Topical Cannabinoids May Fight Itch and Inflammatory Skin Diseases

MedicalResearch.com Interview with:
Jessica S. Mounessa, BS

University of Colorado School of Medicine
Aurora, Colorado and
Robert Dellavalle, MD, PhD, MSPH
Professor of Dermatology and Public Health
University of Colorado School of Medicine
Colorado School of Public Health
Chief, Dermatology Service
US Department of Veterans Affairs
Eastern Colorado Health Care System
Denver, CO 80220 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One in 10 adult cannabis users in the U.S. use it for medicinal purposes. Medicinal cannabis is well studied for its uses in chronic pain, anorexia, and nausea. Numerous recent studies have highlighted other medicinal uses for cannabinoids and related compounds.

We conducted a comprehensive review of the literature on the potential role of cannabinoids in conditions affecting the skin.

Our study reveals the potential benefit of topically prepared cannabinoid compounds, especially for pruritus and eczema.  For example, creams containing Palmitoylethanolamide (PEA), which enhances cannabinoid-receptor binding, have been successful in relieving itch both in the literature, and anecdotally in our clinics.

Though not strictly considered an endocannabinoid, as it does not directly bind to CB1 and CB2 receptors, PEA works by enhancing endocannabinoid binding to these receptors.** Furthermore, the majority of the cannabinoid compounds we studied did not contain psychoactive effects.

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Sonoillumination May Expand Skin Types That Can Be Treated With Laser Therapy

MedicalResearch.com Interview with:

Paul J.D. Whiteside, doctoral candidate and Dr. Heather Hunt, assistant professor of bioengineering University of Missouri

Dr. Heather Hunt and Paul Whiteside

Paul J.D. Whiteside, doctoral candidate and
Dr. Heather Hunt, assistant professor of bioengineering
University of Missouri

MedicalResearch.com: What is the background for this technology? What are the barriers to the use of conventional laser treatment of tattoos?

Response: Traditional laser treatments rely on the concept of selective photothermolysis (laser-induced heating) to specifically target certain structures for treatment, while leaving other parts of the skin unaffected. The problem with traditional laser treatments is that the laser needs to transmit through the epidermis, which acts as a barrier to laser transmission both due to its reflective properties and because it is filled with light-absorbing melanin, the pigment that gives our skin its color. Sonoillumination acts to change the properties of the epidermis temporarily using painless ultrasound technology, thereby allowing more laser light to penetrate deeper into the skin to impact desired targets, such as hair follicles, tattoos, and blood vessels. Funding for clinical trials is currently being sought to provide evidence for what we surmise may be benefits of this technology relative to traditional laser treatments. These benefits may include being able to treat darker-skinned people more effectively, being able to provide laser therapy with less risk of scarring or pigment changes, and being able to do treatments with less discomfort, fewer treatments, and lower laser energy settings.

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Smoking Associated With Comorbidities in Atopic Dermatitis

MedicalResearch.com Interview with:

Jacob P. Thyssen MD, PhD, DmSci Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen Hellerup, Denmark

Dr. Thyssen

Jacob P. Thyssen MD, PhD, DmSci
Department of Dermatology and Allergy
Herlev and Gentofte Hospital
University of Copenhagen
Hellerup, Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atopic dermatitis has been associated with various comorbidities. With the emergence of biologics for the treatment of atopic dermatitis, the hypothesis has been raised that atopic dermatitis is a systemic immune disease affecting more than just the skin.

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Immunotherapy Ruxolitinib Cream Improves Facial Vitiligo

MedicalResearch.com Interview with:

David Rosmarin, MD Dermatologist; Assistant Professor Tufts University School of Medicine

Dr. Rosmarin

David Rosmarin, MD
Dermatologist; Assistant Professor
Tufts University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vitiligo is a disease where the immune system causes depigmentation of the skin. We performed a pilot study to evaluate the use of a new class of medication for the treatment of vitiligo.


MedicalResearch.com: What should readers take away from your report?

Response: After applying topical ruxolitinib cream twice a day, patients had significant repigmentation, particularly those with facial vitiligo.

