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Journal American Acadamy of Dermatology - Tragedy and medical advances during the COVID-19 pandemic (2020-10)

Jubileum nummer

Artikel in PDF
Dirk M. Elston

It is a pleasure to contribute to the 30th anniversary commemorative issue of the Netherland’s Journal of Dermatology and Venereology. What a year this has been!

 This past year could be dubbed the year of the virus and medical journals played a critical role in the vetting, dissemination and archiving of key knowledge about COVID-19. We demonstrated the range of cutaneous manifestations related to the virus and debated whether or not COVID toes are actually a specific viral manifestation. Authors in China also reported a high incidence of cutaneous injuries among healthcare workers related to personal protective equipment and alerted us that manual manipulation of the mask to shift the mask and goggles away from cutaneous erosions could reduce the effectiveness of protective measures. Prevalence of skin damage was 97.0% among frontline healthcare workers with the nasal bridge being the most commonly affected site and simple interventions, including more frequent work rotations and the use of adhesive barrier films could help prevent harm. [1] We also learned that androgen receptors may play a role in viral entry and adverse outcomes [2], and weighed evidence for and against continuation of biologics during the pandemic. [3]

This year also provided us with game changing data on pharmacological interventions for hidradenitis suppurativa and reminded us of the key role surgery continues to play in the treatment of this debilitating disease. [4-7] Recent articles and guidelines address the approach to patients with this devastating disease, risks of medical therapy during the COVID-19 pandemic, current gaps in therapy and new data on agents reported to be effective in this condition. [8-13] While adalimumab has received the most press, high dose infliximab regimens similar to those used with inflammatory bowel disease represent a new treatment paradigm, and when efficacy is lost to neutralizing antibodies there is new evidence suggests that adjuvant therapy with methotrexate or sirolimus has the potential to restore responsiveness. [1422] Other biologics that block Th17 T cells, IL12/23 or IL-23 alone also appear to have efficacy in this setting, and further studies are needed to determine relative efficacy of these biologic agents. [23-25] Short courses of antibiotics can be beneficial but emergence of resistance can complicate longer courses of treatment. [26,27] Cultures are of limited value as anaerobic bacteria predominate and are difficult to grow in culture. [28] Future studies should use molecular techniques to delve into the microbiome of hidradenitis. Topical antiseptics continue to be helpful, and those with less potential for antibiotic resistance are particularly valuable. [29,30] Drugs that affect neutrophils can also be helpful in this setting, including doxycycline, dapsone, anakinra and canakinumab, and antiandrogens including spironolactone can help with long-term control of disease. [31,32] Apremilast, on the other hand improves specific disease measures but an overall effect on quality of life was limited. [33,34] There have also been reminders that hidradenitis suppurativa can coexist with inflammatory bowel disease, and pyoderma gangrenosum, and may represent a systemic inflammatory disorder in the spectrum of autoinflammatory diseases. [35,36]

Important articles published this year demonstrated usefulness of dupilumab in the pediatric age group and new potential roles for dupilumab in the treatment of hand dermatitis, idiopathic dermatitis, nummular eczema, bullous pemphigoid and prurigo nodularis, but also raised awareness that persistent dermatitis in patients on dupilumab may be related to Pityrosporum or contact dermatitis, especially to cocamidopropylbetaine in soaps and shampoo. [37-46] We also received an important warning about the potential for fatal progression of cutaneous T-cell lymphoma (CTCL) in patients treated with dupilumab. [47,48] Authors from UCSF and Northwestern University described seven patients given dupilumab for clinically presumed atopic dermatitis or to treat refractory pruritus in cutaneous CTCL. While six of the seven patients experienced transient improvement, all subsequently demonstrated disease progression and fatalities occurred. [49,50] Dupilumab remains a valuable agent in our therapeutic armamentarium, but physicians should be vigilant for signs of CTCL in patients on dupilumab therapy and the physical examination during follow-up visits should include the buttocks, groin, thighs, and limb girdle areas as these are common sites for the appearance of CTCL. Other authors have reported CTCL following use of dupilumab and more research is needed to determine the magnitude of the risk and contributing factors [51,52] Pathogenesis is likely complex as targeted cytokines appear to modulate lymphomas and can exert a beneficial or negative response in various settings. Dupilumab modulates signaling of both the IL-4 and IL-13 pathways, and interleukin 13 in particular may play a role in progression of various forms of lymphoma.

