Journal Digest: August 12

Archives of Dermatological Research: Increased Femoral Cartilage Thickness in Acne Patients Using Isotretinoin: Could It Be a Sign of Early Osteoarthritis?

Kulakli et al evaluated the impact of isotretinoin treatment on femoral cartilage thickness (FCT) in patients with acne and explored its potential as a risk factor for developing osteoarthritis (OA). The study included 52 patients with acne and 45 healthy controls, with ultrasound measurements of FCT before and after treatment. Kulakli et al’s results demonstrated a significant increase in FCT in multiple knee regions after isotretinoin treatment, suggesting possible early cartilage changes. However, no direct correlation was found between treatment duration, cumulative dose, and FCT changes. According to the study authors, their findings suggest that isotretinoin may trigger early OA-like changes in cartilage, particularly in young patients. However, further studies with longer follow-ups are needed.¹

Pediatric Dermatology: Cystic Fibrosis Dermatitis Arthritis Syndrome: A Series of Four Cases

In their study, Schwartzman et al described a newly recognized condition termed cystic fibrosis dermatitis arthritis syndrome (CF-DAS), characterized by episodic skin eruptions and arthritis in cystic fibrosis (CF) patients. The study focused on 4 female patients, aged 9 to 26, who exhibited recurrent pink papules, plaques, and nodules, lasting 5 to 7 days, primarily on the extremities. The patients’ episodes were associated with severe arthralgias and, in some cases, arthritis. Histopathological findings varied, showing neutrophilic infiltrates and small vessel vasculitis. All 4 patients were treated with supportive nonsteroidal anti-inflammatory drugs, and one patient showed significant improvement with oral dapsone. Schwartzman et al’s study suggests that CF-DAS may be immunologically driven, potentially linked to immune complex deposition, and emphasizes the importance of recognizing CF-DAS to avoid misdiagnosis and inappropriate treatment. According to the authors, CF-DAS is distinct from other similar dermatologic and rheumatologic disorders and does not correlate with pulmonary exacerbations.²

Dermatologic Therapy: Needle Before Scalpel: Considering the Role of Intratumoral Therapy in Melanoma

Katz et al explored the efficacy and safety of various intratumoral (IT) therapies for treating cutaneous melanoma, particularly in cases where surgery or radiation is not viable. IT therapy involves directly injecting therapeutic agents into tumors to achieve local control and potentially stimulate systemic antitumor responses while minimizing systemic toxicity. Katz et al’s review covers several novel IT agents, including immune-enhancing agents such as pembrolizumab and ipilimumab, oncolytic viruses such as talimogene laherparepvec (T-VEC) and coxsackievirus A21, and non-immunologic agents such as rose bengal (PV-10). The study author’s results show that IT therapies offer promising outcomes in terms of overall response rates (ORR) and durability, with a generally favorable safety profile. T-VEC and CVA21 showed notable efficacy, particularly when combined with systemic immunotherapies. According to Katz et al, their study emphasizes the potential of IT therapies as an alternative or adjunct to systemic treatments.³

Lasers in Surgery and Medicine: Exploring Fractional Pigment Toning: A Novel Approach for Treating Benign Pigmented Lesions in Asian Patients With Fitzpatrick Skin Types III–V

Manuskiatti et al’s study evaluated a new laser technique of fractional pigment toning (FPT) for treating benign epidermal pigmented lesions in patients with darker skin tones. A total of 27 patients with solar lentigines underwent treatment using both FPT and a conventional technique (CT) on different sides of the face. The study found that both techniques effectively reduced pigmentation, but FPT resulted in less post-inflammatory hyperpigmentation (PIH) and faster recovery. PIH incidence was significantly higher with the CT approach, reaching 96% at 3 months post-treatment, compared to milder and less widespread PIH with FPT. Although FPT caused more treatment discomfort, it offered comparable or better pigment clearance and fewer adverse effects, suggesting its potential as a safer, more effective option for patients at risk of PIH, according to Manuskiatti et al.⁴

References

1. Kulakli S, Elmas Telli AC, Sari IF, et al. Increased femoral cartilage thickness in acne patients using isotretinoin: could it be a sign of early osteoarthritis?. Arch Dermatol Res. 316, 512 (2024). https://doi.org/10.1007/s00403-024-03264-x
2. Schwartzman G, Zlotoff BJ, Gru AA, Guffey DJ. Cystic fibrosis dermatitis arthritis syndrome: a series of four cases. Pediatr Dermatol. Published online August 8, 2024. doi:10.1111/pde.15727
3. Katz TH, Javed A, Powers JG, Needle before Scalpel: considering the role of intratumoral therapy in melanoma. Dermatol Ther, 2024, 8820105, 10 pages, 2024. https://doi.org/10.1155/2024/8820105
4. Manuskiatti W, Hutachoke T, Viriyaskultorn N, Li JB, Techapichetvanich T, Wanitphakdeedecha R. Exploring fractional pigment toning: a novel approach for treating benign pigmented lesions in Asian patients with Fitzpatrick skin types III-V. Lasers Surg Med. Published online July 29, 2024. doi:10.1002/lsm.23828