5 Must-Know Winter Skincare Tips, According to Dermatologists.

 Longer days, intense wind chill, snowstorms—wintertime brings annual certainties. With the changing weather comes physical factors to consider, perhaps most notably dry, flaky skin.

Freezing wind chills, low humidity levels, and dry indoor heat are all winter conditions that can leave your skin looking less hydrated and radiant than normal.1 These various seasonal characteristics eliminate moisture from your skin, which can cause dryness, redness, flakiness, itchiness, cracking, peeling, and bleeding to the face, hands, feet, legs, and other areas that are exposed.2

“Dry air and wind strip the outer skin layer of oils needed to maintain healthy barrier function. As the skin loses hydration, microscopic cracks develop in the outer layer along with inflammation,” Joshua Zeichner, MD, an associate professor of dermatology and the director of Cosmetic & Clinical Research in Dermatology at Mount Sinai Hospital in New York, told Health.

The good news, Dr. Zeichner explained, is that making small changes to your skincare routine, as well as using the right products, may help soothe your skin, prevent irritation, and help with hydration.

Here are some ways to combat dry and flaky skin during the winter months, according to dermatologists.

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#Plastic Surgery

#Onycholysis

#Paronychia

#Pitting

#Beau lines

#Koilonychia

#Alopecia

#Melanonychia

#Nail

#Melanoma

#Ichthyosis

#Pemphigus

#vitiligo

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Skin diseases: Psoriasis and eczema common problems during winters; expert recommends treatment

 Cold weather conditions continue in several parts of the country. People catch several diseases due to dipping temperatures. Skin diseases also see an uptick in the winter. Psoriasis and eczema are common problems during this time of the year. Hospitals are witnessing a spike in the number of patients with these two diseases. These skin-related complications can turn dangerous and therefore it becomes important to adopt safeguards against them.

Dr Bhawuk Dhir of the department of dermatology at Ram Manohar Lohia (RML) Hospital, Delhi, says that the number of patients with psoriasis and eczema increases during the winter. It is very important to take preventive measures against these diseases.

Dr Dhir says that skin diseases rise in the winter due to lack of moisture in the air, dip in temperature and rise in pollution. Besides, our skin is not used to less humidity when compared to the summer, he adds. Those suffering from eczema and psoriasis face even more trouble at this point in time. Apart from this, other complications related to the skin and hair increase.

What are eczema and psoriasis?

According to Dr Bhawuk Dhir, eczema also known as dermatitis causes red spots on the skin accompanied by a lot of itching. A white layer of skin also starts to peel off. If not treated on time, these diseases can spread to other parts of the body also.

Which other diseases are on rise?

In the winter, people also complain of dry skin, chilblains and numbness in fingers and toes. Another skin disorder called scabies also sees a spike due to a lack of hygiene as people tend to bathe less in the cold weather. This manifests as itching in fingers and armpits. Since this disease is contagious, other members of the family can also get affected by it.

How to take care of skin?

Avoid using very hot water for bathing and washing hands

Keep the room temperature in the medium range

Dont stay in the bathroom for too long

Use light soaps and moisturisers without fragrance

Continue using sunscreen as advised by your doctor, especially if you have melasma and lupus erythematosus.

How to get rid of dandruff?

Avoid using oil in the hair

Wash your scalp regularly

Use water that is neither too hot nor too cold for cleaning hair

Use anti-dandruff shampoo twice a week to clean your scalp (keep the shampoo on the scalp for 5 minutes before washing it)

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Beau’s Lines on Nails: Often a Symptom of a Serious Underlying Condition

 Beau’s lines are ridges that develop across the nails. They happen when nail growth is interrupted at the nail matrix. They can result from environmental factors and some medical issues.

What are Beau’s lines?

Most people don’t pay much attention to their fingernails on a regular basis. Yet our fingernails are a big help to us in our everyday lives: They help us grip, scratch, separate things, and much more.

You might also be surprised to learn that the appearance of your fingernails can help you better understand you health. And in some cases, our nails may pinpoint specific health problems.

One common nail deformation often indicating health trouble is Beau’s lines. Sometimes people mistakenly call these ridges forming across the nail “bows lines,” or “bow lines.”

Beau’s lines occur when nail growth is interrupted at the nail matrix — the place where your nail emerges from your finger.

Usually the cause of Beau’s lines is injury or severe illness, but in some cases, environmental factors may be to blame. In order to treat Beau’s lines, you must treat the underlying medical condition that caused them.

What do Beau’s lines look like?

Beau’s lines are horizontal indentations, or ridges, that develop across the nails. They usually run straight across the nail. A person may develop one or more Beau’s lines on any nail, or across multiple nails.

