Acne vulgaris is one of the most frequent skin diseases worldwide, triggered by multiple endogenous and exogenous factors. Hormones, particularly growth hormone (GH), insulin-like growth factor-1, insulin, CRH, and glucocorticoids, play a major role in the pathogenesis and exacerbation of acne. Excess GH seen in acromegalic patients may result in increased size and function of sweat glands and sebaceous glands, which may contribute to the patient’s worsening acne and interfere with dermatologic treatment. Therefore, understanding the pathogenesis of acne will help in treating resistant acne by diagnosing and treating the underlying etiology using multidisciplinary treatment.

Background: JAK inhibitors are cytokine modulators that are effective in the treatment of numerous autoimmune diseases. However, given their immunosuppressive effects, they may, at least potentially, increase the risk of severe herpes infection in individuals with atopic dermatitis.Objective: To assess the utility of preventative antiviral treatment when initiating JAK inhibitors for atopic dermatitis in order to decrease risk of eczema herpeticum.Results: JAK inhibitors, specifically tofacitinib and baricitinib, used for the treatment of atopic dermatitis confer an increased risk of herpes simplex virus infection. Acyclovir and valacyclovir are effective, safe, and affordable for herpes simplex virus prophylaxis. 26.Bieber T, Thyssen JP, Reich K, et al. Pooled safety analysis of baricitinib in adult patients with atopic dermatitis from 8 randomized clinical trials.

Objective To review pharmacokinetics, efficacy, and safety of tralokinumab in treatment of atopic dermatitis (AD). Data Sources Literature review was conducted using MEDLINE (PubMed), EMBASE, and ClinicalTrials.gov for articles published between January 2010 and May 2022. Study selection and data extraction Articles in English discussing tralokinumab in AD were included. Data synthesis In one phase 2 trial, more subjects treated with tralokinumab 150 and 300 mg achieved an Investigator’s Global Assessment (IGA) of 0/1 with minimum ≥2 point IGA reduction (23%), versus placebo (11.8%, P = 0.10). During 2 phase 3 trials, more subjects treated with tralokinumab achieved IGA success (ECZTRA 1: 15.8% and ECZTRA 2: 22.2%), versus placebo (7.1% and 10.9%, respectively; P = 0.002 and P < 0.001). During one phase 3 trial, in conjunction with topical corticosteroids (TCS), more subjects treated with tralokinumab 300 mg achieved IGA success (ECZTRA 3: 38.9%), versus placebo (26.2%, P = 0.015). During another phase 3 trial in subjects with resistance or contraindication to oral cyclosporine, more subjects treated with tralokinumab 300 mg achieved an Eczema Area Severity Index 75 (64.2%), versus placebo (50.5%, P = 0.018). Relevance to patient care and clinical practice Tralokinumab is efficacious for moderate-to-severe AD, as monotherapy, in conjunction with TCS, and resistance or contraindication to cyclosporine. Although IL-4 and IL-13 are both implicated in AD’s pathogenesis, IL-13 is overexpressed, and head-to-head trials are needed to assess efficacy of tralokinumab, versus dupilumab. Compared with upadacitinib and abrocitinib, tralokinumab is not associated with black-box warnings. Conclusions Tralokinumab is an efficacious and safe systemic treatment for moderate-to-severe AD.

Background: Hallux valgus, a common deformity treated by orthopaedic foot and ankle surgeons, can frequently present with an increased distal metatarsal articular angle (DMAA), which may require correction in addition to the hallux valgus deformity. Thus, we investigated the efficacy of the modified Lapidus procedure, a triplanar correction, in correcting the DMAA in hallux valgus surgery. Methods: A retrospective chart review was performed on patients who underwent the hallux valgus reconstruction with a modified Lapidus procedure between April 26, 2018, and November 19, 2020. Exclusion criteria included patients with inadequate follow-up. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and DMAA were measured on preoperative weight-bearing, 2-week postoperative non-weight-bearing, and at final follow-up weight-bearing radiographs. Results: The study included a total of 99 cases of modified Lapidus procedure for hallux valgus on 85 subjects. On radiologic assessment, the average DMAA decreased from 17.72 ± 6.18 degrees preoperatively to 9.19 ± 5.19 degrees 2 weeks postoperatively (P < .0001) and 9.79 ± 4.62 degrees at the final follow-up (P < .0001). The average HVA decreased from 31.34 ± 10.39 degrees preoperatively to 13.34 ± 6.16 degrees 2 weeks postoperatively (P < .0001) and 15.05 ± 7.43 degrees at final follow-up (P < .0001). Last, the IMA decreased from 14.99 ± 3.82 degrees preoperatively (P < .0001) to 4.66 ± 2.59 degrees 2 weeks postoperatively and 6.62 ± 3.46 degrees at final follow-up (P < .0001). The recurrence rate was 3.03%. Conclusion: The modified Lapidus procedure is an effective procedure in correcting the HVA, IMA, and DMAA in hallux valgus surgery without the need for additional distal or proximal metatarsal osteotomies. Surgeons should consider this technique in patients with moderate to severe hallux valgus deformity who may require correction of their DMAA. Level of Evidence: Level IV-Retrospective comparative study.