- Email: [email protected]
Correlations between dermoscopic and histopathologic findings in actinic keratosis
4963
4393
Co-occurrence of lymphomatoid papulosis and mycosis fungoides: A case report and literature review Natalie Steinhoff, DO, NSUCOM/Largo Medical Center; Brian Wanner, BS, Des Moines University College of Osteopathic Medicine Lymphomatoid papulosis (LyP) and mycosis fungoides (MF) are types of cutaneous T-cell lymphomas (CTCL) that can present separately, simultaneously or consecutively. LyP classically presents with self-regressing, erythematous to brown necrotic papules or small nodules. Mycosis fungoides has a variety of clinical manifestations and is the most common subtype of CTCL. Recognizing LyP is important due to its association with developing lymphomas, most commonly MF, Hodgkin’s disease and anaplastic large cell lymphoma. We report a case of a 35-year-old woman with recurrent LyP lesions since childhood who developed secondary MF. We discuss the need to evaluate LyP patients for secondary lymphomas and provide a concise review of the literature focusing on clinical presentation, disease associations, diagnosis and management.
Correlation of in vitro gene expression analysis with in vivo efficacy Tiffany Oliphant, MS, Floratech; Robert Harper, PhD, Harper & Associates The objective of this research was to conduct in vitro gene expression testing of hydrolyzed jojoba esters and correlate these results with randomized, double-blind, vehicle-controlled in vivo efficacy studies. Gene expression testing of 1% hydrolyzed jojoba esters in glycerin produced the following statistically significant gene expression changes over the vehicle: up regulation in AQP3, AQP5, KLK5, KLK6, KLK7, TXN, TXNRD, and CAT; and down regulation in TNF, MKI67, and EDN1. Current literature shows associations between AQP3 and APQ5 and skin hydration, as well as associations between TNF and an inflammatory response. Three small IRB approved studies were carried out to obtain efficacy data. Study 1: An oil in water emulsion containing 1% hydrolyzed jojoba esters produced statistically significant (P \ .05) increases in skin hydration compared to the vehicle, one and two hours post application (43% and 67%, respectively, n ¼ 17). Study 2: A water-based toner containing 0.2% hydrolyzed jojoba esters produced statistically significant (P \.05) increases in skin hydration compared to the vehicle toner, one and two hours post application (22% and 16%, respectively, n ¼ 15). Study 3: Inflammation was studied in vivo by evaluating erythema and barrier function of insulted (ie, dry shaved) skin. The addition of 0.2% hydrolyzed jojoba esters to a baby wipe formulation produced statistically significant decreases in erythema (P \ .05) and increases in barrier function (P \.05) as compared to the vehicle baby wipe (n ¼ 14). These studies demonstrate the correlation between in vitro gene expression data and in vivo efficacy. Additional in vivo studies will be performed to evaluate desquamation, antioxidant responses, proliferation, and pigmentation as indicated by the remaining genes that were impacted by hydrolyzed jojoba esters.
Commercial support: None identified.
Commercial support: Study was sponsored by Floratech.
4921 Correlation between PASI response and improvement in healthrelated quality of life over time: Results from a phase III clinical trial VOYAGE 1 Andrew Blauvelt, MD, Oregon Medical Research Center; Kim A. Papp, MD, K Papp Clinical Research and Probity Research, Inc.; Christopher E.M. Griffiths, MD, Dermatology Centre, Salford Royal Hospital, U of Manchester, Manchester Academic Health Science Cntr; Chenglong Han, MD, Janssen Research & Development, LLC; Bruce Randazzo, MD, Janssen Research & Development, LLC/University of Pennsylvania; Yasmine Wasfi, MD, Janssen Research & Development, LLC; Shu Li, PhD, Janssen Research & Development, LLC; Alexa B. Kimball, MD, Depart of Dermatology, Harvard Medical School Background: Health-related quality of life (HRQoL) for psoriasis (PsO) patients is poor. The objectives of this study were to explore the correlation between objective clinical responses and subjective improvements in HRQoL, and the treatment effect of guselkumab (GUS) on HRQoL among PsO patients. Methods: VOYAGE 1 is a phase 3, randomized, double-blind, placebo and active comparator-controlled trial. Eligible patients (age $18 years) had plaque PsO for $6 months, an IGA $3, PASI $12, and BSA involvement of $10%, and were candidates for systemic therapy or phototherapy. At baseline, 837 patients were randomized to either GUS 100 mg at wks 0/4/12, and q8wk through wk 44 (n ¼ 