Scarring alopecia remains one of our most difficult disease categories and many patients with alopecia have multifactorial disease leading to confusion and suboptimal outcomes. It is important to remember that pattern alopecia affects almost half of adults of European decent. By extension, this means that roughly half of the patients of European descent whom we treat for scarring alopecia also have a background of pattern hair loss and addressing both conditions can lead to better treatment outcomes. [53] Topical minoxidil has a defined role in the treatment of pattern alopecia, but recent studies have focused on the effectiveness and tolerability of low dose minoxidil administered orally. [5460] Antiandrogens such as spironolactone and cyproterone acetate may also be helpful to treat background pattern alopecia and improve hair density in women, and patients should also be evaluated for papulosquamous disease, thyroid disorders and dietary issues that may contribute to superimposed telogen effluvium. Targeted therapy has led to dramatic improvement in many conditions, including JAK-inhibitor therapy for alopecia areata, vitiligo, granuloma annulare, lichen planopilaris, sarcoidosis, and chronic eczema and rituximab therapy for immunobullous diseases. [61-67] As dermatologists prescribe more of these agents, it is important to remain vigilant for potentially lethal side-effects of therapy. JAK inhibitors can cause cytopenias, lipid abnormalities and an increase thrombotic risk with the associated risk of fatal pulmonary embolism. Patients should be monitored appropriately and counseled about the risks, early recognition of complications, and preventive strategies.

Covid-19 has not been the only infectious disease that gained focus this year. Patients on immunosuppressive agents should be assessed for the presence of any underlying disease prior to the initiation of therapy. In particular, those on rituximab must be monitored for reactivation of hepatis B with massive hepatic necrosis.

All clinicians should be aware of issues with screening for hepatitis B, in particular the removal of core IgG antibody from acute hepatitis panels reducing our ability to screen for latent infection in patients who are surface antigennegative. The core IgG antibody must be ordered separately and patients should be monitored for signs, symptoms and laboratory evidence of hepatitis. In our patients with immunobullous disease, glucocorticoids are often used concurrently with rituximab or other steroid-sparing agents and can mask hepatitis reactivation. Prompt intervention is key and some evidence suggests that rituximab therapy may be possible in patients with latent infection if given together with antiviral prophylaxis. Physicians should also be aware that false-­positive serological and DNA testing for hepatitis can occur in patients who have been recently vaccinated. Careful evaluation of patient history is key.

The past year has been a challenging one and few of us well be sad to see it go, but we should remember the remarkable advances in disease treatment and prevention that have emerged during this year. Covid-19 has been a potent reminder that we are all in this together and physicians play a key role not only in disease treatment, but also in prevention, public policy and as important role models. It is an honor and a privilege to serve society in the role of physician and healer. May we all carry those banners proudly and live up to the sacred calling we accepted. Keep well so you can continue to serve your patients.


