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Atopic Dermatitis (AD) is a complex inflammatory cutaneous disorder characterized by immune mediated inflammation and epidermal barrier dysfunction. Arising from a complex interplay between environmental and genetic factors, the definitive etiology of AD is perplexing and controversial. Advances in molecular medicine are radically transforming our understanding of AD pathogenesis. Increasing knowledge on the pathogenesis of AD results in novel therapeutic targets and pathways. This article details the pathogenesis section of the Curriculum United for Better Eczema Care (CUBE-C), facilitating primary care and sub-specialist education on the scientific advances driving recent AD therapeutic innovations.

Background HHV6-positivity in context of drug hypersensitivity syndrome (DHS) may influence disease severity. Systemic corticosteroid treatment of those with DHS, testing positive for HHV6, has been speculated to prolong the duration of disease. Objectives This study's objectives are to: (1) Evaluate whether DHS patients with HHV6-positivity develop a more severe illness compared to DHS patients without presumed reactivation in the pediatric population, and (2) Evaluate the response to systemic corticosteroid treatment. Methods Retrospective case series of 29 pediatric inpatients treated for DHS and tested for HHV6. HHV6-positive and -negative patients were identified and stratified to groups treated with and without systemic corticosteroids to examine their disease severity on the basis of hospital length-of-stay (LOS), total number of febrile days (Tfeb), and days until cessation of progression (CTP). Results HHV6-positive patients had similar demographic characteristics as HHV6-negative patients, but had significantly longer hospital LOS (11.5 days v 5 days, p=0.0386), Tfeb (12.5 days v 3 days, p=0.0325), and CTP (4 days v 2 days, p=0.0141). All HHV6-positive patients and most (80%) of the HHV6-negative patients received systemic corticosteroids. Among the HHV6-negative patients, those who received corticosteroids showed significantly shorter CTP than those who did not receive corticosteroids (3 days v 2 days, p=0.043). Additionally, there was a trend towards shorter hospital LOS and Tfeb among HHV6-negative patients who received corticosteroids when compared with those who did not, though these differences were not statistically significant. The most common inciting drugs included trimethoprim-sulfamethoxazole (33%), phenytoin (10%), and amoxicillin (10%). Conclusions HHV6-positivity with DHS is associated with a more severe disease course. Treatment with systemic corticosteroids was associated with a non-statistical trend toward reduced hospital LOS and febrile days, and a statistically reduced number of days until cessation of progression.

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BACKGROUND With the rising popularity of dermal fillers, the number of complications associated with fillers has increased. OBJECTIVE To identify and review reports of adverse events involving cosmetic injectable soft-tissue fillers from the FDA Manufacturer and User Facility Device Experience (MAUDE) database from June 1993 to August 2014. MATERIALS AND METHODS The authors conducted a search of adverse events within the U.S. Food and Drug Administration database that involved injectable dermal fillers for soft-tissue augmentation from June 1993 to August 2014. Search terms included generic and trade names of commercially available soft-tissue fillers. RESULTS Three thousand seven hundred eighty-two complications involving dermal fillers were identified in the MAUDE database. Forty-four percent of complications implicated hyaluronic acid fillers, 40% involved poly-l-lactic acid fillers, 15% complications included calcium hydroxylapatite fillers, and <1% complications arose from polymethylmethacrylate fillers. Common adverse events included lumps, infection, allergic reaction, ischemia, and swelling. Rare events included trigger of autoimmune reactions, visual disturbances, and stroke. CONCLUSION Although complications with dermal fillers are infrequent in comparison with the growing number of filler procedures being performed in the United States every year, this study underscores the importance of appropriate skill and training when administering dermal fillers. Physicians using injectable dermal fillers should be trained to recognize potential complications and know how to appropriately manage them.

Background and Objective Recent prospective trials have supported treatment of nonfacial BCC with long‐pulsed 1064 nm Nd:YAG laser based on short‐term histologic clearance rates. Studies have yet to identify the long‐term clinical clearance rates of this specific laser therapy for BCC. Study Design/Material and Methods This is a retrospective review of BCC treated with long‐pulsed 1064 nm Nd:YAG laser, which have been clinically monitored for at least 6 months, to assess for recurrence and cosmetic outcomes of the treated area. Results 16 BCC lesions (11 subjects) treated with 1064 nm Nd:YAG laser were enrolled. Our analysis revealed 100% clearance rate in all subjects (16 of 16 BCC) treated with long‐pulsed Nd:YAG laser based on mean follow‐up of 9 months (range 6–15 months). Minimal scarring and no long‐term adverse events were noted. Conclusions This study supports the use of 1064 nm Nd:YAG laser as a therapeutic modality for BCC based on the absence of clinical recurrence upon a mean follow‐up of 9 months. As studies progress, we are beginning to observe a potential role for laser as an alternative to patients who refuse surgery, have multiple co‐morbidities, or decline non‐surgical therapies. Laser treatment with 1064 nm Nd:YAG is an evolving, promising story that we continue to investigate to optimize parameters. Lasers Surg. Med. 51:34–39, 2019. © 2018 Wiley Periodicals, Inc.

Phosphodiesterase 4 (PDE4) is a cyclic AMP degrading enzyme in leukocytes. Several decades ago, increased PDE activity was demonstrated in patients with atopic dermatitis (AD). Currently, several PDE4 inhibitors in both topical and oral formulation have been developed to target the inflammatory cascade of AD. This review shows the pathogenic rationale behind these inhibitors, and discusses multiple PDE4 inhibitors that are under evaluation or in the market. PDE4 inhibitors may be considered as favorable agents in the repertoire of current interventions for AD.