Background/Objective
Melasma is a commonly acquired disorder of hyperpigmentation that often poses a therapeutic challenge for dermatologists. Recently, cysteamine cream has shown promising results compared to placebo. This study aims to determine the efficacy of cysteamine cream compared to hydroquinone cream in the treatment of melasma.
Methods
A randomised, double‐blinded, single‐centre trial was conducted in Victoria, Australia. 20 recruited participants were given either cysteamine cream or hydroquinone cream for 16 weeks. The primary outcome measure was a change in the modified Melasma Area and Severity Index (mMASI). Quality of life at baseline and week 16 as well as standard digital photography at each follow‐up visit was assessed as secondary outcome measures.
Results
At week 16, 14 participants completed the study with 5 participants in the cysteamine group and 9 patients in the hydroquinone group. In the intention to treat analysis, there was a 1.52 ± 0.69 (21.3%) reduction in mMASI for the cysteamine group and a 2.96 ± 1.15 (32%) reduction in the hydroquinone group. The difference between groups was not statistically significant (P = 0.3). Hydroquinone cream was generally better tolerated that cysteamine cream.
Conclusion
Our study suggests that topical cysteamine may have comparable efficacy to topical hydroquinone. Cysteamine thus provides a possible alternative to patients and clinicians who wish to avoid or rotate off topical hydroquinone. While side effects were more common for participants using cysteamine compared with hydroquinone, these were mild and reversible. Larger studies comparing cysteamine and hydroquinone are required to support these findings.
Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.
Key Clinical Message
Pembrolizumab is an immune checkpoint inhibitor with antitumor activity in other organ malignancies. We present this case —demonstrating multiple inflammatory adverse events associated with Pembrolizumab (in a single patient), in order to increase awareness and facilitate earlier identification of the wide‐ranging cutaneous side effects associated with immunotherapy.
Pathergy reaction is the phenomenon of formation of non-healing skin lesions or ulcers following minor injuries. Although conceptually similar to the isomorphic reaction (Koebnerisation), these are two separate phenomena that should be distinguishable to treating clinicians. The underlying pathomechanisms of pathergy are not yet fully understood and subsequently therapy is lacking. Recent advances in the understanding of wound healing through keratinocyte and fibroblast cross-talk and mesenchymal stem cell (MSC) may hopefully foster the development of novel targeted therapies for pathergy-associated wounds and diseases in the near future.
2]. Available from:. https://www.fda.gov/ regulatory-information/search-fda-guidance-documents/intravascular-catheters-wires-and-delivery-systems-lubricious-coatingslabeling-considerations. 6. Falanga V, Fine MJ, Kapoor WN. The cutaneous manifestations of cholesterol crystal embolization.
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