1.     Lan J, Song Z, Miao X, Li H, Li Y, Dong L, Yang J, An X, Zhang Y, Yang L, Zhou N, Yang L, Li J, Cao J, Wang J, Tao J. Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol. 2020 May;82(5):1215-1216. doi: 10.1016/j.jaad.2020.03.014. Epub 2020 Mar 18. PMID: 32171808; PMCID: PMC7194538.
2. Wambier CG, Goren A. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to be androgen mediated. J Am Acad Dermatol. 2020 Jul;83(1):308-309.
3. Lebwohl M, Rivera-Oyola R, Murrell DF. Should biologics for psoriasis be interrupted in the era of COVID-19? J Am Acad Dermatol. 2020 May;82(5):1217-1218.
4. Daveluy S. Medical therapy is the optimal treatment for hidradenitis suppurativa. J Am Acad Dermatol. 2020 Sep;83(3):977-978.
5. Melendez Gonzalez MDM, Sayed CJ. Surgery is an essential aspect of managing patients with hidradenitis suppurativa. J Am Acad Dermatol. 2020 Sep;83(3):979-980.
6. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019 Jul;81(1):76-90.
7. Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019 Jul;81(1):91-101.
8. Flood KS, Porter ML, Kimball AB. A visit guide for hidradenitis suppurativa - managing a complex disease in a busy clinic. J Am Acad Dermatol. 2020 Sep30:S0190-9622(20)32677-3. doi: 10.1016/j. jaad.2020.09.076. Epub ahead of print. PMID: 33010310.
9. Savage KT, Singh V, Patel ZS, Yannuzzi CA, McKenzie-Brown AM, Lowes MA, Orenstein LAV. Pain management in hidradenitis suppurativa and a proposed treatment algorithm. J Am Acad Dermatol. 2020 Sep 17:S0190-9622(20)32627-X. doi: 0.1016/j.jaad.2020.09.039. Epub ahead of print. PMID: 32950543.
10. van Straalen KR, Prens LM, Hylkema TH, Janse IC, Dickinson J, Houwing R, van der Zee HH, Brouwer S, Prens EP, Horváth B. Impact of Hidradenitis Suppurativa on work productivity and associated risk factors. J Am Acad Dermatol. 2020 Aug 4:S0190-9622(20)32318-5.
11. Narla S, Price KN, Sachdeva M, Shah M, Shi V, Hamzavi I, Alavi A, Lowes MA. Proceeding report of the fourth Symposium on Hidradenitis Suppurativa Advances (SHSA) 2019. J Am Acad Dermatol. 2020 Jun 1:S0190-9622(20)30989-0.
12. Seltzer JA, Okeke CAV, Perry JD, Shipman WD, Okoye GA, Byrd AS. Exploring the risk of severe COVID-19 infection in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2020 Aug;83(2):e153-e154.
13. Garg A, Neuren E, Cha D, Kirby JS, Ingram JR, Jemec GBE, et al. Evaluating patients’ unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project. J Am Acad Dermatol. 2020 Feb;82(2):366-376.
14. Zouboulis CC, Okun MM, Prens EP, Gniadecki R, Foley PA, Lynde C, Weisman J, Gu Y, Williams DA, Jemec GBE. Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study. J Am Acad Dermatol. 2019 Jan;80(1):60-69.e2.
15. Kimball AB, Sundaram M, Shields AL, Hudgens S, Okun M, Foley C, Ganguli A. Adalimumab alleviates skin pain in patients with moderate-to-severe hidradenitis suppurativa: Secondary efficacy results from the PIONEER I and PIONEER II randomized controlled trials. J Am Acad Dermatol. 2018 Dec;79(6):1141-1143.
16. Ghias MH, Johnston AD, Kutner AJ, Micheletti RG, Hosgood HD, Cohen SR. High-dose, high-frequency infliximab: A novel treatment paradigm for hidradenitis suppurativa. J Am Acad Dermatol. 2020 May;82(5):1094-1101.
17. Fougerousse AC, Reguiai Z, Roussel A, Bécherel PA; Groupe d’Etudes Multicentriques (GEM) ResoVerneuil. Hidradenitis suppurativa management using tumor necrosis factor inhibitors in patients younger than 18 years: A series of 12 cases. J Am Acad Dermatol. 2020 Jul;83(1):199-201.
18. Oskardmay AN, Miles JA, Sayed CJ. Determining the optimal dose of infliximab for treatment of hidradenitis suppurativa. J Am Acad Dermatol. 2019 Sep;81(3):702-708.
