C) eachconsistingof30 patients &amp; each group with one type of treatment modality, like group A for 2% diltiazem, B for lords anal dilatation &amp; C for LIS. Follow-up of the patients was done by history and per-rectalexamination to assess the efficacy of the treatment and the complications like pain,bleeding,sphincter spasm, dischargeperanum and incontinence. Results :This study showed the results in favour of Lateral Internal Sphincterotomywith a healing rate of 100% with faster pain-relief and minimal or no complications ifperformedbythehands of an experienced surgeon, whereas latency in the clearance of symptoms and lesions was seen with 2% Diltiazem and Lords Anal Dilatation with adverse effects as well. With the healingrate of 100% of Fissure-in-ano in LIS therapy group, 81% in Lords Anal Dilatation and 71% with topical 2% Diltiazem therapy, &amp; adverse effects or complications being maximum in 2% Diltiazem therapy group, 13 patients (46%) when compared to Lords Anal Dilatation (41% , 11 patients) and LIS group (32%, 09 patients), weconcludethatLateralinternalsphinterotomy(LIS) appearstobethebetterlineoftreatmentasthereis 100%healingrate, minimal complications and no recurrence.

Involvement of TLR9 in priming the immune response in oral papillomatosis induced by low-risk HPV.

Oral papillomatosis represents a benign lesion of the oral mucosa often induced by human papillomavirus (HPV) or having a non-infection local or general etiology. HPVs are very well adapted and efficient viruses able to produce changes in the immune system, endowed with the ability to replicate in the keratinocytes and to remain silent. The natural evolution of HPV infection is different, depending on the efficiency of the innate immune system. The purpose of this study was to explore Toll-like receptor 9 (TLR9) immunohistochemical expression in low-risk (LR)-HPV oral infection and its ability to facilitate an efficient immune response by activating the macrophages, which serve as main antigen-presenting cells. Samples of two groups of oral mucosae - LR-HPV-positive and HPV-negative - were processed for immunohistochemistry technique and incubated with antibody against TLR9 and cluster of differentiation 68 (CD68). Image analysis and morphometry were conducted to assess the intensity of TLR9 immune signal in the epithelium and the number of macrophages labeled by CD68. We found a statistically significant difference between macrophage count for the subjects in HPV-positive and HPV-negative groups; thought no significant differences of TLR9 immune signal was noted, which demonstrates a diminished immune response in HPV-positive group, probably influencing the time of lesion's clearance.

Clinical study to evaluate the efficacy of autoinoculation in genital molluscum contagiosum in reproductive age group.

Molluscum contagiosum (MC) typically presents as asymptomatic or itchy, discrete, smooth, flesh-colored, dome-shaped papules with central umbilication. Lesions on the genitals are often sexually transmitted and tend to be seen in young adults. Homologous auto implantation is a simple technique which helps in inducing a cell-mediated immune response to the antigens, aiding clearance of both local and distant lesions. The aim of the study is to evaluate the efficacy and side effect of the technique of autoinoculation for the treatment of genital MC in terms of reduction in number of lesions. Thirty-one patients having >5 genital molluscum attending skin outpatient department were enrolled out of which 30 remain. A well-defined mc lesion was approached using an insulin syringe (30 G) and pierced from a site just adjacent to the lesion. Results were assessed every 2 weeks for 2 months. 60% (n = 18) patients showed excellent response, 20% (n = 6) patients showed very good response, 6.6% (n = 2) patients showed good response and 13.3% (n = 4) showed poor response at the end of the study. The autoinoculation technique is an effective technique in terms of excellent clearance of MC lesions with fewer chances of recurrence, side effects, and shorter duration taken to achieve a complete response to distant lesions.

