Expert Insights: Complex Dermatology Cases

The final session on the first day of Spring Dermatology Week 2024, saw Shawn Kwatra, MD; Joseph Merola, MD, MMSc, FAAD, FACR; Mital Patel-Cohen, MD; and Vishal Patel, MD, discuss their latest case reports in, “Complex Dermatology Cases.”

The session began with Dr Joe Merola, a dermatologist and rheumatologist, welcoming everyone to the discussion on complex dermatology cases. He shared a case involving a 58-year-old physician with a history of immune thrombocytopenic purpura  and atopic dermatitis, who developed arthritis after starting dupilumab therapy. The patient's workup revealed a seronegative, nonerosive, inflammatory arthritis resembling psoriatic arthritis. Treatment with prednisone and hydroxychloroquine was attempted, but the patient ultimately responded well to prednisone alone.

Dr Merola discussed the emerging phenomenon of dupilumab-associated arthritis, highlighting the need for appropriate workup and management, including nonsteroidal anti-inflammatory drugs, low-dose prednisone, methotrexate, or Janus kinase (JAK) inhibitors based on disease severity.

Next, Dr Merola presented a case of a 45-year-old woman with systemic lupus and psoriasis, successfully treated with deucravacitinib, a dual inhibitor of IL-12/23 and type 1 interferon, suggesting potential efficacy in cutaneous lupus.

Dr Patel then shifted the discussion to dermatologic oncology, presenting a case of a 50-year-old man with a large squamous cell carcinoma (SCC) requiring surgical intervention. He discussed the evolving risk stratification for SCC, highlighting the efficacy of immune checkpoint inhibitors in advanced disease.

Dr Patel emphasized the importance of pathologic response in predicting outcomes and discussed the role of neoadjuvant immunotherapy in borderline resectable tumors, citing impressive survival rates and potential sparing of adjuvant radiation.

Finally, Dr Patel-Cohen discussed a case of anti-TNF-induced psoriasis-like eruption in a patient with Crohn disease. She highlighted the challenges in managing such cases, including selecting appropriate treatment options based on disease severity and patient factors.

Dr Patel-Cohen shared insights from published case series and discussed the evolving landscape of treatment options, including oral JAK inhibitors and newer biologics like risankizumab. She also discussed a rare paradoxical reaction to risankizumab, underscoring the importance of careful monitoring and biopsy in unusual presentations.

Overall, the session provided a comprehensive overview of complex dermatology cases, emphasizing the importance of tailored treatment approaches and multidisciplinary collaboration in optimizing patient outcomes.

For more meeting coverage, visit the Spring Dermatology Week 2024 newsroom.

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Reference
Kwatra S, Merola J, Patel-Cohen M, Patel V. Complex dermatology cases. Presented at: Dermatology Week; May 8–11, 2024; Virtual.