19. Blaszczak A, Trinidad JCL, Cartron AM. Adalimumab for treatment of hidradenitis suppurativa during the COVID-19 pandemic: Safety considerations. J Am Acad Dermatol. 2020 Jul;83(1):e31.
20. Khullar G. Comment on “Sirolimus as combination rescue therapy with tumor necrosis alpha inhibitors for severe, refractory hidradenitis suppurativa”. J Am Acad Dermatol. 2020 Aug 12:S0190- 9622(20)32420-8.
21. Orenstein LAV, Wright S, Strunk A, Garg A. Low prescription of tumor necrosis alpha inhibitors in hidradenitis suppurativa: a cross-sectional analysis. J Am Acad Dermatol. 2020 Aug 3:S0190-9622(20)32310-0.
22. Wang LL, Micheletti RG. Low-dose methotrexate as rescue therapy in patients with hidradenitis suppurativa and pyoderma gangrenosum developing human antichimeric antibodies to infliximab: A retrospective chart review. J Am Acad Dermatol. 2020 Feb;82(2):507-510.
23. Casseres RG, Prussick L, Zancanaro P, Rothstein B, Joshipura D, Saraiya A, Turkowski Y, Au SC, Alomran A, Abdat R, Abudu M, Kachuk C, Dumont N, Gottlieb AB, Rosmarin D. Secukinumab in the treatment of moderate to severe hidradenitis suppurativa: Results of an open-label trial. J Am Acad Dermatol. 2020 Jun;82(6):1524-1526.
24. Frew JW, Navrazhina K, Grand D, Sullivan-Whalen M, Gilleaudeau P, Garcet S, Ungar J, Krueger JG. The effect of subcutaneous brodalumab on clinical disease activity in hidradenitis suppurativa: An open-label cohort study. J Am Acad Dermatol. 2020 May 13:S0190-622(20)30834-3.
25. Casseres RG, Kahn JS, Her MJ, Rosmarin D. Guselkumab in the treatment of hidradenitis suppurativa: A retrospective chart review. J Am Acad Dermatol. 2019 Jul;81(1):265-267.
26. Delage M, Jais JP, Lam T, Guet-Revillet H, Ungeheuer MN, Consigny PH, Nassif A, Join-Lambert O. Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 Hidradenitis Suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients. J Am Acad Dermatol. 2020 Jan 10:S0190-9622(20)30049-9.
27. Caposiena Caro RD, Cannizzaro MV, Botti E, Di Raimondo C, Di Matteo E, Gaziano R, Bianchi L. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasound observations. J Am Acad Dermatol. 2019 May;80(5):1314-1321.
28. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology,clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020 May;82(5):1045-1058.
29. Leiphart P, Ma H, Naik HB, Kirby JS. The effect of antimicrobial washes on antibacterial resistance in hidradenitis suppurativa lesions. J Am Acad Dermatol. 2019 Mar;80(3):821-822.
30. Pascual JC, Encabo B, Ruiz de Apodaca RF, Romero D, Selva J, Jemec GB. Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up. J Am Acad Dermatol. 2017 Dec;77(6):1175-1178.
31. Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Current and emerging treatments. J Am Acad Dermatol. 2020 May;82(5):1061-1082.
32. Golbari NM, Porter ML, Kimball AB. Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 2019 Jan;80(1):114-119.
33. Vossen ARJV, van Doorn MBA, van der Zee HH, Prens EP. Apremilast for moderate hidradenitis suppurativa: Results of a randomized controlled trial. J Am Acad Dermatol. 2019 Jan;80(1):80-88.
34. Aarts P, Vossen ARJV, van der Zee HH, Prens EP, van Straalen KR. Long-term treatment with apremilast in hidradenitis suppurativa: 2-year follow-up of initial responders. J Am Acad Dermatol. 2020 Sep 3:S0190-9622(20)32540-8.
35. Deckers IE, Benhadou F, Koldijk MJ, Del Marmol V, Horváth B, Boer J, van der Zee HH, Prens EP. Inflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study. J Am Acad Dermatol. 2017 Jan;76(1):49-53.
