The edition · Dermatology
A gentler laser endpoint cleared ABNOM as well, with far less post-inflammatory pigmentation
A split-face trial in skin types III–V favoured stopping short of immediate whitening. Omalizumab in chronic urticaria is usually stopped because the disease settles, not because of side effects, and refined histology added little to squamous cell carcinoma risk assessment.
The edition in brief
In a randomised, evaluator-blinded split-face trial of 30 Asian patients with acquired bilateral naevus of Ota-like macules, a 755-nm picosecond laser set to a larger spot and lower fluence (no immediate whitening) cleared lesions as well as the conventional whitening endpoint over three sessions, with much less post-inflammatory hyperpigmentation (4.8% vs 22.6%) and scabbing. It is single-centre and small, but directly relevant to pigmented skin. A meta-analysis of eight observational studies (4,516 patients) put median omalizumab drug survival in chronic urticaria at 3.1 years; early stopping was mostly for good control, adverse-event withdrawals were uncommon, and autoimmune (mainly thyroid) comorbidity roughly doubled stopping for lack of effect. Two Dutch nested case-control studies found that refined histological features such as tumour budding and peritumoral infiltrate added little to conventional risk factors for metastasis of cutaneous squamous cell carcinoma. A 33-patient case series reported rapid improvement of toxic erythema of chemotherapy and radiation dermatitis after one or two 100,000 IU doses of vitamin D, without calcium changes; with no control group, this is a reason for trials, not routine use. The pearl covers antihistamine up-dosing before biologics in urticaria.
Omalizumab in chronic urticaria lasted a median of three years, and early stopping was mostly for good control
Counsel patients that omalizumab is usually long-term but often ends because the urticaria settles, and note autoimmune thyroid disease before starting.
Refined histology added little to predicting metastasis in cutaneous squamous cell carcinoma
Stay with conventional risk features to stage cutaneous squamous cell carcinoma; the refined histological variables tested here added little.
High-dose vitamin D was followed by rapid settling of chemotherapy and radiation skin toxicity in a small series
Do not add high-dose vitamin D for chemotherapy or radiation skin toxicity outside a trial on this uncontrolled series.
Up-dose the antihistamine before moving to a biologic in chronic urticaria
Give an adequate trial of up-dosed second-generation antihistamine before escalating chronic urticaria to omalizumab.
Stopping short of whitening cleared ABNOM equally, with a fifth of the pigmentation
Consider a non-whitening endpoint with larger spot and lower fluence for ABNOM in pigmented skin to reduce post-inflammatory hyperpigmentation.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for dermatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free