Psoriasiform Dermatitis - the Derms on Drugs take on your worst nightmare when it comes to path reports.  Dermatitis?  Psoriasis?  Both?  Neither?  We'll get into the weeds with Amber Atwater, who looked at what the final diagnoses ended up being in hundreds of patients with psoriasiform dermatitis that gives us some clues on how to approach these patients. We also review the latest work on idiopathic erythroderma - not so idiopathic anymore, thanks to the hard work and genius of Shawn Kwatra at the University of Maryland. And, stick around to the end for some hard hitting trivia on the American Contact Dermatitis Society's last 25 years of Allergens of the Year.

Join us for another episode of Derms on Drugs, brought to you by Scholars in Medicine.

1.  Targeted dual biologic therapy for erythroderma of unknown etiology guided by high-parameter peripheral blood immunophenotyping
https://pubmed.ncbi.nlm.nih.gov/39809837/

2.  Molecular Structure and Function of Janus Kinases: Implications for the Development of Inhibitors
https://pubmed.ncbi.nlm.nih.gov/32083640/

3.  Final clinical diagnosis in cases of histopathologic psoriasiform dermatitis: retrospective cross-sectional analysis of a Southeastern United States population, 2004-2017
https://pubmed.ncbi.nlm.nih.gov/39792248/

4.  Epidermal spongiotic Langerhans cell collections, but not eosinophils, are a clue to the diagnosis of allergic contact dermatitis: A series of 170 clinically- and patch test-confirmed cases
https://pubmed.ncbi.nlm.nih.gov/39709083/

5.  The 2023 Annual Report of DataDerm: The database of the American Academy of Dermatology
https://pubmed.ncbi.nlm.nih.gov/38936667/

6.  Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis
https://pubmed.ncbi.nlm.nih.gov/24290431/

7.  The atopic dermatitis spectrum disorder. Recognizing the clinical heterogeneity in patients with atopic related skin conditions in order to improve therapeutic decision-making and outcomes: an expert panel consensus statement
https://pubmed.ncbi.nlm.nih.gov/34365875/

8.  Toluene-2,5-Diamine Sulfate: Allergen of the Year 2025
https://pubmed.ncbi.nlm.nih.gov/39862176/

We all kind of freaked out when the news broke that benzene had been detected in benzoyl peroxide. I mean, makes sense, right -benzene even sounds like benzoyl - how did nobody think of this before! And the lab that detected it got Zantac pulled from the market and it was even discussed at Fall Clinical..."There is no safe amount of exposure to benzene..." The final straw was when an article dropped in JID -JID for goodness sake - about the problem.

Not so fast. Our trio did a deep dive and there is WAY more to this story than meets the eye. Join us as we get into the nitty grittywith John Barbieri (from Harvard!) about his published research on the topic along with the well­ known Australian cosmetic chemist, Michelle Wong, PhD (aka "Lab Muffin").

Derms on Drugs is produced by Scholars in Medicine.

John Barieri 

John Barbieri, MD, MBA is an Assistant Professor at Harvard Medical School and the Director of the Advanced Acne Therapeutics Clinic at the Brigham and Women’s Hospital. He is an associate editor at JAMA Dermatology and is also the co-chair of the American Academy of Dermatology Acne Guidelines Work Group. His research is focused on conducting innovative clinical trials, health economic, and epidemiology studies to identify the best approaches to care for patients with acne. He also focuses on exploring the role of patient-reported outcomes to ensure we are capturing the patient’s voice and perspective on their care. 

Dr. Barbieri has received consulting fees from Honeydew Care.

Michelle Wong

Michelle Wong is a science educator and chemistry PhD. In 2011 she started the website Lab Muffin Beauty Science, where she explains the science behind beauty products for a general audience. She has since expanded to YouTube, Instagram and TikTok, and is known for her work debunking myths. Her book The Science of Beauty was released in June 2024, and she is the cofounder of BeautySciComm. Through her science communication work, Michelle has worked with many brands on campaigns, and delivered invited talks at international conferences. Her work has been featured in Wired, The New York Times, ABC News, and Chemistry & Engineering News.

Social media handles:

YouTube, IG, Threads, TikTok: @labmuffinbeautyscience

Bluesky: labmuffin.com

Website: labmuffin.com

Substack: labmuffin.substack.com

Resources:

1.   Evaluation of Benzene Presence and Formation in Benzoyl Peroxide Drug Products

 PubMed: https://pubmed.ncbi.nlm.nih.gov/39384016/

Full Text Link: www.jidonline.org/action/showPdf?