36. Tannenbaum R, Strunk A, Garg A. Overall and subgroup prevalence of pyoderma gangrenosum among patients with hidradenitis suppurativa: A population-based analysis in the United States. J Am Acad Dermatol. 2019 Jun;80(6):1533-1537.
37. Muzumdar S, Zubkov M, Waldman R, DeWane ME, Wu R, Grant-Kels JM. Characterizing dupilumab facial redness in children and adolescents: A single-institution retrospective chart review. J Am Acad Dermatol. 2020 Jul 2:S0190-9622(20)32103-4.
38. Shahriari N, Strober B, Shahriari M. The role of dupilumab in the management of idiopathic chronic eczematous eruption of aging. J Am Acad Dermatol. 2020 Jul 15:S0190-9622(20)32187-3.
39. Paller AS, Siegfried EC, Thaçi D, Wollenberg A, Cork MJ, Arkwright PD, Gooderham M, Beck LA, Boguniewicz M, Sher L, Weisman J, O’Malley JT, Patel N, Hardin M, Graham NMH, Ruddy M, Sun X, Davis JD, Kamal MA, Khokhar FA, Weinreich DM, Yancopoulos GD, Beazley B, Bansal A, Shumel B. Efficacy and safety of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with severe atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2020 Jun 20:S0190-9622(20)31152-X. doi: 10.1016/j. jaad.2020.06.054. Epub ahead of print. PMID: 32574587.
40. Shah P, Milam EC, Lo Sicco KI, Cohen DE. Dupilumab for allergic contact dermatitis and implications for patch testing: Irreconcilable differences. J Am Acad Dermatol. 2020 Sep;83(3):e215-e216.
41. Chiricozzi A, Maurelli M, Gori N, Argenziano G, De Simone C, Calabrese G, Girolomoni G, Peris K. Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. J Am Acad Dermatol. 2020 Jul;83(1):39-45
42. Geller S. Interleukin 4 and interleukin 13 inhibition: A promising therapeutic approach in bullous pemphigoid. J Am Acad Dermatol. 2020 Jul;83(1):37-38.
43. Waldman RA, DeWane ME, Sloan B, Grant-Kels JM, Lu J. Dupilumab for the treatment of dyshidrotic eczema in 15 consecutive patients. J Am Acad Dermatol. 2020 May;82(5):1251-1252.
44. Choi S, Zhu GA, Lewis MA, Honari G, Chiou AS, Ko J, Chen JK. Dupilumab treatment of nummular dermatitis: A retrospective cohort study. J Am Acad Dermatol. 2020 May;82(5):1252-1255.
45. Raffi J, Suresh R, Botto N, Murase JE. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: A retrospective chart review. J Am Acad Dermatol. 2020 Jan;82(1):132-138.
46. Igelman S, Kurta AO, Sheikh U, McWilliams A, Armbrecht E, Jackson Cullison SR, Kress DW, Smith A, Castelo-Soccio L, Treat J, Boothe WD, Diaz LZ, Levy ML, Patel A, Lee LW, Fraile-Alonso MC, Antaya RJ, Shah S, Kittler N, Arkin L, Siegfried E. Off-label use of dupilumab for pediatric patients with atopic dermatitis: A multicenter retrospective review. J Am Acad Dermatol. 2020 Feb;82(2):407-411.
47. Heymann WR. Dupilumab cuts both ways. J Am Acad Dermatol. 2020 Jul;83(1):35-36.
48. Elston DM. Dupilumab and cutaneous T-cell lymphoma. J Am Acad Dermatol. 2020 Jul;83(1):33-34.
49. Espinosa ML, Nguyen MT, Aguirre AS, Martinez-Escala ME, Kim J, Walker CJ, Pontes DS, Silverberg JI, Choi J, Pro B, Pincus LB, Guitart J, Zhou XA. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patients. J Am Acad Dermatol. 2020 Jul;83(1):197-199.
50. Abdat R, Waldman RA, de Bedout V, Czernik A, Mcleod M, King B, Gordon S, Ahmed R, Nichols A, Rothe M, Rosmarin D. Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series. J Am Acad Dermatol. 2020 Jul;83(1):46-52.
51. Miyashiro D, Vivarelli AG, Gonçalves F, Cury-Martins J, Sanches JA. Progression of mycosis fungoides after treatment with dupilumab: A case report. Dermatol Ther. 2020 Jun 19:e13880. doi: 10.1111/dth.13880. Epub ahead of print. PMID: 32558148.