This treatment holds promise as a potential new treatment for vitiligo. Because it is a topical, it spares many side effects of taking a medication orally.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Secukinumab Provides Sustained Improvements in Dermatology-Specific Quality of Life in Moderate to Severe Psoriasis Patients Through 3 Years of Treatment

MedicalResearch.com
Eric Hughes
Global Development Franchise Head Immunology & Dermatology
Novartis

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Psoriasis is a chronic immune-mediated inflammatory disease that negatively impacts patients’ quality of life (QOL); therefore QOL outcomes are increasingly recognized as an important measure of efficacy in psoriasis, complementing traditional measures of severity such as the Psoriasis Area and Severity Index (PASI).

Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A (IL-17A), exhibits significant efficacy in the treatment of moderate-to-severe psoriasis, ankylosing spondylitis and psoriatic arthritis, demonstrating a rapid onset of action and a favorable safety profile.

Biologic therapies for psoriasis have previously been associated with a fall-off in efficacy over time; accordingly, extended follow-up is required to adequately evaluate novel therapeutic strategies like IL-17A inhibition. Recently, results from the extension of the SCULPTURE secukinumab trial showed that high responses initially achieved with secukinumab at year 1 in the SCULPTURE study were sustained over time up to 3 years with no new or unexpected safety concerns. In this analysis, we examined whether the sustained efficacy observed in SCULPTURE up to 3 years was translated into sustained effect of secukinumab on patient’s QOL measured by the Dermatology Life Quality Index (DLQI) questionnaire.

SCULPTURE, a multi-center extension study, was conducted with subjects who completed 52 weeks of treatment. Subjects were randomized into two maintenance dosing regimens; a fixed-interval schedule of secukinumab 300 mg every 4 weeks (Fixed interval dosing regimen (FI) cohort), and secukinumab retreatment-as-needed (Retreatment as needed (RAN) cohort), in which subjects received placebo until start of relapse, at which time secukinumab 300 mg every 4 weeks was re-initiated.

The analysis using as-observed data showed that at Year 3, improvements in the total score on DLQI was well sustained in both FI and RAN cohorts. Approximately two-thirds of the subjects in the FI cohort reported no impact of skin disease on QOL (corresponding to a score of 0 or 1 on DLQI). The proportion of patients in the RAN cohort reporting no impact of the disease on their QOL was well sustained through 3 years but remained consistently lower than those observed in the FI cohort. The results for each subscale of the DLQI questionnaire were consistent with those with DLQI total score i.e. showing high and sustained proportions of patients reporting no impact of the disease on different domains of health-related QOL in the two secukinumab cohorts with greater effect in the FI cohort compared to the RAN cohort.

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Review of Systemic Immunomodulating Therapies for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

MedicalResearch.com Interview with:
Prof. Dr. Maja Mockenhaupt

Dept. of Dermatology
Medical Center – University of Freiburg
Deutschland / Germany

MedicalResearch.com: What is the background for this study?

Response: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse reactions that are associated with high morbidity and mortality. Primarily due to their rareness, therapeutic effects are often studied in observational settings. An evidence-based standardized treatment protocol for SJS/TEN is still missing.
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Safer Immunotherapy Dupilumab (Dupixent) FDA Approved For Atopic Dermatitis

MedicalResearch.com Interview with:

Emma Guttman, MD, PhD Professor, Dermatology, Medicine and Clinical Immunology Vice Chair of Research in the Dermatology Department Director of the center for Excellence  Eczema in the Occupational/Contact Dermatitis clinic  Director of the Laboratory of Inflammatory Skin Diseases Icahn School of Medicine at Mount Sinai Medical Center New York

Dr. Guttman

Emma Guttman, MD, PhD
Professor, Dermatology, Medicine and Clinical Immunology
Vice Chair of Research in the Dermatology Department
Director of the center for Excellence
Eczema in the Occupational/Contact Dermatitis clinic
Director of the Laboratory of Inflammatory Skin Diseases
Icahn School of Medicine at Mount Sinai Medical Center
New York

MedicalResearch.com: Would you briefly explain what is meant by atopic dermatitis? How many people are affected by this disorder?

Response: Atopic dermatitis or eczema as most people know it is an itchy red scaly skin disorder characterized by a very severe itch, that disrupts daily activities, and sleep and severely impairs the quality of life of patients. In the US 30 million people are affected by it, and 1/3 of these we expect to be moderate to severe.

