VIDEO: A challenging case of lichen planus

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– For challenging cases of oral or cutaneous lichen planus, bullous pemphigoid, or lupus, Miriam S. Bettencourt, MD, recommends thinking outside the box and considering off-label treatments.

At the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar, Dr. Bettencourt discussed such cases, including a series of patients with oral lichen planus who improved with apremilast, an oral phosphodiesterase 4 inhibitor approved for psoriasis.

In a video interview at the meeting, she described one of those patients, a 73-year-old woman with mouth ulcers who was diagnosed with oral lichen planus. Multiple topical and oral therapies proved unsuccessful, and her condition was eventually controlled with apremilast, and the patient is doing well, “with occasional flares,” said Dr. Bettencourt, of the University of Nevada, Las Vegas.

She described this case in her annual presentation at the meeting, titled “Great Cases From the Las Vegas Dermatology Society.”

Dr. Bettencourt disclosed relationships with multiple companies including AbbVie, Aclaris, Celgene, IntraDerm, Pfizer, Promium, Sun Pharma, and Valeant.

SDEF and this news organization are owned by the same parent company.

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– For challenging cases of oral or cutaneous lichen planus, bullous pemphigoid, or lupus, Miriam S. Bettencourt, MD, recommends thinking outside the box and considering off-label treatments.

At the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar, Dr. Bettencourt discussed such cases, including a series of patients with oral lichen planus who improved with apremilast, an oral phosphodiesterase 4 inhibitor approved for psoriasis.

In a video interview at the meeting, she described one of those patients, a 73-year-old woman with mouth ulcers who was diagnosed with oral lichen planus. Multiple topical and oral therapies proved unsuccessful, and her condition was eventually controlled with apremilast, and the patient is doing well, “with occasional flares,” said Dr. Bettencourt, of the University of Nevada, Las Vegas.

She described this case in her annual presentation at the meeting, titled “Great Cases From the Las Vegas Dermatology Society.”

Dr. Bettencourt disclosed relationships with multiple companies including AbbVie, Aclaris, Celgene, IntraDerm, Pfizer, Promium, Sun Pharma, and Valeant.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

– For challenging cases of oral or cutaneous lichen planus, bullous pemphigoid, or lupus, Miriam S. Bettencourt, MD, recommends thinking outside the box and considering off-label treatments.

At the Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar, Dr. Bettencourt discussed such cases, including a series of patients with oral lichen planus who improved with apremilast, an oral phosphodiesterase 4 inhibitor approved for psoriasis.

In a video interview at the meeting, she described one of those patients, a 73-year-old woman with mouth ulcers who was diagnosed with oral lichen planus. Multiple topical and oral therapies proved unsuccessful, and her condition was eventually controlled with apremilast, and the patient is doing well, “with occasional flares,” said Dr. Bettencourt, of the University of Nevada, Las Vegas.

She described this case in her annual presentation at the meeting, titled “Great Cases From the Las Vegas Dermatology Society.”

Dr. Bettencourt disclosed relationships with multiple companies including AbbVie, Aclaris, Celgene, IntraDerm, Pfizer, Promium, Sun Pharma, and Valeant.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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VIDEO: Metabolic regulator FGF21 improves fibrosis in NASH patients

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– Fibroblast growth factor 21 (FGF21), a nonmitogenic hormone, improved fibrosis, liver injury, and steatosis in patients with nonalcoholic steatohepatitis (NASH), according to a study presented at the American Association for the Study of Liver Disease’s annual meeting.

There is no drug therapy currently available for NASH, the most advanced form of nonalcoholic fatty liver disease (NAFLD), creating a strong need for effective treatments, according to Arun Sanyal, MD, of the Virginia Commonwealth University, Richmond, said in a video interview.

This treatment “relative to placebo was associated with improvements in biomarkers of fibrosis, metabolic parameters, and markers of hepatic injury,” said Dr. Sanyal. “These results suggest BMS-986036 [FGF21] has beneficial effects on steatosis, liver injury, and fibrosis in NASH.”

Investigators conducted a phase 2 multicenter, double-blind, placebo-controlled study of 74 NASH patients to test BMS-986036, a pegylated version of FGF21.

Patients were an average of 51 years old, most were women (64%), who were predominantly white (96%), with a mean hepatic fat fraction of 19%.

Patients received either a 10-mg treatment daily, a 20-mg treatment weekly, or placebo, over the course of 16 weeks, with patients distributed equally among the three arms.