2.   No evidence for an association between benzoyl peroxide use and increased blood benzene levels in the National Health and Nutrition Examination Survey

PubMed: https://pubmed.ncbi.nlm.nih.gov/38950699/

Full Text: https://www.jaad.org/article/S0190-9622(24)00980-0/fulltext

3.   Benzoyl peroxide for acne treatment is not associated with an increased risk of malignancy: A retrospective cohort study

PubMed: https://pubmed.ncbi.nlm.nih.gov/39002561/

Full Text: https://www.jaad.org/article/S0190-9622(24)01051-X/fulltext

4: Benzene in your products, Part 2: The story of Valisure. Lab Muffin Beauty Science.

 https://labmuffin.com/benzene-in-your-products-part-2-the-story-of-valisure/

5: Shelf-stable formulations of benzoyl peroxide and methods of producing same https://patents.google.com/patent/WO2023177625A1/en

6. A Legal Shakedown Exposed: How Valisure tried to cash in on its dubious claims about cancer. https://www.wsj.com/articles/valisure-cancer-claims-zantac-dry-shampoo-david-Iight-11675806424

• Litfulo for when all hope for hair seems lost...when Olumiant strikes out, can Litfulo pinch hit and save the day?
• Hand eczema: Did we really need a 60,000-patient study to find out who's most likely to have horrible hands?
• The Hand Eczema Whisperer: Jacob Thyssen joins us all the way from the University of Copenhagen for some hand-to-hand combat: What causes it, what can you do about it right now, and what's on the horizon for hand eczema.
• But that's not all — the Derms on Drugs always bring the best stuff from the literature.

Derms on Drugs is produced by Scholars in Medicine.

Jacob P. Thyssen, MD, PhD, DmSci 

Dr. Thyssen has spent nearly 20 years as a clinical dermatologist at university hospitals in Copenhagen, where he currently serves as a professor emeritus. His research in inflammatory skin diseases and allergy has earned him numerous awards. Dr. Thyssen has co-authored more than 700 peer-reviewed articles, with his work appearing in prestigious journals such as The Lancet and NEJM. He holds PhD and medical doctor degrees and has been a research fellow at Harvard Medical School, Boston, UCSF in San Francisco, and a visiting professor at UZH in Zürich. 

Resources:

1.  Efficacy and tolerability of neoadjuvant therapy with Talimogene laherparepvec in cutaneous basal cell carcinoma: a phase II trial (NeoBCC trial)
https://pubmed.ncbi.nlm.nih.gov/39820126/
2.  Efficacy and Safety of Switching from Baricitinib to Ritlecitinib in Severe Alopecia Areata
https://pubmed.ncbi.nlm.nih.gov/39707907/
3.  Major improvement of very severe alopecia areata in patients treated with the combination of baricitinib and low doses of corticosteroids: an eight-case series
https://pubmed.ncbi.nlm.nih.gov/37467740/
4.  Prevalence of Chronic Hand Eczema in adults: A cross-sectional survey of over 60,000 respondents in the general population in Canada, France, Germany, Italy, Spain, and the United Kingdom
https://pubmed.ncbi.nlm.nih.gov/39797908/
5.  The Prevalence and Determinants of Hand and Face Dermatitis during COVID-19 Pandemic: A Population-Based Survey
https://pubmed.ncbi.nlm.nih.gov/33376481/
6.  Guidelines for diagnosis, prevention, and treatment of hand eczema
https://pubmed.ncbi.nlm.nih.gov/34971008/
7.  Short-term glucocorticoid treatment compromises both permeability barrier homeostasis and stratum corneum integrity: inhibition of epidermal lipid synthesis accounts for functional abnormalities
https://pubmed.ncbi.nlm.nih.gov/12603860/
8.  Association Between Topical Corticosteroid Use and Type 2 Diabetes in Two European Population-Based Adult Cohorts
https://pubmed.ncbi.nlm.nih.gov/30936111/
9.  The Low Nickel Diet
https://www.thelownickeldiet.com/?gad_source=1&gclid=Cj0KCQiA-5a9BhCBARIsACwMkJ7Ah9ysdVxzpqlxk2KRJoUlUouvxmfcL6UzkNvmG7o8CIXjfNXlZnkaAlhYEALw_wcB
10.  Imiquimod Cream Preceded by Superficial Curettage vs Surgical Excision for Nodular Basal Cell Carcinoma: A Secondary Analysis of a Randomized Clinical Trial
https://pubmed.ncbi.nlm.nih.gov/39878970/
11.  Off-label use of tralokinumab in the treatment of bullous pemphigoid- a case series
https://pubmed.ncbi.nlm.nih.gov/39878153/
12.  Association between use of antihypertensives and treatment of actinic keratoses: A TriNetX population- based study
https://pubmed.ncbi.nlm.nih.gov/39894367/
13.  Perspectives on Artificial Intelligence-Generated Responses to Patient Messages
https://pubmed.ncbi.nlm.nih.gov/39412810/
14.  Sofdra prescribing information
https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217347s000lbl.pdf
15.  A Pivotal Study on the Safety and Effectiveness of a Targeted Alkali Thermolysis Patch for Treatment of Primary Axillary Hyperhidrosis or Excessive Axillary Sweating
https://pubmed.ncbi.nlm.nih.gov/39480962/
16.  Impact of Needle Design and Suture Gauge on Tissue Tearing During Skin Suturing: A Comparative Analysis
https://pubmed.ncbi.nlm.nih.gov/39325023/

