International Journal of DermatologyEarly View Letter to the Editor Prevalence of malignancy and associated risk factors in prurigo nodularis patients: a retrospective study Iryna Savinova, Iryna Savinova orcid.org/0000-0002-0413-3033 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorManal Alrabai, Manal Alrabai Division of Dermatology, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorDana Taghaddos, Dana Taghaddos orcid.org/0009-0001-4215-7132 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorMohannad Abu-Hilal, Corresponding Author Mohannad Abu-Hilal [email protected] Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada Division of Dermatology, McMaster University, Hamilton, ON, CanadaSearch for more papers by this author Iryna Savinova, Iryna Savinova orcid.org/0000-0002-0413-3033 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorManal Alrabai, Manal Alrabai Division of Dermatology, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorDana Taghaddos, Dana Taghaddos orcid.org/0009-0001-4215-7132 Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, CanadaSearch for more papers by this authorMohannad Abu-Hilal, Corresponding Author Mohannad Abu-Hilal [email protected] Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada Division of Dermatology, McMaster University, Hamilton, ON, CanadaSearch for more papers by this author First published: 11 April 2024 https://doi.org/10.1111/ijd.17176 Conflict of interest: IS, MA, and DT declare no conflict of interest. MAH reports previous experience advising and/or consulting for AbbVie, Galderma, Janssen, Leo, Lilly, L'Oreal, Medexus Pharma, Novartis, Pfizer, and Sun Pharma. Funding source: None. IRB approval status: The Hamilton Integrated Research Ethics Board (HiREB) has reviewed and approved the above-mentioned study, project ID 16274. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Williams KA, Roh YS, Brown I, Sutaria N, Bakhshi P, Choi J, et al. Pathophysiology, diagnosis, and pharmacological treatment of prurigo nodularis. Expert Rev Clin Pharmacol. 2021; 14(1): 67–77. https://doi.org/10.1080/17512433.2021.1852080 10.1080/17512433.2021.1852080 CASPubMedWeb of Science®Google Scholar 2Lee MR, Shumack S. Prurigo nodularis: a review. Australas J Dermatol. 2005; 46(4): 211–220. https://doi.org/10.1111/j.1440-0960.2005.00187.x 10.1111/j.1440-0960.2005.00187.x PubMedWeb of Science®Google Scholar 3Larson VA, Tang O, Stander S, Miller LS, Kang S, Kwatra SG. Association between prurigo nodularis and malignancy in middle-aged adults. J Am Acad Dermatol. 2019; 81(5): 1198–1201. https://doi.org/10.1016/j.jaad.2019.03.083 10.1016/j.jaad.2019.03.083 PubMedWeb of Science®Google Scholar 4Green M, Williams L, Kuraitis D. Clinical and temporal characteristics of malignancy-associated prurigo nodularis: a systematic review. J Am Acad Dermatol. 2022; 87(3):AB31. https://doi.org/10.1016/j.jaad.2022.06.156 10.1016/j.jaad.2022.06.156 Web of Science®Google Scholar 5Bazaliński D, Przybek-Mita J, Barańska B, Więch P. Marjolin's ulcer in chronic wounds - review of available literature. Contemp Oncol (Pozn). 2017; 21(3): 197–202. https://doi.org/10.5114/wo.2017.70109 10.5114/wo.2017.70109 PubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Background: Prurigo nodularis (PN) is a complex chronic skin disease characterized by severe pruritic nodules. PN is often associated with mental health disorders and chronic medical comorbidities. Until recently, PN treatment has been challenging and difficult. Objectives: This study aims to describe the demographic, clinical characteristics, and comorbidities associated with PN. Also, we aim to describe the effectiveness of systemic therapies, including methotrexate, cyclosporine, and narrow band ultraviolet (NB-UVB) in adult patients with PN. Methods: This is a retrospective chart review of adult patients diagnosed with PN at Hamilton Health Science Center and/or McMaster University in Hamilton, Ontario, between 2015 and 2023. Results: The study included 81 patients (57% female). The mean age was 52.8 years, and the mean age of PN diagnosis was 50 years. Reported symptoms included: itching (100%), dry skin (53%), pain (17%), and burning sensation (5%). Lower and upper extremities were the most common areas involved in 93% and 69%, respectively. Mental health disorders were present in 79% of patients, with depression (58%) and anxiety (52%) being the most common. Atopic dermatitis was the most common skin comorbidity noted. Treatments used included cyclosporine, and NB-UVB, and MTX, which resulted in significant improvement of pruritus in 38%, 35%, and 31% of patients, respectively, at week 16. Conclusions: PN is associated with increased risk of mental health disorders and other medical comorbidities. Cyclosporine, methotrexate, and NB-UVB therapy may be effective treatment options, however clinicians must consider the potential short- and long-term adverse effects of these treatments.

Background: Tildrakizumab is an interleukin-23 inhibitor approved in Canada in 2021 for the treatment of adults with moderate-to-severe plaque psoriasis. Objectives: To evaluate real-world effectiveness of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis in Canada. Methods: A multicenter, retrospective study was conducted in Canada in adults with moderate-to-severe plaque psoriasis for ≥1 year treated with tildrakizumab for ≥12 weeks. Effectiveness was evaluated from proportions of patients achieving ≥75%/≥90%/100% improvement from baseline in Psoriasis Area and Severity Index (PASI 75/90/100 response) and Physician Global Assessment (PGA) 0 or 1 at weeks 16 (±4), 24 (±8), and 48 (±12). Subgroup analyses were performed based on prior biologic use and special site involvement. Results: The study included 75 patients (mean age, 50.5 years; 52.0% female; 82.7% bio-naïve; 73.3% with special site involvement). Absolute mean (standard deviation) PASI score improved from 16.1 (6.7) at baseline to 1.3 (1.7) at the week 48 (91.7% improvement), 95.7%/69.6%/34.8% of patients achieved PASI 75/90/100 response, and 93.0% achieved PGA 0/1 at the week 48. In subgroup analyses, 94.7%/71.1%/34.2% of bio-naïve patients, 100.0%/62.5%/37.5% of bio-experienced patients, 100.0%/71.4%/28.6% of patients with special site involvement, and 81.8%/63.6%/54.6% of patients without special site involvement achieved PASI 75/90/100 response, and 87.5%, 94.3%, 97.0%, and 80.0% of patients, respectively, achieved PGA 0/1 at the week 48. None of the differences among subgroups were statistically significant; however, patient numbers were too small to support robust conclusions. Conclusions: Tildrakizumab is effective for the treatment of moderate-to-severe plaque psoriasis in adults in a real-world setting in Canada.

To the Editor: Although Janus kinase inhibitors (JAKis) demonstrated robust efficacy for treatment of plaque psoriasis (PsO) in randomized clinical trials, an increased incidence of infections was reported with their use.1 This systematic review with meta-analysis characterizes infections observed in JAKi-treated patients with PsO.

To the Editor: The development of immune checkpoint inhibitors (ICIs) is a significant therapeutic advancement in medical oncology. However, adverse events of psoriasis onset were reported in small studies.1 This systematic review characterizes all reports of ICI-associated psoriasis to improve our understanding of the clinical implications.

It is not uncommon for the closure of a surgical wound to leave a small puckering of skin known as a dog ear.1,2 Especially with Mohs surgery, where the defect is asymmetric, closure will result in excess tissue at the end of the wound. Sometimes, this excess tissue is so small that it can be difficult to lift and excise the puckered skin without further extending the wound.