Overall hepatic fat fraction among the daily and weekly treatment groups reduced by 6.8% and 5.2%, respectively, compared with the placebo group, which reduced by 1.3% (P less than .001).

Patients in the treatment arms also saw improvement in average adiponectin levels, growing 15.3% in the daily arm and 15.7% in the weekly arm. Meanwhile, adiponectin levels dropped by an average of 3.5% in the placebo group.

In investigating serum Pro-C3 levels, which are associated with fibrosis, patients in the daily and weekly treatment group saw an average drop of 29% and 19%, respectively, as opposed to an increase of 2% in the placebo group (P less than .0001).

Patients in the treatment groups saw no serious adverse effects, and no patients died during the study.

Dr. Sanyal received funding for this study from Bristol-Myers Squibb and reported receiving financial compensation from Pfizer, Nimbus, Novartis, AstraZeneca, and other similar companies.

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– Fibroblast growth factor 21 (FGF21), a nonmitogenic hormone, improved fibrosis, liver injury, and steatosis in patients with nonalcoholic steatohepatitis (NASH), according to a study presented at the American Association for the Study of Liver Disease’s annual meeting.

There is no drug therapy currently available for NASH, the most advanced form of nonalcoholic fatty liver disease (NAFLD), creating a strong need for effective treatments, according to Arun Sanyal, MD, of the Virginia Commonwealth University, Richmond, said in a video interview.

This treatment “relative to placebo was associated with improvements in biomarkers of fibrosis, metabolic parameters, and markers of hepatic injury,” said Dr. Sanyal. “These results suggest BMS-986036 [FGF21] has beneficial effects on steatosis, liver injury, and fibrosis in NASH.”

Investigators conducted a phase 2 multicenter, double-blind, placebo-controlled study of 74 NASH patients to test BMS-986036, a pegylated version of FGF21.

Patients were an average of 51 years old, most were women (64%), who were predominantly white (96%), with a mean hepatic fat fraction of 19%.

Patients received either a 10-mg treatment daily, a 20-mg treatment weekly, or placebo, over the course of 16 weeks, with patients distributed equally among the three arms.

Overall hepatic fat fraction among the daily and weekly treatment groups reduced by 6.8% and 5.2%, respectively, compared with the placebo group, which reduced by 1.3% (P less than .001).

Patients in the treatment arms also saw improvement in average adiponectin levels, growing 15.3% in the daily arm and 15.7% in the weekly arm. Meanwhile, adiponectin levels dropped by an average of 3.5% in the placebo group.

In investigating serum Pro-C3 levels, which are associated with fibrosis, patients in the daily and weekly treatment group saw an average drop of 29% and 19%, respectively, as opposed to an increase of 2% in the placebo group (P less than .0001).

Patients in the treatment groups saw no serious adverse effects, and no patients died during the study.

Dr. Sanyal received funding for this study from Bristol-Myers Squibb and reported receiving financial compensation from Pfizer, Nimbus, Novartis, AstraZeneca, and other similar companies.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

– Fibroblast growth factor 21 (FGF21), a nonmitogenic hormone, improved fibrosis, liver injury, and steatosis in patients with nonalcoholic steatohepatitis (NASH), according to a study presented at the American Association for the Study of Liver Disease’s annual meeting.

There is no drug therapy currently available for NASH, the most advanced form of nonalcoholic fatty liver disease (NAFLD), creating a strong need for effective treatments, according to Arun Sanyal, MD, of the Virginia Commonwealth University, Richmond, said in a video interview.

This treatment “relative to placebo was associated with improvements in biomarkers of fibrosis, metabolic parameters, and markers of hepatic injury,” said Dr. Sanyal. “These results suggest BMS-986036 [FGF21] has beneficial effects on steatosis, liver injury, and fibrosis in NASH.”

Investigators conducted a phase 2 multicenter, double-blind, placebo-controlled study of 74 NASH patients to test BMS-986036, a pegylated version of FGF21.

Patients were an average of 51 years old, most were women (64%), who were predominantly white (96%), with a mean hepatic fat fraction of 19%.

Patients received either a 10-mg treatment daily, a 20-mg treatment weekly, or placebo, over the course of 16 weeks, with patients distributed equally among the three arms.

Overall hepatic fat fraction among the daily and weekly treatment groups reduced by 6.8% and 5.2%, respectively, compared with the placebo group, which reduced by 1.3% (P less than .001).

Patients in the treatment arms also saw improvement in average adiponectin levels, growing 15.3% in the daily arm and 15.7% in the weekly arm. Meanwhile, adiponectin levels dropped by an average of 3.5% in the placebo group.