MedicalResearch.com: What is the background for Dupilumab therapy? How does it differ from emollients, steroids or topical immunomodulator treatments for eczema ie Protopic?

Response: The background is that we currently do not have good treatments for long term use for our moderate to severe patients. The only approved drug by the FDA for atopic dermatitis in the US is oral prednisone, that has many long term side effects and causes disease rebound upon discontinuation. Other treatments with many side effects

are broad immune suppressants–Cyclopsorin A, Mycophenolate mofetyl and phototherapy that is not feasible for most patients.

Thus there is a large unmet need for safer and better treatments for moderate to severe atopic dermatitis patients.

Dupilumab is different since it only targets one immune axis–Th2 axis, providing a safer alternative, with high efficacy, that is equal or even better than cyclosporin A, that is the current gold standard immune suppressant, and harbors many side effects including permanent effects on the kidneys after long term use. Topical treatments, while useful for mild patients, are often not adequate or sufficient to control moderate to severe patients that usually have more than 10% body surface area involved and need a systemic treatment.

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Pediatric Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the US

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study?

Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults.

However, little is known about the epidemiology of pediatric SJS/TEN.

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Curcumin Gel May Speed Healing of Scalds and Burns

MedicalResearch.com Interview with:

Madalene Heng MD, FRACP, FACD, FAAD</strong> Professor of Medicine/Dermatology UCLA School of Medicine

Dr. Madalene Heng

Madalene Heng MD, FRACP, FACD, FAAD
Professor of Medicine/Dermatology
UCLA School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Curcumin, the active ingredient in the spice, turmeric, is an excellent anti-inflammatory agent with unique healing properties.

However, this is only observed with our preparation of topical curcumin but not with oral curcumin. This is because curcumin is not absorbed and does not cross cell membranes – low bioavailability.

The biochemical basis for the efficacy of topical curcumin is based on the fact that it is a phosphorylase kinase inhibitor. Phosphorylase kinase is an enzyme released by injured tissue 5 mins following injury, and is responsible for activating the transcription activator (NF-kB), resulting in turning on over 200 genes responsible for inflammation, and scarring among others, resulting in redness, swelling, pain, and eventually scarring. By blocking phosphorylase kinase activity early in the injury pathway, topical curcumin (curcumin gel) results in rapid healing with minimal or no scarring following many types of healing, including burns and scalds. The unique healing properties are also due to the fact that curcumin induces cell death (apoptosis) to damaged cells, resulting in the “space” for replacement by new healthy cells, resulting in normal appearing skin following burns and scalds.

The salutary result depends on when the curcumin gel is applied – the earlier the better. We observed that when curcumin gel was applied within 4 days to second degree burns- hourly applications, tapering after the patient is improved – we observed rapid healing within 5 days, with the skin returning to normal within 6 weeks to 2 months without redness or visible scarring. Minor burns and scalds heal even more rapidly. Pain was improved within hours.

MedicalResearch.com: What should readers take away from your report?

Response: If the readers happen to have curcumin gel (Psoria-Gold) in their first aid kit, they should apply curcumin gel multiple times as soon as possible. Within the first hour, they should apply it every 5-10 mins, tapering off when the pain and swelling is improved. If they do this, it is possible that blistering may be aborted. The scarring is also minimal. The curcumin gel should be applied twice daily until the skin returns to normal (no redness, swelling, pigmentation etc) and no visible scarring is seen.

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Dermatology Physician Assistants Helping To Supplement Care in Underserved Areas

MedicalResearch.com Interview with:
Dr. Alex M. Glazer MD
National Society for Cutaneous Medicine
New York, New York 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We had previously studied the geographic distribution of dermatologists throughout the United States which revealed that dermatologists are unevenly geographically distributed throughout the country, with many regions having fewer than the 4 providers per 100,000 people needed to adequately care for a population. Because of the influx of PAs and NPs into the healthcare workforce throughout the past decade, we wanted to see how these providers were supplementing dermatologic care.

