Faculty Bibliography

BACKGROUND:The use of artificial intelligence (AI) for skin cancer assessment has been an emerging topic in dermatology. Leadership of dermatologists is necessary in defining how these technologies fit into clinical practice. OBJECTIVE:To characterize the evolution of AI in skin cancer assessment and characterize the involvement of dermatologists in developing these technologies. METHODS:An electronic literature search was performed using PubMed searching machine learning or artificial intelligence combined with skin cancer or melanoma. Articles were included if they used AI for screening and diagnosis of skin cancer using datasets consisting of dermatoscopic images or photographs of gross lesions. RESULTS:Fifty-one articles were included, of which 41% had dermatologists included as authors. Manuscripts including dermatologists described algorithms built using more images (mean 12111 vs 660). In terms of underlying technology, AI used for skin cancer assessment has followed trends in the field of image recognition. LIMITATIONS/CONCLUSIONS:This review focused on models described in the medical literature and did not account for those described elsewhere. CONCLUSIONS:Greater involvement of dermatologists is needed in thinking through issues in data collection, dataset biases, and applications of technology. Dermatologists can provide access to large, diverse datasets that are increasingly important for building these models.

Background: The psoriasis symptom inventory (PSI) is a validated tool measuring patient-reported psoriasis signs and symptoms, with higher scores indicating increased severity. This post hoc analysis examines PSI response rates and scores stratified by sex and skin clearance levels in clinical trials of brodalumab, an interleukin-17 receptor A antagonist efficacious for treatment of moderate-to-severe psoriasis.
Method(s): Data were analyzed from two double-blind, placebo- and active-comparator-controlled, phase 3 studies (AMAGINE-2/-3). This analysis includes patients who received continuous brodalumab 210 mg every 2 weeks (Q2W) or ustekinumab through 12 weeks. Rates of PSI response (total score of <=8) were stratified by sex. Mean PSI scores were stratified by sex and psoriasis area and severity index improvement scores from baseline of 75% to <90% (PASI 75 to <90), PASI >=90 to <100, and PASI 100.
Result(s): Regardless of sex, brodalumab was associated with significantly higher PSI response rates than ustekinumab from week 2 (P <.0001) through week 12 (P =.002). At week 12, PSI response rates in brodalumab and ustekinumab cohorts, respectively, were 72.3% vs 59.7% (males) and 67.3% vs 57.5% (females). Among patients with PASI 75 to <90 at week 12, brodalumab was associated with numerically lower mean (standard error) PSI scores vs ustekinumab for males (4.89 [0.72] vs 5.85 [0.51]) and females (6.40 [1.24] vs 7.37 [0.93]).
Conclusion(s): In male and female patients, brodalumab was associated with achievement of PSI response by week 2 and a trend toward greater symptom relief for those with incomplete PASI responses at week 12 vs ustekinumab.
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Patients with psoriasis have high rates of depression and may be at increased risk for suicidal ideation and behavior (SIB). Attempted and completed suicides during clinical trials and other studies of psoriasis therapies, including brodalumab, highlight the importance of understanding psychiatric risk factors in patients with psoriasis. Recent meta-analyses, research studies, and published data from brodalumab clinical studies were reviewed. We also summarize research on effects of brodalumab on depression symptoms and occurrences of SIB in brodalumab clinical trials. Psoriasis elevates the risk for depression and possible suicide. Brodalumab has a boxed suicide warning; however, it states that there is no established causal association between treatment with brodalumab and increased risk for SIB. Clinicians are urged to evaluate patients with psoriasis for psychiatric risk factors regardless of their therapy and to consider the package insert and a comprehensive evaluation of relevant literature to make a well-balanced decision.

BACKGROUND:Prescription medications are among the most common causes of sexual dysfunction, and patients are often hesitant to seek help when experiencing these symptoms. OBJECTIVE:In this review, we identified the available evidence of sexual side effects in men using systemic dermatologic medications and suggest screening protocols and actions that may improve a patient's symptom where possible. METHODS:A systematic review was conducted of all articles in the PubMed database published from the time of inception to May 2018 to identify studies evaluating use of systemic dermatologic medications in men with evidence of sexual side effects. Subsequently, a secondary in-depth literature review was performed for each individual medication. RESULTS:5497 articles were reviewed in the primary systematic review. A total of 59 articles covering 11 systemic dermatologic medications met inclusion criteria. We identified level 1 evidence for sexual side effects as a primary outcome in patients taking finasteride. LIMITATIONS/CONCLUSIONS:Many included studies were limited by sample size and methodology. CONCLUSION/CONCLUSIONS:The information in this review may serve as a reference of side effects when deciding on a therapeutic agent and a guide to identify patients to screen for sexual dysfunction.