In investigating serum Pro-C3 levels, which are associated with fibrosis, patients in the daily and weekly treatment group saw an average drop of 29% and 19%, respectively, as opposed to an increase of 2% in the placebo group (P less than .0001).

Patients in the treatment groups saw no serious adverse effects, and no patients died during the study.

Dr. Sanyal received funding for this study from Bristol-Myers Squibb and reported receiving financial compensation from Pfizer, Nimbus, Novartis, AstraZeneca, and other similar companies.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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VIDEO: New herpes zoster vaccine may boost vaccination rate

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LAS VEGAS– One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

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LAS VEGAS– One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

LAS VEGAS– One of the benefits of the recently approved inactivated herpes zoster is its efficacy in older adults, Kenneth J. Tomecki, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

In addition, the vaccine will be recommended not only for healthy adults, but for ill adults aged 50 years and older, said Dr. Tomecki of the department of dermatology at the Cleveland Clinic. “Efficacy is greater than 90% for zoster and postherpetic neuralgia” with the new vaccine, he added.

Vaccination rates among eligible adults with the current vaccine, which is highly effective, are low, but ideally, the advent of the new vaccine will boost vaccination rates, especially in older adults, he noted.

The new vaccine, which will be marketed as Shingrix, was approved in October by the Food and Drug Administration for preventing herpes zoster in adults aged 50 years and older. The currently available herpes zoster vaccine, Zostavax, a live attenuated virus vaccine, was approved by the FDA in 2006.

Dr. Tomecki had no financial conflicts to disclose.

SDEF and this news organization are owned by the same parent company.
 

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VIDEO: Consider a multifaceted acne treatment approach to achieve clear skin

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LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

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LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

LAS VEGAS – Patients with acne don’t want to be better, they want to be clear, Julie Harper, MD, said at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

Even one lesion on the face can ruin someone’s day, said Dr. Harper, a dermatologist in private practice in Birmingham, Ala., and an author of the 2016 American Academy of Dermatology’s acne management treatment guidelines. Clinicians need to think outside the box and consider a combination of treatments, and they should not underestimate the potential role of oral contraceptives as part of an acne treatment plan, she added.

“As a specialty, we need to learn how to really clear acne,” she said in a video interview. “People don’t want to be 50% better, they want to be clear.”

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

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VIDEO: Rosacea patients no longer considered in ‘buckets’

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Fri, 01/18/2019 - 17:09

 

LAS VEGAS– Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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LAS VEGAS– Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

LAS VEGAS– Clinicians are starting to see and treat rosacea differently, Julie Harper, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas Dermatology Seminar.

“For a long time, we thought about putting rosacea patients into buckets,” based on the predominant type of rosacea they had, such as papulopustular, ocular, or erythematotelangiectatic rosacea, but “what we find is that people have pieces and parts of all of those,” she commented.

In the interview, Dr. Harper, a dermatologist in private practice in Birmingham, Ala., emphasized the importance of directing treatment to all aspects of an individual patient’s rosacea, using combinations of treatments that are approved by the Food and Drug Administration, “or at least proven to be effective for these different parts” of the disease. “That’s something that’s really new in our thinking,” she said.

Dr. Harper disclosed relationships with multiple companies including Allergan, Bayer, Galderma, La Roche-Posay, Promius, and Valeant.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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VIDEO: Various treatments for acne in clinical trials

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LAS VEGAS– “It’s an exciting time in the treatment of acne,” Linda F. Stein Gold, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.

In the interview, Dr. Stein Gold, director of dermatology research at the Henry Ford Health System in Detroit, discussed several new developments in the field of acne, including a once-daily oral antibiotic, sarecycline, and topical minocycline drugs in different stages in the research pipeline.

Scarring can occur with any degree of acne severity, but new data suggest that patients struggling with scars may benefit from a fixed combination of adapalene gel 0.3% and benzoyl peroxide gel 2.5%, Dr. Stein Gold noted.

She disclosed relationships with multiple companies including Allergan, Anacor, Celgene, Dermira, Foamix, Galderma, LEO, Medimetriks, Novan, Novartis, Promius, Sol-gel, and Valeant.

SDEF and this news organization are owned by the same parent company.

 

 

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LAS VEGAS– “It’s an exciting time in the treatment of acne,” Linda F. Stein Gold, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.

In the interview, Dr. Stein Gold, director of dermatology research at the Henry Ford Health System in Detroit, discussed several new developments in the field of acne, including a once-daily oral antibiotic, sarecycline, and topical minocycline drugs in different stages in the research pipeline.