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Types of Plastic Surgery

•  Head, face, and eyes
  
  
  
  
• Facelift
  Brow/forehead lift
  Eyelid lift
  Ear pinning
  Ear reshaping
  Hair replacement surgery
  Nasal surgery
  Nose reshaping
  Chin, cheek, or jaw reshaping / facial implants
  Lip augmentation
  Cleft lip and cleft palate
  Craniosynostosis (craniofacial anomaly)
  
  Mouth and teeth
  
  Oral and maxillofacial surgery
  
  Breasts
  
  Breast augmentation
  Breast reconstruction
  Breast reduction in men with gynecomastia
  Breast lift
  
  Abdomen
  
  Tummy tuck (abdominoplasty)
  Liposuction
  
  Hand and upper limb
  
  Chase Hand & Upper Limb Center
  
  Skin
  
  Chemical peel
  Dermabrasion / dermaplaning
  Collagen/fat injectable fillers
  Botox/filler injections (restylane, radiesse)
  Glycolic peels
  Laser peels
  Vein removal
  Scar revision
  Tattoo removal
  
  
  
  
• 
  
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• 
  
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Dermatology Drug Pipeline

 The skin is the body’s largest organ, and dermatologists must be able to treat a variety of pathologies, including infectious, neoplastic, autoimmune, inflammatory, genetic, and traumatic. They must also know how to apply the many therapies developed to treat these different conditions, among them monoclonal antibodies, JAK inhibitors, DMARDs, steroids, antibiotics, and chemotherapeutic agents whose administration may be topical, oral, intravenous, intralesional, subcutaneous, or intramuscular. As a result, dermatology has always been one of the most robust markets for pharmaceuticals, one that is expected to reach $64 billion by 2027, which represents a compound annual growth rate of 12.9%. Such growth is driven not only by an increased incidence of common dermatoses such as acne, atopic dermatitis, and psoriasis, but also by patient demand for medications to treat common diseases for which there are no approved therapies and rare ones like epidermolysis bullosa.

Although there are more than 10 biologic agents available for use against psoriasis, more are in development given the common nature of the disease and the need for more effective therapies to address psoriasis and psoriatic arthritis. Adalimumab (Humira; AbbVie), the best-selling drug of 2020 with over $20 billion in sales, was approved by the FDA for multiple dermatologic conditions, including psoriasis, psoriatic arthritis, and hidradenitis suppurativa. Traditionally considered one of the best medications for inhibiting joint destruction, its efficacy in the skin is modest due to the fact that only 71% of patients achieve PASI 75 at week 16. By contrast, risankizumab (Skyrizi; Boehringer Ingelheim & AbbVie) is a new biologic for the condition whose use led to a PASI of 90 in 73% of patients. This highlights the continued need for newer, more effective therapies and particularly for those with lower rates of adverse events (AEs). This article will review some of the key dermatology drugs that may be approved in the coming year.

One of the most anticipated approvals is for ritlecitinib (Pfizer), a dual inhibitor of the TEC group of tyrosine kinases and Janus kinase 3 (JAK3) for the treatment of alopecia areata (AA). This autoimmune disease causes patchy hair loss on the scalp and can progress to hair loss in the entire body. It is important to treat AA because it is associated with poor health-related quality of life and can lead to psychological morbidities like anxiety and depression. Until the recent approval of baricitinib, a JAK 1 inhibitor, there were no FDA-approved therapies for the disorder and clinicians relied on minimally effective approaches with intralesional or topical corticosteroids.

Ritlecitinib was studied in the phase 2a ALLEGRO trial, a randomized, double-blind, multicenter study of patients with moderate to severe alopecia areata (≥50% scalp hair loss), including patients with totalis (complete hair loss on scalp) and universalis (complete hair loss over entire body). Ritlecitinib had an effect as early as 6 weeks, and after 24 months, at least 50% of patients who received it achieved a SALT-30 score and 25% a SALT-90 score. Sixty-seven percent of patients reported at least 1 AE. The most common AEs were headache (5/48 [10%]), nasopharyngitis (5/48 [10%]), and upper respiratory tract infection (4/48 [8%]).

In 2021, the FDA issued a warning about increased risk of health-related events like myocardial infarction, cerebral vascular accident, cancer, and death associated with JAK inhibitors like baricitinib. Preliminary data has shown that ritlecitinib may not have these side effects and, in particular, has now shown changes in lipid labs.  “It is clear that alopecia areata treatment remains a need for many dermatology patients,” said Christopher G. Bunick, MD/PhD, associate professor of dermatology at Yale School of Medicine. “Baricitinib was a major advance in care for AA patients; however, more therapeutic options are needed to help patients overcome this complex disease. Ritlecitinib differs from the current JAK inhibitor approved for AA because its mechanism of action is two-part: TEC kinase and JAK3 inhibition.”