The main finding of our study is that dermatology PAs are helping to supplement dermatologists and together are providing broader, more uniform coverage across the United States

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Taltz Demonstrates Improved Clearing of Psoriasis Compared to Stelara

MedicalResearch.com Interview with:

Prof. Dr. Kristian Reich, Dermatologikum Hamburg, Hamburg 07.04.2009 | Prof. Dr. Kristian Reich, Dermatologikum Hamburg, Hamburg, Germany, 07.04.2009 | [© (c) Martin Zitzlaff, Emilienstr.78, 20259 Hamburg, Germany, Tel. +491711940261, http://www.zitzlaff.com, martin@zitzlaff.com, Postbank Hamburg BLZ 20010020 Kto.-Nr. 10204204, MwSt. 7%, Veroeffentlichung nur gegen Honorar (MFM) und Belegexemplar, mit Namensnennung]

Prof. Reich

Prof. Dr. med. Kristian Reich
Dermatologie, Allergologie
Psoriasis- und Neurodermitis-Trainer
Hamburg

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The IXORA-S study compared the efficacy and safety of Taltz® (ixekizumab) and Stelara®* (ustekinumab) for the treatment of moderate-to-severe plaque psoriasis at 24 weeks.

In this study, patients were randomized to receive either Stelara (45 mg or 90 mg weight-based dosing per label) or Taltz (80 mg every two weeks followed by 80 mg every four weeks), following an initial starting dose of 160 mg. At 24 weeks, patients treated with Taltz achieved significantly higher response rates compared to patients treated with Stelara, including 83 percent of patients who achieved Psoriasis Area Severity Index (PASI) 90—the study’s primary endpoint—compared to 59 percent of patients who achieved PASI 90 after treatment with Stelara.

Results at 24 weeks also found:
• 91.2 percent of patients treated with Taltz achieved PASI 75 compared to 81.9 percent of patients treated with Stelara (p=0.015)
• 49.3 percent of patients treated with Taltz achieved PASI 100 compared to 23.5 percent of patients treated with Stelara (p=0.001)
• 86.6 percent of patients treated with Taltz achieve static Physician’s Global Assessment score (sPGA) 0 or 1 compared to 69.3 percent of patients treated with Stelara (p<0.001)

The majority of treatment-emergent adverse events were mild or moderate. There were no statistically significant differences between treatment groups in overall treatment-emergent adverse events. The safety profile for Taltz was consistent with previous clinical trials.

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Doxycycline vs Steroids For Blistering Disease Bullous Pemphigoid

MedicalResearch.com Interview with:

Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator Director of the NIHR Health Technology Assessment Programme Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology, University of Nottingham Queen’s Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK

Dr. Williams

Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator
Director of the NIHR Health Technology Assessment Programme
Professor of Dermato-Epidemiology and
Co-Director of the Centre of Evidence-Based Dermatology,
University of Nottingham
Queen’s Medical Centre
Nottingham University Hospitals NHS Trust,
Nottingham, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pemphigoid is a potentially serious skin condition characterised by the appearance of large tense blisters appearing on the skin. These blisters are itchy and eventually burst, leaving raw areas of skin that can become infected. Pemphigoid is much commoner in the elderly, and is on the increase. It is due to the body’s own immune system attaching certain structures in the skin ie an auto-immune disease. The main treatment for pemphigoid is oral steroids (prednisolone). Prednisolone is usually quite good at clearing the blisters, but when given for long periods as is needed for people with pemphigoid, they cause serious side effects such as diabetes, infection, raised blood pressure and fractures, so safer oral treatments are needed for this disease. Tetracycline antibiotics are one such possible treatment – they have been used by some for pemphigoid for many years, but our Cochrane review did not find any good evidence to show that it works.

So we applied to the UK National Institute of Health Research Health Technology Programme to do a definitive evaluation of treating pemphigoid with one of the tetracyclines called doxycycline. We tested the strategy of staring patients with pemphigoid with doxycycline versus standard treatment with oral prednisolone. If those starting on doxycycline did not achieve good enough control, they could switch to prednisolone as would happen in clinical practice. Our main outcomes were blister control at 6 weeks, and severe, life threatening and fatal treatment related adverse events at 52 weeks. The study was designed as a non-inferiority study – by that we mean that we never expected doxycycline to be as good as prednisolone for blister control, so we agreed to put up with a degree of lower effectiveness provided that there were clear long term safety gains.

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