P10 Blastic plasmacytoid dendritic cell neoplasm: two representative cases

Abstract Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignant proliferation of plasmacytoid dendritic cells, representing &amp;lt; 1% of primary cutaneous lymphomas. It most commonly presents in the skin and has a poor prognosis with median survival of 1 year. The fifth World Health Organization classification of haematolymphoid tumours encompasses two entities in plasmacytoid dendritic cell neoplasms: BPDCN and ‘mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm’. We present two cases, one representing each subset. Our first case was a 58-year-old man who presented with an asymptomatic, rapidly progressive, skin coloured-to-ery­thematous and hyperpigmented firm papules, nodules and plaques over the trunk, upper limbs and face of 2.5 months’ duration. This was associated with loss of appetite, loss of weight and leucopenia (2180 cells μL−1). Skin biopsy revealed a grenz zone with pandermal infiltration by large cells with high nuclear : cytoplasmic ratio, vesicular nuclei and prominent nucleoli, and frequent mitotic figures. Immunohistochemistry (IHC) was leucocyte common antigen (LCA)+ but CD3–, CD20–, myeloperoxidase (MPO)– and CD117–. Bone marrow biopsy showed a similar infiltrate of cells, but the peripheral blood smear and flow cytometry was within normal limits. Further IHC was CD4+, CD56+, CD43+ and CD123+, establishing a diagnosis of BPDCN, and the patient was initiated on the Hoelzer protocol with 80% clearance of lesions after two cycles of chemotherapy. The second case was a 60-year-old woman who presented with asymptomatic firm skin-coloured nodules on her scalp, trunk, extremities and oral mucosa, associated with a low-grade fever, fatigability, weight loss, generalized lymphadenopathy and hepatosplenomegaly of 4 months’ duration. Histopathology showed similar features to the first case, with IHC being negative for CD3, CD20, CD138 and MPO. However, cells were LCA+, CD4+, CD56+ and CD43+. Bone marrow showed 77% acute leukaemia blasts with a MPO+ result, establishing diagnosis of acute myeloid leukaemia, suggestive of a mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm. To conclude, BPDCN is an aggressive neoplasm that commonly presents in the skin and should be suspected by dermatologists when screening IHC for lymphoid and myeloid cell lines is negative in a suspected case of leukaemia cutis. A panel of CD4/CD56/CD43/CD123 may be used to establish the diagnosis.

DP06 (P10) Blastic plasmacytoid dendritic cell neoplasm: two representative cases

Abstract Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignant proliferation of plasmacytoid dendritic cells, representing &amp;lt;1% of primary cutaneous lymphomas. It most commonly presents in the skin and has a poor prognosis with median survival of 1 year. The fifth World Health Organization classification of haematolymphoid tumours encompasses two entities in plasmacytoid dendritic cell neoplasms: BPDCN and ‘mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm’. We present two cases, one representing each subset. Our first case was a 58-year-old man who presented with an asymptomatic, rapidly progressive, skin coloured-to-ery­thematous and hyperpigmented firm papules, nodules and plaques over the trunk, upper limbs and face of 2.5 months’ duration. This was associated with loss of appetite, loss of weight and leucopenia (2180 cells μL–1). Skin biopsy revealed a grenz zone with pandermal infiltration by large cells with high nuclear:cytoplasmic ratio, vesicular nuclei and prominent nucleoli and frequent mitotic figures. Immunohistochemistry (IHC) was leucocyte common antigen (LCA)+ but CD3–, CD20–, myeloperoxidase (MPO)– and CD117–. Bone marrow biopsy showed a similar infiltrate of cells, but the peripheral blood smear and flow cytometry was within normal limits. Further IHC was CD4+, CD56+, CD43+ and CD123+, establishing a diagnosis of BPDCN, and the patient was initiated on the Hoelzer protocol with 80% clearance of lesions after two cycles of chemotherapy. The second case was a 60-year-old woman who presented with asymptomatic firm skin-coloured nodules on her scalp, trunk, extremities and oral mucosa, associated with a low-grade fever, fatigability, weight loss, generalized lymphadenopathy and hepatosplenomegaly of 4 months’ duration. Histopathology showed similar features to the first case, with IHC being negative for CD3, CD20, CD138 and MPO. However, cells were LCA+, CD4+, CD56+ and CD43+. Bone marrow showed 77% acute leukaemia blasts with a MPO+ result, establishing diagnosis of acute myeloid leukaemia, suggestive of a mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm. To conclude, BPDCN is an aggressive neoplasm that commonly presents in the skin and should be suspected by dermatologists when screening IHC for lymphoid and myeloid cell lines is negative in a suspected case of leukaemia cutis. A panel of CD4/CD56/CD43/CD123 may be used to establish the diagnosis.