52. Chiba T, Nagai T, Osada SI, Manabe M. Diagnosis of mycosis fungoides following administration of dupilumab for misdiagnosed atopic dermatitis. Acta Derm Venereol. 2019 Jul 1;99(9):818-819.
53. Vano-Galvan S, Trindade de Carvalho L, Saceda-Corralo D, RodriguesBarata R, Kerkemeyer KL, Sinclair RD, Hermosa-Gelbard Á, Moreno- Arrones ÓM, Jimenez-Cauhe J, Bhoyrul B. Oral minoxidil improves background hair thickness in lichen planopilaris. J Am Acad Dermatol. 2020 Apr 11:S0190-9622(20)30566-1.
54. Randolph M, Tosti A. Oral minoxidil treatment for hair loss: A review of efficacy and safety. J Am Acad Dermatol. 2020 Jul 1:S0190- 9622(20)32109-5. doi: 10.1016/j.jaad.2020.06.1009. Epub ahead of print. PMID: 32622136.
55. Jha AK, Sonthalia S, Zeeshan MD, Vinay K. Efficacy and safety of verylow-dose oral minoxidil 1.25 mg in male androgenetic alopecia. J Am Acad Dermatol. 2020 May 31:S0190-9622(20)31005-7. doi: 10.1016/j. jaad.2020.05.129. Epub ahead of print. PMID: 32492469.
56. Therianou A, Vincenzi C, Tosti A. How safe is prescribing oral minoxidil in patients allergic to topical minoxidil? J Am Acad Dermatol. 2020 Apr 11:S0190-9622(20)30567-3.
57. Pirmez R, Salas-Callo CI. Very-low-dose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation. J Am AcadDermatol. 2020 Jan;82(1):e21-e22.
58. Jimenez-Cauhe J, Saceda-Corralo D, Moreno-Arrones OM, OrtegaQuijano D, Fernandez-Nieto D, Vaño-Galvan S. Reply to: “Very-lowdose oral minoxidil in male androgenetic alopecia: A study with quantitative trichoscopic documentation”. J Am Acad Dermatol. 2020 Jan;82(1):e23-e24.
59. Ramos PM, Sinclair RD, Kasprzak M, Miot HA. Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female-pattern hair loss: A randomized clinical trial. J Am Acad Dermatol. 2020 Jan;82(1):252-253.
60. Jimenez-Cauhe J, Saceda-Corralo D, Rodrigues-Barata R, HermosaGelbard A, Moreno-Arrones OM, Fernandez-Nieto D, Vaño-Galvan S. Effectiveness and safety of low-dose oral minoxidil in male androgenetic alopecia. J Am Acad Dermatol. 2019 Aug;81(2):648-649.
61. Peterson D, King B. UVL in combination with other therapies for vitiligo:synergy or necessity? J Am Acad Dermatol. 2020 Sep 3:S0190- 9622(20)32584-6.
62. Kim BS, Sun K, Papp K, Venturanza M, Nasir A, Kuligowski ME. Effects of ruxolitinib cream on pruritus and quality of life in atopic dermatitis: Results from a phase 2, randomized, dose-ranging, vehicle- and active-controlled study. J Am Acad Dermatol. 2020 Jun;82(6):1305-1313.
63. Nakagawa H, Nemoto O, Igarashi A, Saeki H, Kaino H, Nagata T. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: A phase 3, randomized, double-blind, vehicle-controlled study and an open-label, longterm extension study. J Am Acad Dermatol. 2020 Apr;82(4):823-831.
64. Damsky W, Thakral D, McGeary MK, Leventhal J, Galan A, King B. Janus kinase inhibition induces disease remission in cutaneous sarcoidosis and granuloma annulare. J Am Acad Dermatol. 2020 Mar;82(3):612-621.
65. Hosking AM, Juhasz M, Mesinkovska NA. Topical Janus kinase inhibitors: A review of applications in dermatology. J Am Acad Dermatol. 2018 Sep;79(3):535-544.
66. Guttman-Yassky E, Silverberg JI, Nemoto O, Forman SB, Wilke A, Prescilla R, de la Peña A, Nunes FP, Janes J, Gamalo M, Donley D, Paik J, DeLozier AM, Nickoloff BJ, Simpson EL. Baricitinib in adult patients with moderate-to-severe atopic dermatitis: A phase 2 parallel, double-blinded, randomized placebo-controlled multiple-dose study. J Am Acad Dermatol. 2019 Apr;80(4):913-921.
67. Plante J, Eason C, Snyder A, Elston D. Tofacitinib in the treatment of lichen planopilaris: A retrospective review. J Am Acad Dermatol. 2020 May.


Dirk M. Elston, MD
E-mail: elstond@musc.edu