Is your Litfulo not pulling its weight? New research gives you the inside scoop on when to throw in the towel

We’re buzzing about oral JAK inhibitors for vitiligo, but do they really outshine NBUVB alone? We’ve got the answer 

And guess what? While basking in the sun might up your skin cancer risk, it turns out those rays also help you dodge death from heart disease, cancer and other nasty surprises— at least if you happen to be living in England

Join Richard Weller, the genius behind these sacrilege statements, as he helps us rethink how we guide our patients on sun exposure—taking into account their skin type and the sunny vibes of their locale.

We’ll also dive into Dupixent’s surprising benefits for cancer immunotherapy, its heart-friendly profile, and how it shields kids from ADD, depression, and anxiety.  Ever wonder if switching up your psoriasis biologic is worth it? We’ll tackle that enigma. And don’t miss our head-to-head trial of Pregabalin vs. Gabapentin for the intensely itchy, plus a look at the long-term risk of psoriasis after a first bout of guttate psoriasis.  Oh, and do we really need sterile gloves in derm surgery? Tune in for all this and more—with the trusty team at Derms on Drugs! Join Drs. Ferris, Zirwas and Patton for a new episode every Friday

Derms on Drugs is produced by ⁠Scholars in Medicine.⁠ 

Guest: Richard Weller, Professor

I graduated in medicine at St Thomas’ Hospital, University of London (now part of King’s College, London) and undertook my general/internal medicine training in the north of England and in Australia.Having gained my MRCP I trained in dermatology at the Institute of Dermatology (St John’s) in London, and in Aberdeen and Edinburgh. I spent some time out of my clinical training to complete a research MD degree.  Having completed my dermatology training, I gained a scholarship from the University of Edinburgh, and spent three years in post-doctoral research training in the laboratories of Prof Victoria Kolb-Bachofen, Heinrich-Heine Universität, Dusseldorf, and of Dr Tim Billiar, University of Pittsburgh, USA.I was recruited from America to the post of Senior Lecturer, and latterly Reader in Dermatology and Associate Principal Investigator at the Centre for Inflammation Research, University of Edinburgh.My time is divided between clinical duties, where I am an honorary NHS Consultant Dermatologist with a particular interest in medical dermatology and eczema, and the University where I have an active research group, and also a significant teaching commitment as Programme Director of the M.Med.Sci degree. 

Buckle-up Kids.  Our Derms on Drugs are answering some of the hottest questions in dermatology again this week:

• Melanoma's Mental Massacre: Discover which patients are most likely to spiral into anxiety and depression after diagnosis and how we can help save their sanity!
• Biosimilar Backstabbing: Why do patients switched to biosimilars fare worse than newbies to psoriasis? We'll peel back the layers of this pharmaceutical puzzle.
• Eczema Epidemic Exposed: Hold onto your moisturizers, folks! We've cracked the code on why everyone and their itchy grandmother has atopic dermatitis. Spoiler alert: It's not just your genes being jerks!
• Air Pollution: The Silent Skin Assassin: Dr. Ian Myles spills the tea on how he caught air pollution red-handed in the great eczema explosion of the '70s. Urban dwellers, your skin's arch-nemesis has been unmasked!