421 The role of itch resolution and skin clearance in patient-reported atopic dermatitis severity and quality of life: real-world insights from TARGET-DERM AD

Abstract Severity of atopic dermatitis (AD) itch and lesions is associated with poor quality of life. However, there is limited evidence describing the combined impact of itch and skin severity on patient outcomes in AD. This study aims to assess the independent and combined effects of itch and skin severity on patient-reported symptoms and quality-of-life outcomes. The study included adult participants (age ≥18 years) with AD enrolled in TARGET-DERM AD, an observational, longitudinal study of more than 3158 participants across 43 academic/community centers in the USA and Canada. Itch severity was assessed by the Patient-Reported Outcome Measurement Information System Itch-Severity, specifically the item evaluating ‘itch at its worst’, a 0–10 numeric rating scale. A score of 0 or 1 was interpreted as no/minimal itch. Skin severity was assessed by the validated Investigators Global Assessment of AD (vIGA-AD), with a score of 0 or 1 representing clear/almost clear skin (vIGA-AD 0/1). The association of AD symptoms representing patient-reported clear/almost clear disease [Patient-Oriented Eczema Measure (POEM) 0–2] and no impact of AD on quality of life [Dermatology Life Quality Index (DLQI) 0/1] with itch and skin severity was assessed using descriptive statistics and logistic regression models that included main and interaction effects for itch and skin severity. Among adult participants (n = 1795; 59% female; 60% non-Hispanic White; mean age 44.5 years), vIGA-AD, POEM, Worst Itch and DLQI data at enrollment were available for 95% (1702), 44% (792), 43% (783) and 43% (783) of participants, respectively. The proportion reporting POEM 0–2 and DLQI 0/1 was highest among those with no/minimal worst itch (73% POEM 0–2; 72% DLQI 0/1) and clear/almost clear skin (46% POEM 0–2; 45% DLQI 0/1), with decreasing proportions observed at greater itch and skin severity levels. Among those with both no/minimal itch and clear/almost clear skin, 87.5% (42/48) and 95.8% (46/48) reported POEM 0–2 and DLQI 0/1, respectively. Logistic regression results suggest that no/minimal itch and clear/almost clear skin are significantly associated with POEM 0–2 and DLQI 0/1, though the interaction effect was not statistically significant in despite all models assessed. Relative to those who did not have either no/minimal itch or clear/almost clear skin, the odds ratio of reporting POEM 0–2 and DLQI 0/1 was highest among those with both no/minimal itch and clear/almost clear skin (82.9 for POEM 0–2; 35.4 for DLQI 0/1), followed by no/minimal itch only (15.9 for POEM 0–2; 10.5 for DLQI 0/1) and clear/almost clear skin only (5.9 for POEM 0–2; 3.8 for DLQI 0/1). Complete or almost complete relief of itch and skin lesions is associated with greater odds of achieving ideal states in PROs (POEM and DLQI) with itch relief exhibiting a relatively higher impact than skin clearance. These results underscore the importance of assessing and documenting both itch severity and skin clearance to support shared decision-making. Moreover, clearance of both itch and skin lesions should be considered when setting treatment goals in patients with AD. Future research should include analyzing discrepant data (e.g. patients with no/minimal itch, but some skin lesions) to more precisely identify which aspect drives the patient-reported outcomes.

415 Efficacy of 2% crisaborole ointment in 49 patients of atopic dermatitis with chronic hyperplasia lesions: a real-world study