329), placebo (PBO) at wks 0/4/12 followed by GUS 100 mg at wks 16/20, and q8wk through wk 44 (n ¼ 174); or ADA 80 mg at wk 0, 40 mg at wk 1, and 40 mg q2wk through wk 47 (n ¼ 334). Clinical responses were assessed using the Psoriasis Area and Severity Index (PASI) and disease specific HRQoL was assessed using the Dermatology Life Quality Index (DLQI). Total DLQI scores of 0 or 1 indicate no impact of PsO on a patient’s HRQoL. For over time comparisons, this post hoc analysis only includes patients in the ADA and GUS groups. Correlations between improvement in PASI and DLQI scores were analyzed using Pearson’s correlation. Results: At baseline, in the combined ADA and GUS groups (n ¼ 650), the median DLQI was 14, indicating a very large impact of PsO on a patient’s daily HRQoL. A statistically significant but weak correlation between improvement in PASI and DLQI was observed at wk 16 (r ¼ 0.30, P \.001), wk 24 (r ¼ 0.33, P \.001), and wk 48 (r ¼ 0.39, P \.001) in the combined group. In the subset of patients who had 90 to \100% improvement in PASI score, the proportion of patients who achieved a DLQI score of 0 or 1 was 51.2% at wk 16, 57.7% at wk 24, and 56.5% at wk 48. Among patients who had a PASI 100 response, the proportion of patients who achieved a DLQI score of 0 or 1 was 73.7% at wk 16, 76.2% at wk 24, and 82.1% at wk 48, indicating better HRQoL in PASI 100 responders. A greater proportion of patients in the GUS vs ADA group achieved a DLQI score of 0 or 1 at wk 24 (60.9% vs. 39.5, P \ .001) and wk 48 (62.5% vs. 38.9%, P \.001). Conclusions: Objective clinical assessments of PsO improvement correlated with subjective patient-reported measurements of HRQoL over time. In addition, GUS therapy, when compared with ADA therapy, resulted in greater improvements in HRQoL in patients with moderate-severe PsO. Commercial support: Janssen Research & Development, LLC. sponsored this study 100%.
AB84
J AM ACAD DERMATOL
4736 Correlations between dermoscopic and histopathologic findings in actinic keratosis Dong Won Lee, MD, Korea University College of Medicine; Dae Yeon Kim, MD, Korea University College of Medicine; Tae Hyung Ryu, MD, Korea University College of Medicine; Jae Eun Choi, MD, Korea University College of Medicine; Soo Hong Seo, MD, Korea University College of Medicine; Young Chul Kye, MD, Korea University College of Medicine These days, a variety of tools has been developed and used to diagnose skin lesions more easily and precisely, and the dermoscope is one of the most commonly used. With the help of dermoscopy, one can determine actinic keratosis (AK) diagnosis with more confidence. We conducted the study to explore the correlationships between dermoscopic and histopathologic findings in actinic keratosis. Forty-seven patients diagnosed with AK in our center from October 22nd, 2014 to March 22nd, 2016 were enrolled. Median age was 73, and 18 male and 29 female participated. We figured out the positive ratio of strawberry sign, rosette sign, erythematous background, targetoid sign, scale, white structureless area, pigmentation among our patients, and measured the diameter of the vessel lumen, the thickness of viable epidermis, the existence and thickness of ortho- and parakeratosis, the level of solar elastosis, and the existence of flap sign. When targetoid sign was present, vascular diameter was significantly larger (P ¼.0159). The patient was relatively older when whitish structure was present (P ¼ .0519). The level of solar elastosis was significantly high (P ¼ .0095) when scale was present. According to correlation analysis, the thickness of ortho- and parakeratosis showed a correlation (r ¼ 0.47355, P ¼.0008). The correlation between the thickness of viable epidermis and vascular diameter was shown as well (r ¼ -0.35280, P ¼.015). We could predict the vascular diameter to be larger when the lesion has red background, although statistically not significant. The telangiectasia or angiogenesis caused by photodamage or inflammation could result in the increase of vascular diameter, leading to the speculation that the same factors could influence the increase of the positive ratio of the targetoid sign and the decrease in the thickness of viable epidermis. Age and whitish structure showed a relatively significant relationship. Considering the whitish structure is a secondary change, we assumed that actinic keratosis has been developing for a long time. We found some correlations between dermoscopic and pathologic conditions. Based on the results, we expect the dermoscopy to contribute to correct diagnosis and assessment of AK. Commercial support: None identified.