Scarring can occur with any degree of acne severity, but new data suggest that patients struggling with scars may benefit from a fixed combination of adapalene gel 0.3% and benzoyl peroxide gel 2.5%, Dr. Stein Gold noted.

She disclosed relationships with multiple companies including Allergan, Anacor, Celgene, Dermira, Foamix, Galderma, LEO, Medimetriks, Novan, Novartis, Promius, Sol-gel, and Valeant.

SDEF and this news organization are owned by the same parent company.

 

 

LAS VEGAS– “It’s an exciting time in the treatment of acne,” Linda F. Stein Gold, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.

In the interview, Dr. Stein Gold, director of dermatology research at the Henry Ford Health System in Detroit, discussed several new developments in the field of acne, including a once-daily oral antibiotic, sarecycline, and topical minocycline drugs in different stages in the research pipeline.

Scarring can occur with any degree of acne severity, but new data suggest that patients struggling with scars may benefit from a fixed combination of adapalene gel 0.3% and benzoyl peroxide gel 2.5%, Dr. Stein Gold noted.

She disclosed relationships with multiple companies including Allergan, Anacor, Celgene, Dermira, Foamix, Galderma, LEO, Medimetriks, Novan, Novartis, Promius, Sol-gel, and Valeant.

SDEF and this news organization are owned by the same parent company.

 

 

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VIDEO: Smartphones could ‘democratize’ EEG

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SAN DIEGO – Epilepsy is a common condition, but many people live in areas too poor or underserved to benefit from electroencephalogram (EEG) testing to confirm a diagnosis. Modern technology may be changing that. Smartphones wirelessly linked to headsets can collect EEG data and potentially serve as an alternate platform for diagnosis of epilepsy.

To test the efficacy of one such system, Farrah Mateen, MD, PhD, a neurologist at Massachusetts General Hospital, Boston, conducted a study in the remote, mountainous Kingdom of Bhutan, which lies between India and China. Her group compared the signals between a smartphone EEG and standard EEG.

The sensitivity was low, at around 40%, but the device’s specificity was 90%-95%. For now, the device performs better as a confirmatory test than as a screening device, but the researchers hope to adjust the lead location to improve sensitivity.

The headset used was designed for use by video gamers, and at a cost of less than $300, it represents a low-cost entry into portable EEG.

Dr. Mateen discussed the smartphone EEG study in a video interview at the annual meeting of the American Neurological Association.

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SAN DIEGO – Epilepsy is a common condition, but many people live in areas too poor or underserved to benefit from electroencephalogram (EEG) testing to confirm a diagnosis. Modern technology may be changing that. Smartphones wirelessly linked to headsets can collect EEG data and potentially serve as an alternate platform for diagnosis of epilepsy.

To test the efficacy of one such system, Farrah Mateen, MD, PhD, a neurologist at Massachusetts General Hospital, Boston, conducted a study in the remote, mountainous Kingdom of Bhutan, which lies between India and China. Her group compared the signals between a smartphone EEG and standard EEG.

The sensitivity was low, at around 40%, but the device’s specificity was 90%-95%. For now, the device performs better as a confirmatory test than as a screening device, but the researchers hope to adjust the lead location to improve sensitivity.

The headset used was designed for use by video gamers, and at a cost of less than $300, it represents a low-cost entry into portable EEG.

Dr. Mateen discussed the smartphone EEG study in a video interview at the annual meeting of the American Neurological Association.

SAN DIEGO – Epilepsy is a common condition, but many people live in areas too poor or underserved to benefit from electroencephalogram (EEG) testing to confirm a diagnosis. Modern technology may be changing that. Smartphones wirelessly linked to headsets can collect EEG data and potentially serve as an alternate platform for diagnosis of epilepsy.

To test the efficacy of one such system, Farrah Mateen, MD, PhD, a neurologist at Massachusetts General Hospital, Boston, conducted a study in the remote, mountainous Kingdom of Bhutan, which lies between India and China. Her group compared the signals between a smartphone EEG and standard EEG.

The sensitivity was low, at around 40%, but the device’s specificity was 90%-95%. For now, the device performs better as a confirmatory test than as a screening device, but the researchers hope to adjust the lead location to improve sensitivity.

The headset used was designed for use by video gamers, and at a cost of less than $300, it represents a low-cost entry into portable EEG.

Dr. Mateen discussed the smartphone EEG study in a video interview at the annual meeting of the American Neurological Association.

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Are we on the verge of a cocaine epidemic?

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Barbara Vickrey, MD, MPH

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