Abstract Asian Atopic dermatitis (AD) presents as a mixed phenotype between the European American (EA) AD and psoriasis phenotypes, with highly atypical features for AD, including clearer demarcation of lesions, with more prominent scaling, lichenification, parakeratosis, hyperplasia and a unique cytokine profile with coactivation of the TH2 and TH17 axes. The cutaneous immune dysregulation in Chinese patients with AD usually exhibit remarkable increase in epidermal hyperplasia and parakeratosis, frequently observed in areas such as the hands, feet, knees and elbows. Currently, the response of chronic hyperplastic lesions to various conventional treatment modalities, including topical corticosteroids and topical calcineurin inhibitors, is not optimistic and often accompanied by various complications. As a Phosphodiesterase 4 (PDE4) inhibitor, crisaborole broadly inhibits inflammatory signaling pathways, and has demonstrated definite efficacy in AD partly due to its smaller molecular weight and higher transdermal absorption efficiency. This study aims to find the clinical efficacy of 2% crisaborole ointment monotherapy for chronic hyperplastic lesions of AD in real-world research in China. We retrospectively enrolled 49 patients with AD aged 12 years or older with chronic hyperplastic lesions and an Investigator’s Static Global Assessment (ISGA) score of mild or moderate. The patients were administered with 2% crisaborole ointment for twice-daily application until the complete clearance of lesion. The efficacy endpoints comprised the onset time of pruritus and lesion remission, and the time of complete lesion clearance. A 1-grade or more improvement of the VAS scores from baseline was defined as the pruritus remission. An improvement of 1 point or more of the ISGA scores was indicative of improved skin lesions. The ISGA score of 0 (clear) or 1 (almost clear) with a ≥2-grade improvement from baseline indicated complete remission of skin lesions. After subgrouping the patients by age and AD duration, we further compared differences in efficacy endpoints to explore potential influencing factors on the effectiveness of crisaborole. Two percent crisaborole ointment showed good efficacy for treating chronic hyperplasia lesions in Asian patients with AD, with minor irritation, early remission of pruritus [7.0 ( 3.0, 10.0) days] and lesions [7.0 (5.0, 10.0) days]. The median time for complete lesion clearance was 30 days. Two percent crisaborole ointment showed different efficacy in the different age. The onset of pruritus remission appeared to be more rapid in the elderly [2.0 (1.0, 10.0)] compared with the adolescents [4.0 (2.3, 6.5)] and the adults [7.0 (3.5, 10.0)], but with no statistically significant difference (P = 0.072). The adolescents had an earlier onset of lesion remission by approximately 3 days compared with the adults and the elderly (P = 0.044). Although the onset of pruritus remission for the adolescents and the adults was similar to their onset of lesion remission, the elderly seemed to experience significantly earlier pruritus remission compared with their lesion remission onset. There was no statistical difference in complete lesion clearance time among different age groups (P = 0.019). Commonly seen in Asian patients with AD, chronic hyperplasia lesions generally do not respond well to other topical medications. Two percent crisaborole ointment monotherapy is an effective treatment for chronic hyperplasia lesions in patients with AD of all age groups, and onset of pruritus and lesion remission is different in the different age group.

Safety and Efficacy of a Novel Combination Cream (GN-037) in Healthy Volunteers and Patients with Plaque Psoriasis: A Phase 1 Trial.

Psoriasis is a common skin disorder associated with physical and psychological burdens. Visible disfiguration can trigger a negative reaction which can cause much of the readily measurable psychological burden of the disease. Although many biological treatments provide some success in the initial clearance of lesions, there is a dispute about the long-term maintenance of the disease, as no current biological treatment has been shown to be curative. Topical therapies are still the most widely used agents as first-line and maintenance treatment for psoriasis. The present study aimed to investigate the safety, tolerability, and, to some extent, efficacy of GN-037 cream in patients with psoriasis and healthy volunteers. A randomized, double-blind, single-center, placebo-controlled phase 1 clinical study was conducted to evaluate the safety, tolerability, and clinical efficacy of GN-037 cream topically applied twice daily for 2weeks in healthy subjects (n = 12) and patients (n = 6) diagnosed with plaque-type psoriasis. Six healthy subjects received placebo. Patients with plaque psoriasis were evaluated by a dermatologist, and Physician Global Assessment (PGA) score was required to be ≥ 3 (moderate psoriasis) at screening. A total of 31 adverse events (AEs) occurred in 13 participants during the study: 9 AEs in healthy subjects receiving GN-037 cream, 3 AEs in healthy subjects receiving placebo, and 1 AE in one psoriatic patient. The most frequently reported AEs were reactions at the application site, including erythema, exfoliation, pruritus, and burning sensation. During the baseline evaluation, one patient had a PGA score of 3 (moderate) and five patients had a PGA score of 4 (severe). On day 14, in treatment, four patients experienced second grade and two patients third grade improvements compared with baseline, indicating a shift of patients from moderate and severe disease to mild disease and to almost clear (score 2 or 1). There were slight increases in plasma tumor necrosis factor (TNF)-α, interleukin-17 (IL-17) and interleukin-23 (IL-23) levels in both healthy volunteers and patients throughout the study, as compared with baseline. The results of this phase 1 trial conducted in 18 healthy volunteers and 6 patients with plaque psoriasis demonstrated a favorable safety and tolerability profile for GN-037; therefore, further clinical development of GN-037 in a phase 2 clinical trial has been initiated in patients with mild to moderate plaque psoriasis (NCT05706870). NCT05428202.

Poor Adherence to Self-Applied Topical Drug Treatment Is a Common Source of Low Lesion Clearance in Patients with Actinic Keratosis-A Cross-Sectional Study.