Another candidate drug expected to be approved in 2023 is beremagene geperpavec (B-VEC) for the treatment of recessive dystrophic epidermolysis bullosa (RDEB). This chronic genodermatosis causes blistering, ulcerations, and scarring due to a mutation in COL7A1, which encodes collagen IIV (the anchoring fibril component of the basement membrane zone). B-VEC is a topical agent that can be repeatedly applied without serious AEs. Randomized, placebo-controlled, phase 1 and 2 clinical trials using B-VEC topically met important end points, including primary and secondary objectives of C7 expression, anchoring fibril assembly, wound surface area reduction, duration of wound closure, and time to wound closure following B-VEC therapy.9 No deaths or serious AEs were reported in the studies. Novel drug technology such as this has the potential to improve the treatment of rare dermatologic diseases.

It was expected that bimekizumab (Bimzel, UCB), a pipeline biologic medication for psoriasis, would be approved in 2022, but it was delayed by the FDA. It is an interleukin (IL)-17 blocker that selectively blocks IL-17A and IL-17F. It was studied versus secukinumab, and at week 16, 61.7% of patients in the bimekizumab group and 48.9% in the secukinumab group achieved PASI 100. Thus, bimekizumab was shown to be superior to secukinumab, which is already one of the most effective medications for psoriasis. Furthermore, in a phase 2b study, bimekizumab achieved significant improvements, with an acceptable safety profile, in the ACR50 score compared with placebo. Although additional long-term studies are needed, bimekizumab appears to be one of the most efficacious biologics for psoriasis and psoriatic arthritis. “Bimekizumab has shown excellent clinical results in psoriasis and psoriatic arthritis, the clinical space where it is likely to be approved and excel in patient outcomes, including PASI-100 responses, and it may also provide substantial benefit to patients with hidradenitis suppurativa”, Bunick said.

The coming year will prove to be an exciting one for dermatologic therapy and pharmacology. Given the more than 3000 diseases of the skin, hair, and nails that dermatologists have to treat, new and improved medications are always welcome and highly anticipated in this ever-evolving specialty.

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Top 3 Dermatology

 This week on HCPLive, several major research studies were explored in the dermatology field, with topics ranging from plaque psoriasis treatment options to gene therapy for dystrophic epidermolysis bullosa.

Some of the articles included in this list involve well-explored dermatologic conditions, whereas others covered rarer conditions with more rare genetic disorders.

The research included this week covered an array of topics, but these particular articles covered subjects of interest with a significant amount of depth and substantial data.

Highlights from This Week

1. Dystrophic Epidermolysis Bullosa: Positive Results from Topical Gene Therapy

The research explored in this article concerned a topical gene therapy known as beremagene geperpavec (B-VEC) for patients with the rare disorder known as dystrophic epidermolysis bullosa (DEB)—a condition known known to cause skin fragility and small everyday wounds.

The research demonstrated that the treatment group’s wounds saw a 70% complete wound closure rate following 6 months of B-VEC treatment, according to the study investigators.

“In a previous phase 1–2 study, electron microscopy of skin biopsy samples obtained from patients with recessive dystrophic epidermolysis bullosa showed that B-VEC restored C7 expression on immunofluorescence staining at the basement-membrane zone and induced formation of anchoring fibrils.”

The research was summarized by Aimee S. Payne, MD, PhD, of University of Pennsylvania’s Center for Cellular Immunotherapies.

2. Keratinocyte Grafts for Dystrophic Epidermolysis Bullosa Found to Be Safe, Efficacious

In this article, the research covered the long-term safety and efficacy seen in recessive DEB (RDEB) patients treated with autologous gene-corrected keratinocyte grafts (EB-101) for their wounds.

These keratinocyte grafts were developed by transducing keratinocytes with a retrovirus containing the COL7A1 gene and growing them into sheets which were used on RDEB patient wounds.

“In conclusion, autologous gene-corrected keratinocyte grafts may be a safe, durable treatment for chronic RDEB wounds, and the results of this Phase 1/2a trial demonstrate early evidence of sustained, long-term clinical benefit for patients with RDEB.”

The research team was led by Jodi Y. So, MD, of the Stanford University School of Medicine’s Department of Dermatology.

3. Study Indicates Deucravacitinib Superior to Apremilast, Placebo for Plaque Psoriasis Patients

The research included in this article was the result of the phase 3 trial known as POETYK PSO-2, which indicated that adult plaque psoriasis patients saw better efficacy from deucravacitinib treatment than from apremilast and placebo.

The investigators’ research concluded that their patients' response rates for outcomes increased by 24 weeks, and were found at weeks 16 and 24 to be consistently higher with deucravacitinib compared to apremilast.

“The overall safety profile of deucravacitinib, including a slight increase in the risk of nonserious viral infections, appears to be consistent with the mechanism of selective TYK2 inhibition.”

The investigators were led by Bruce Strober, MD, PhD, of the Depart of Dermatology at Yale University School of Medicine.

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