Biologics in dermatologic therapy - an update

Risk of HBV reactivation in psoriasis vulgaris patients receiving biological agent therapy

OBJECTIVE

Recently, adalimumab has become an important drug frequently used by dermatologists in the treatment of Hidradenitis suppurativa. While there are many publications by rheumatologists about the risk of hepatitis B and tuberculosis reactivation, the literature on reactivation in the treatment of hidradenitis is not extensive. With this study, we wanted to emphasize that adalimumab is a safe drug despite the risk of hepatitis B and tuberculosis reactivation and the importance of porphylaxis during the treatment of hidradenitis suppurativa.

METHODS

In this study, data from 462 HS patients followed up at the Dicle University Dermatology Clinic between 1 January 2017 and 30 June 2024 were retrospectively analyzed. Adalimumab use was detected in 56 of the 462 patients. Patients over 18 years of age and used adalimumab for at least 6 months were selected for this study. Two of these patients were not included in the study because they did not meet the criteria for age and duration of adalimumab use.

RESULTS

Of the 12 patients at risk of hepatitis B reactivation during adalimumab treatment, 8 received entecavir, and 4 received tenofovir prophylaxis. No hepatitis B reactivation was observed in any of the 12 patients during adalimumab treatment. Among the 54 patients, 4 were at risk of TB reactivation, and 4 received isoniazid as preophylactic treatment. None of the 4 patients were observed to have TB reactivation.

CONCLUSION

Adalimumab has become a frequently preferred drug in the treatment of hidradenitis, and it is known that there is a risk of hepatitis b and TBc reactivation, which should be prevented. Despite these risks, we found that adalimumab can be safely used to treat hidradenitis suppurativa, especially with the use of prophylaxis.

COVID vaccine recommendations in dermatologic patients on immunosuppressive agents: Lessons learned from pandemic

BACKGROUND

Since SARS-CoV2 vaccines were approved without enough long-term monitoring due to emergent situations, some issues have been raised about timing and protocol of receiving them by patients treated by different immunosuppressive agents.

AIM AND METHOD

Here, we present different aspects of SARS-CoV-2 vaccination in such patients in the field of dermatology.

RESULT

In brief, SARS-CoV-2 vaccination is recommended in all dermatologic patients, regardless of their disorders and therapeutic regimens. Nevertheless, special considerations should be given to the immunosuppressive therapy and its association with vaccination timing due to the decreased immunogenicity of vaccines in this setting.

CONCLUSION

Novel biologic immunotherapies are advantageous over conventional systemic therapies not only in their safety and selective functions but also in this aspect that many of them do not affect vaccines immunogenicity.

Long-Term Single Center Experience in Treating Plaque Psoriasis With Guselkumab

BACKGROUND

Clinical trial data have shown guselkumab, an interleukin-23 inhibitor, to be efficacious and safe for the treatment of psoriasis. However, there is very little real-world experience using guselkumab in the community setting that has been documented.

OBJECTIVES

The goal of this study was to determine real-life outcomes of guselkumab use in patients with moderate-to-severe psoriasis in a community dermatology practice.

METHODS

A retrospective chart review of electronic medical records was conducted in patients with moderate-to-severe psoriasis who were prescribed guselkumab at a community dermatology office in Ontario, Canada.

RESULTS

Of the 89 patients who received at least 1 dose of guselkumab, 79 had follow-up information at the time of review, with 71 patients receiving ongoing treatment. In our cohort of patients, 73.3% achieved clinically significant clearance of psoriasis with a global assessment of clear or almost clear defined as a body surface area involvement of <1%. Guselkumab was generally well tolerated and caused no serious adverse events. The most common reported side effects were nasopharyngitis, headaches, upper respiratory tract infections, gastrointestinal upset, and arthralgia.

CONCLUSION

Overall, guselkumab was a safe and well-tolerated treatment with significant clinical improvement in our patient population.

The Use of Biologic Therapy in the Treatment of Acrodermatitis Continua of Hallopeau: A Review

Acrodermatitis continua of Hallopeau is a rare subtype of pustular psoriasis that presents as a sterile, pustular eruption commonly in the finger tips and toes. This disease inflicts both the skin and nail bed, and causes severe disfigurement of the distal phalanges. Because it is a variant of pustular psoriasis, acrodermatitis continua of Hallopeau is commonly managed with antipsoriatic medications. Common approaches to treatment include topical therapy (corticosteroids, vitamin D analogs, and calcineurin inhibitors), systemic therapy, and in more severe cases, biologic therapy. This review will discuss how acrodermatitis continua of Hallopeau is diagnosed and how it is managed, with a particular emphasis on the use of biologics.

Hailey-hailey disease responding to thalidomide

Familial benign chronic pemphigus or Hailey-Hailey disease (HHD) is a rare autosomal dominant disorder characterized by the development of recurrent blisters and erosions in the intertriginous areas. Various topical and systemic treatment options include corticosteroids, topical 5-fluorouracil, topical vitamin D analogs, topical zinc oxide, dapsone, psoralen plus ultraviolet A, systemic retinoids, cyclosporine, methotrexate, and photodynamic therapy. In recalcitrant cases, further options including, invasive methods such as grenz ray therapy, carbon dioxide laser abrasion, and erbium: YAG laser ablation, dermabrasion, electron beam therapy, botulinum toxin, and full-thickness excision of affected skin with repair by split-thickness grafting have been reported as useful in treatment of HHD. We describe a case of HHD who was treated with several treatment modalities including antibiotics, corticosteroids, and dapsone earlier and when presented to us had a severe recalcitrant disease. Thalidomide, as a modality of treatment has been successfully used in few cases earlier. Our patient responded well to thalidomide.