But wait, there's more! We'll also dive into:

• The return of the zit: Predicting acne's revenge after isotretinoin
• Dupilumab: The accidental cancer crusader?
• Tralokinumab: Savior for dupilumab dropouts or just another letdown?
• Ferulic acid vs. Rosacea: The face-off you never knew you needed
• Cysteamine and hydroquinone duke it out in the melasma arena
• Digital mucous cysts: Because even your fingers deserve some drama

You’ll laugh, you’ll cry, you might even learn something new… Join Drs. Ferris, Zirwas and Patton for a new episode every Friday

Derms on Drugs is produced by ⁠Scholars in Medicine.⁠

Guest: Ian A. Myles, MD, Mph

Guest Bio: Dr. Myles, Principal Investigator, Epithelial Therapeutics Unit, graduated with a B.S. in biology from Colorado State University in 2001 and then obtained an M.D. from the University of Colorado in 2005. He completed an internal medicine residency at The Ohio State University prior to beginning fellowship training in allergy and clinical immunology at NIH. In 2011, Dr. Myles became a commissioned officer in the United States Public Health Service Commissioned Corps. In 2013, he was awarded a position as an assistant clinical investigator in the NIAID Transition Program in Clinical Research. Dr. Myles received his M.P.H. from George Washington University in 2016. In 2018, Dr. Myles became the head of the newly formed Epithelial Therapeutics Unit to evaluate the efficacy and safety of a topical, live bacterial treatment for atopic dermatitis (eczema). He is currently a participant in the Lasker Clinical Research Scholars and Distinguished Scholars programs.

Links to Articles and Websites

1.  Prevalence and odds of anxiety and depression in cutaneous malignant melanoma: a proportional meta-analysis and regression

2.  Drug Survival and Safety of Biosimilars Compared with Originator Adalimumab for Psoriasis: A Multinational Cohort Study

3.  The clinical, mechanistic, and social impacts of air pollution on atopic dermatitis

4.  Exposure to isocyanates predicts atopic dermatitis prevalence and disrupts therapeutic pathways in commensal bacteria

5.  Environmental and behavioral mitigation strategies for patients with atopic dermatitis

6.  Acne Relapse and Isotretinoin Retrial in Patients With Acne

7.  Risk of malignancy associated with use of dupilumab versus other treatments in atopic dermatitis patients: A national database analysis

8.  Tralokinumab Treatment in Adult Atopic Dermatitis Patients: 28-Week Evaluation of Clinical Effectiveness, Safety, Serum Proteins and Total IgE Levels

9.  Ferulic Acid in the Treatment of Papulopustular Rosacea: A Randomized Controlled Study

10.  Efficacy and safety of cysteamine 5% cream for the management of melasma: a systematic review and meta-analysis of randomized controlled trials

11.  Effectiveness of surgical versus non-surgical interventions in treatment of digital mucous cysts

Melanoma Prognosis Calculator

http://www.lifemath.net/cancer/melanoma/outcome/index.php

Skinesa Defensin+ Probiotic Spray

https://www.skinesa.com/products/defensin-probiotic-spray

Buckle up! We're diving deep into the wild world of dermatology, where the only thing more dangerous than a weird mole is a boxed warning. Here's what's cooking in this episode:

• Rinvoq vs. Dupixent: Two drugs enter, one drug leaves! We break down this pharmaceutical cage match and wonder if we learned anything besides how to pronounce "upadacitinib."
• Actinic keratoses get a glow-up with calcipotriol and 5-FU. Spoiler alert: It's not what you think, unless you think it's magic. Then you're right.
• Boxed warnings: Giving us more childhood suicides? We explore how these little black boxes are wreaking havoc on patients and ask, "Who's really getting schooled here?"
• Dr. Ted Lain attempts to convince our hosts there's actual science in skincare. Spoiler: It's harder than getting rid of back acne.

Plus, we'll tackle burning questions like: Are JAK inhibitors the new Russian roulette? Is switching IL-23s just dermatological musical chairs? And is Topical Steroid Withdrawal the new gluten intolerance? Join us as we dive into the best articles of the last week.

Warning: Side effects may include uncontrollable laughter, raised eyebrows, and a sudden urge to moisturize. Join Drs. Ferris, Zirwas and Patton for a new episode every Friday.

Derms on Drugs is produced by Scholars in Medicine.