Peter A. Foley

Description:Terra firma-forme dermatosis is a benign condition characterised by asymptomatic hyperkeratotic, dark papules or plaques. The diagnosis may be confirmed by firmly rubbing the lesions with 70% isopropyl alcohol, resulting in resolution of the lesions. Wolf's isotopic response refers to the development of a new dermatosis in the same location that a previous, healed, unrelated skin condition occupied. We report the case of a patient developing Terra firma-forme dermatosis at the site of resolved psoriatic plaques.

Description:With its chronicity and varied symptomatology, moderate to severe atopic dermatitis (AD) remains a significant challenge for both patients and health care professionals. Novel targeted therapies, including the JAK inhibitors (JAKi) offer significant hope. There are many systematic reviews and meta-analyses of the use of JAKi for the management of atopic dermatitis, but few offer practical advice for the clinician. The aim of this consensus development was to place the current literature for JAKi use in atopic dermatitis within the clinical context of practice in Australasia. The Australasian Medical Dermatology Group (AMDG) reviewed the evidence for the use of JAKi in the management landscape of atopic dermatitis, adding in their cumulative experience, and used an eDelphi process to agree on best practice. In the first round of 133 eDelphi clinical practice statements, consensus was achieved in 117 (88%-complete 27.8%, close 60.1%), with no consensus in 16 (12.0%) of the statements. The 16 clinical practice statements that did not reach consensus were reviewed and revised to 15 statements and then subjected to a second round: complete consensus was achieved in 5/15 statements, close consensus in 6/15, and no consensus in 4/15. Over the two eDelphi rounds, consensus was achieved in 128/132 (97%-complete 32%, close 64%) and no consensus in 4/132 (3%). Statements regarding screening for prior varicella infection, age-appropriate cancer screening intervals, and management of flares did not reach full consensus. This study highlights areas where further research is needed to assist practicing dermatologists in safe prescribing and management of atopic dermatitis with JAK inhibitors.

Description:Real-world use of dupilumab has unveiled a spectrum of side effects that were not fully appreciated in initial clinical trials. While dupilumab remains a highly effective treatment for atopic dermatitis, clinicians must be aware of real-world adverse effects including ocular complications, inflammatory arthritis, psoriasiform eruptions and head and neck dermatitis; as well as reported associations including cutaneous T-cell lymphoma, alopecia areata, vitiligo and weight gain.

Description:Background: The pivotal Phase 3 VOYAGE 1 and VOYAGE 2 studies established the robust efficacy and safety of guselkumab for up to 5 years in patients with moderate-to-severe psoriasis. Here, the long-term efficacy of guselkumab by baseline disease severity and treatment history was analyzed using pooled data from the VOYAGE studies. Methods: Patients were randomized to guselkumab 100 mg every 8 weeks, placebo with week 16 crossover to guselkumab, or adalimumab with week 52 crossover to guselkumab (VOYAGE 1) or week 28-76 randomized withdrawal/re-treatment (VOYAGE 2); all patients then received open-label guselkumab through week 252. These post hoc analyses evaluated the Investigator’s Global Assessment of cleared/minimal (IGA 0/1) and Psoriasis Area and Severity Index (PASI) 90 responses from week 100-252 by baseline PASI (<20/≥20), IGA (=3/=4), body surface area (BSA; <20%/≥20%), and prior psoriasis treatments. Analyses used observed data after applying treatment failure rules. Results: At all assessment timepoints from weeks 100-252, response rates were similar by baseline PASI <20 vs ≥20 (IGA 0/1: 82.0%-85.4% vs 81.1%-81.4%; PASI 90: 78.6%-81.1% vs 81.4%-83.8%), IGA=3 vs =4 (IGA 0/1: 82.7%-85.4% vs 77.6%-79.0%; PASI 90: 79.1%-82.7% vs 79.7%-82.9%), BSA <20% vs ≥20% (IGA 0/1: 82.5%-86.2% vs 81.1%-82.6%; PASI 90: 80.4%-82.7% vs 79.1%-82.0%), prior phototherapy no vs yes (IGA 0/1: 81.7%-84.3% vs 81.5%-83.8%; PASI 90: 82.2%-84.0% vs 77.5%-81.1%), prior nonbiologic use no vs yes (IGA 0/1: 81.1%-84.5% vs 81.9%-84.1%; PASI 90: 80.9%-83.0% vs 79.0%-82.0%), and prior biologic use no vs yes (IGA 0/1: 83.2%-85.3% vs 75.3%-79.5%; PASI 90: 82.2%-83.8% vs 71.2%-76.3%). Conclusions: Durable guselkumab efficacy was sustained through 5 years of treatment among patient subpopulations irrespective of baseline disease severity or prior treatment history. J Drugs Dermatol. 2025;24(2):196-202. doi:10.36849/JDD.8344.

Description:This retrospective analysis of Hedgehog inhibitor treatment in 32 patients with Gorlin syndrome, locally advanced and metastatic basal cell carcinoma (BCC) at three tertiary referral centres in Victoria, Australia from April 2017 until 30 June 2024 demonstrated an 84% overall objective response rate (partial and complete response combined). However, 90% of patients experienced adverse effects impacting quality of life. Secondary acquired drug resistance occurred in 77% (10/13) of locally advanced and metastatic BCC patients after a median duration of 13 months. Further work is needed to optimise the neoadjuvant use of Hedgehog inhibitors with radiotherapy or surgery given poor long-term Hedgehog inhibitor tolerability and to develop strategies to counteract the issue of acquired resistance.