Many treatments for actinic keratosis (AK) have been proven efficient in clinical trials. However, patients with AK may still experience unsatisfactory therapeutic outcomes in clinical practice. To investigate patient adherence to self-applied topical interventions for AK and to explore factors associated with adherence in a real-world setting. A cross-sectional study was conducted. Patients presenting with AK were asked to complete a self-administered questionnaire about their last topical AK treatment. A total of 113 patients participated with a median age of 78.5 years (range 58-94). Fifty-four patients (47.8%) received topical diclofenac, ten (8.8%) imiquimod, nine (8%) 5-fluorouracil, nine (8%) 5-fluorouracil plus salicylic acid, and eight (7.1%) photodynamic therapy. The non-adherence rate was 46.9% (n = 53), and only 30.9% (n = 35) used the topical treatments according to the summary of product characteristics (SmPC). These subgroups were compared. Patients of the non-compliant group were significantly less informed about the application time of the specific topical intervention (p = 0.002) and adjusted the timeframe (p < 0.001) and application frequency of the therapy (p = 0.02) independently of their physician. Conversely, patients reporting a sufficient pre-treatment consultation (p = 0.019) generally complied with the SmPC compliance application. A thorough pre-treatment consultation can help to increase treatment adherence and ensure lesion clearance.

Long-pulsed 1064 nm Nd: YAG laser in treatment of palmoplantar warts: A prospective study

Objectives: Palmoplantar warts are a challenge to treat. Standard treatment methods include electrocautery, radiofrequency ablation and cryosurgery, carbon dioxide laser, and Erbium-doped Yttrium Aluminum Garnet laser, which are ablative, invasive, and have downtime. Non-ablative lasers like pulsed dye laser and long-pulsed Neodymium: Yttrium-Aluminum-Garnet (Nd: YAG) have been tried earlier for the treatment of warts to overcome these deficiencies. The aim of the study was to assess the efficacy and safety of long-pulsed 1064 nm Nd: YAG laser in the treatment of palmoplantar warts. Material and Methods: Eleven adult subjects with a total of 58 hand and foot warts were enrolled in the clinical trial from January 2016 to January 2017 to receive treatment with long-pulsed 1064 nm Nd: YAG laser. The thick hyperkeratotic part of the wart was removed by paring and then the lesion was treated, at monthly intervals for four sessions or until the clearance of the warts. Response was assessed at the beginning, before each treatment session and after the final treatment. Results: A total of 8 subjects with 52 warts completed the study. Forty (76.9%) warts showed complete clearance of lesion and 2 (3.8%) warts showed marked improvement. Ten (19.2%) warts did not get cleared. The average number of sessions was 2.2. Mild pain was noticed during the procedure. There was no wound, no infection and no bandages were required after the procedure. Post-inflammatory pigmentation or scarring was not observed in any case. Conclusion: Long-pulsed 1064 nm Nd: YAG laser is safe, effective, non-destructive, and relatively painless for the treatment of palmoplantar warts.

ROLE OF GLYCOLIC ACID PEELING (35%) IN MANAGEMENT OF ACNE VULGARIS: A PROSPECTIVE COMPARATIVE STUDY

Introduction: Acne vulgaris is a common dermatological disorder primarily affecting adolescents and young adults. In spite of various modalities of treatment available, it still poses a therapeutic problem to the dermatologists. The advent of new and potent topical therapeutic modalities such as chemical peeling has resulted in signicant improvement in the treatment of acne. This study aims to observe the therapeutic res Objective: ponse of 35% glycolic acid peeling in active acne lesions as an adjuvant to conventional anti acne therapy. This Materials &amp; Methods: was randomized control study in which 100 patients of mild – moderate grade acne vulgaris were taken and divided into 2 groups of 50 each. Group A was given conventional anti acne management and group B was given Glycolic acid peeling every 3 weeks in addition to the conventional anti acne management. Follow up was done for 4 months and results were compared between the 2 groups. we found that acne grade improved faster in Group B patients (patients undergoi Result &amp; Conclusion: ng GLA peel). Although Group B patients showed faster improvement in clearance of acne lesions but by the end of the study i.e., at 15 weeks both the group had equal response rate. This means that glycolic acid peeling can be used as an adjuvant with conventional antiacne management to fasten the resolution of acne lesions but nal response after full course of treatment is similar in both group