JUNE 2017
4393
Co-occurrence of lymphomatoid papulosis and mycosis fungoides: A case report and literature review Natalie Steinhoff, DO, NSUCOM/Largo Medical Center; Brian Wanner, BS, Des Moines University College of Osteopathic Medicine Lymphomatoid papulosis (LyP) and mycosis fungoides (MF) are types of cutaneous T-cell lymphomas (CTCL) that can present separately, simultaneously or consecutively. LyP classically presents with self-regressing, erythematous to brown necrotic papules or small nodules. Mycosis fungoides has a variety of clinical manifestations and is the most common subtype of CTCL. Recognizing LyP is important due to its association with developing lymphomas, most commonly MF, Hodgkin’s disease and anaplastic large cell lymphoma. We report a case of a 35-year-old woman with recurrent LyP lesions since childhood who developed secondary MF. We discuss the need to evaluate LyP patients for secondary lymphomas and provide a concise review of the literature focusing on clinical presentation, disease associations, diagnosis and management.
Correlation of in vitro gene expression analysis with in vivo efficacy Tiffany Oliphant, MS, Floratech; Robert Harper, PhD, Harper & Associates The objective of this research was to conduct in vitro gene expression testing of hydrolyzed jojoba esters and correlate these results with randomized, double-blind, vehicle-controlled in vivo efficacy studies. Gene expression testing of 1% hydrolyzed jojoba esters in glycerin produced the following statistically significant gene expression changes over the vehicle: up regulation in AQP3, AQP5, KLK5, KLK6, KLK7, TXN, TXNRD, and CAT; and down regulation in TNF, MKI67, and EDN1. Current literature shows associations between AQP3 and APQ5 and skin hydration, as well as associations between TNF and an inflammatory response. Three small IRB approved studies were carried out to obtain efficacy data. Study 1: An oil in water emulsion containing 1% hydrolyzed jojoba esters produced statistically significant (P \ .05) increases in skin hydration compared to the vehicle, one and two hours post application (43% and 67%, respectively, n ¼ 17). Study 2: A water-based toner containing 0.2% hydrolyzed jojoba esters produced statistically significant (P \.05) increases in skin hydration compared to the vehicle toner, one and two hours post application (22% and 16%, respectively, n ¼ 15). Study 3: Inflammation was studied in vivo by evaluating erythema and barrier function of insulted (ie, dry shaved) skin. The addition of 0.2% hydrolyzed jojoba esters to a baby wipe formulation produced statistically significant decreases in erythema (P \ .05) and increases in barrier function (P \.05) as compared to the vehicle baby wipe (n ¼ 14). These studies demonstrate the correlation between in vitro gene expression data and in vivo efficacy. Additional in vivo studies will be performed to evaluate desquamation, antioxidant responses, proliferation, and pigmentation as indicated by the remaining genes that were impacted by hydrolyzed jojoba esters.
Commercial support: None identified.
Commercial support: Study was sponsored by Floratech.
4921 Correlation between PASI response and improvement in healthrelated quality of life over time: Results from a phase III clinical trial VOYAGE 1 Andrew Blauvelt, MD, Oregon Medical Research Center; Kim A. Papp, MD, K Papp Clinical Research and Probity Research, Inc.; Christopher E.M. Griffiths, MD, Dermatology Centre, Salford Royal Hospital, U of Manchester, Manchester Academic Health Science Cntr; Chenglong Han, MD, Janssen Research & Development, LLC; Bruce Randazzo, MD, Janssen Research & Development, LLC/University of Pennsylvania; Yasmine Wasfi, MD, Janssen Research & Development, LLC; Shu Li, PhD, Janssen Research & Development, LLC; Alexa B. Kimball, MD, Depart of Dermatology, Harvard Medical School Background: Health-related quality of life (HRQoL) for psoriasis (PsO) patients is poor. The objectives of this study were to explore the correlation between objective clinical responses and subjective improvements in HRQoL, and the treatment effect of guselkumab (GUS) on HRQoL among PsO patients. Methods: VOYAGE 1 is a phase 3, randomized, double-blind, placebo and active comparator-controlled trial. Eligible patients (age $18 years) had plaque PsO for $6 months, an IGA $3, PASI $12, and BSA involvement of $10%, and were candidates for systemic therapy or phototherapy. At baseline, 837 patients were randomized to either GUS 100 mg at wks 0/4/12, and q8wk through wk 44 (n ¼ 329), placebo (PBO) at wks 0/4/12 followed by GUS 100 mg at wks 16/20, and q8wk through wk 44 (n ¼ 174); or ADA 80 mg at wk 0, 40 mg at wk 1, and 40 mg q2wk through wk 47 (n ¼ 334). Clinical responses were assessed using the Psoriasis Area and Severity Index (PASI) and disease specific HRQoL was assessed using the Dermatology Life Quality Index (DLQI). Total DLQI scores of 0 or 1 indicate no impact of PsO on a patient’s HRQoL. For over time comparisons, this post hoc analysis only includes patients in the ADA and GUS groups. Correlations between improvement in PASI and DLQI scores were analyzed using Pearson’s correlation. Results: At baseline, in the combined ADA and GUS groups (n ¼ 650), the median DLQI was 14, indicating a very large impact of PsO on a patient’s daily HRQoL. A statistically significant but weak correlation between improvement in PASI and DLQI was observed at wk 16 (r ¼ 0.30, P \.001), wk 24 (r ¼ 0.33, P \.001), and wk 48 (r ¼ 0.39, P \.001) in the combined group. In the subset of patients who had 90 to \100% improvement in PASI score, the proportion of patients who achieved a DLQI score of 0 or 1 was 51.2% at wk 16, 57.7% at wk 24, and 56.5% at wk 48. Among patients who had a PASI 100 response, the proportion of patients who achieved a DLQI score of 0 or 1 was 73.7% at wk 16, 76.2% at wk 24, and 82.1% at wk 48, indicating better HRQoL in PASI 100 responders. A greater proportion of patients in the GUS vs ADA group achieved a DLQI score of 0 or 1 at wk 24 (60.9% vs. 39.5, P \ .001) and wk 48 (62.5% vs. 38.9%, P \.001). Conclusions: Objective clinical assessments of PsO improvement correlated with subjective patient-reported measurements of HRQoL over time. In addition, GUS therapy, when compared with ADA therapy, resulted in greater improvements in HRQoL in patients with moderate-severe PsO. Commercial support: Janssen Research & Development, LLC. sponsored this study 100%.
AB84
J AM ACAD DERMATOL
4736 Correlations between dermoscopic and histopathologic findings in actinic keratosis Dong Won Lee, MD, Korea University College of Medicine; Dae Yeon Kim, MD, Korea University College of Medicine; Tae Hyung Ryu, MD, Korea University College of Medicine; Jae Eun Choi, MD, Korea University College of Medicine; Soo Hong Seo, MD, Korea University College of Medicine; Young Chul Kye, MD, Korea University College of Medicine These days, a variety of tools has been developed and used to diagnose skin lesions more easily and precisely, and the dermoscope is one of the most commonly used. With the help of dermoscopy, one can determine actinic keratosis (AK) diagnosis with more confidence. We conducted the study to explore the correlationships between dermoscopic and histopathologic findings in actinic keratosis. Forty-seven patients diagnosed with AK in our center from October 22nd, 2014 to March 22nd, 2016 were enrolled. Median age was 73, and 18 male and 29 female participated. We figured out the positive ratio of strawberry sign, rosette sign, erythematous background, targetoid sign, scale, white structureless area, pigmentation among our patients, and measured the diameter of the vessel lumen, the thickness of viable epidermis, the existence and thickness of ortho- and parakeratosis, the level of solar elastosis, and the existence of flap sign. When targetoid sign was present, vascular diameter was significantly larger (P ¼.0159). The patient was relatively older when whitish structure was present (P ¼ .0519). The level of solar elastosis was significantly high (P ¼ .0095) when scale was present. According to correlation analysis, the thickness of ortho- and parakeratosis showed a correlation (r ¼ 0.47355, P ¼.0008). The correlation between the thickness of viable epidermis and vascular diameter was shown as well (r ¼ -0.35280, P ¼.015). We could predict the vascular diameter to be larger when the lesion has red background, although statistically not significant. The telangiectasia or angiogenesis caused by photodamage or inflammation could result in the increase of vascular diameter, leading to the speculation that the same factors could influence the increase of the positive ratio of the targetoid sign and the decrease in the thickness of viable epidermis. Age and whitish structure showed a relatively significant relationship. Considering the whitish structure is a secondary change, we assumed that actinic keratosis has been developing for a long time. We found some correlations between dermoscopic and pathologic conditions. Based on the results, we expect the dermoscopy to contribute to correct diagnosis and assessment of AK. Commercial support: None identified.
JUNE 2017