4600
A new proposed severity score for seborrheic dermatitis of the
face: SEborrheic Dermatitis Area and Severity Index (SEDASI)
Giuseppe Micali, MD, Dermatology Clinic, University of Catania;
Francesco Lacarrubba, MD, Dermatology Clinic, University of
Catania; Federica Dall’Oglio, MD, Dermatology Clinic, University of Catania;
Aurora Tedeschi, MD, Dermatology Clinic, University of Catania; Thomas
Dirschka, MD, Dermatologic Practice Centre, Wuppertal, and Faculty of
Health, University Witten-Herdecke
Seborrheic dermatitis (SD) is a common chronic inflammatory skin disorder, mainly
localized on the face and characterized by erythema, scaling, and itch. The clinical
manifestations of SD are typical, but severity scores are not available so far, hence, a
new simple tool, named SEborrheic Dermatitis Area and Severity Index (SEDASI), is
presented. This severity scoring system is based on the evaluation of four facial
regions, each representing approximately 25% of the entire face surface: nose
(including nasolabial folds), forehead (including eyebrows and upper eyelids), left
cheek (including lower eyelids, ear, and chin) and right cheek (including lower
eyelids, ear, and chin). For each region, 4 items are considered: 1) extension of SD
lesions expressed as percentage area of involvement (no visible lesions ¼ 0; 1-9% ¼
1; 10-29% ¼ 2; 30-49% ¼ 3; 50-69% ¼ 4; 70-89% ¼ 5; 90-100% ¼ 6); 2) presentation
pattern (no visible lesions ¼ 0; few small scattered patches ¼ 1; multiple and/or
clustered patches ¼ 2; large and/or confluent patches ¼ 3); 3) erythema degree
(none ¼ 0; pink ¼ 1; pink-red ¼ 2; intense red ¼ 3); 4) scaling degree (none ¼ 0; tiny
scales ¼ 1; medium-size thicker scales ¼ 2; large, thickened scales ¼ 3). Total score
may range from 0 (no SD) to 60 (SD of the worst possible degree). Finally, based on
the preliminary evaluation of a series of 50 patients affected by DS, we propose to
define face SEDASI score as follows: 1-14 mild; 15-29 moderate; 30-44 severe; [45
very severe. Similar to other dermatologic severity scoring systems, such as the
Psoriasis Area and Severity Index (PASI) for plaque psoriasis and the Eczema Area
and Severity Index (EASI) for atopic dermatitis, SEDASI is proposed as a new
quantitative tool for assessing facial DS severity in daily clinical practice so as to
facilitate the appropriate treatment as well as to evaluate treatment response in
clinical trials.
Commercial support: None identified.
4420
A new sonic massage device for antiaging benefits
Ortblad Katherine, MPA, L’Oreal Research & Innovation; Nina Koski,
L’Oreal Research & Innovation; Shilpa Rapaka, MS, L’Oreal Research &
Innovation; Elisa Caberlotto, PhD, L’Oreal Research & Innovation;
Mickael Poletti, L’Oreal Research & Innovation; Gregory Peterson, PhD, L’Oreal
Research & Innovation
Background: There are many changes associated with aging of human skin that
happen at the tissue, cellular and histologic level such as reduction in the thickness
of the epidermis, flattening of the dermoepidermal junction, alteration of the dermal
extracellular matrix, changes in cellular communication pathways, etc. The new
scientific field of mechanobiology describes the ability of cells to convert mechan-
ical stimuli into biochemical signals. Several studies were conducted on ex-vivo skin
to investigate the effect of sonic vibrations on antiaging effects, revealing the strong
potential of sonic frequency to promote the expression of skin biomarkers
characteristic of youthful skin (laminin 5, perlecan, fibronectin). Based on these
findings, a new sonic massage device has been developed. This sonic massage device
is designed to be used twice daily on the face, neck, and decolletage.
Objective and Methods: A single-arm, single-center, evaluator-blinded 12-week
clinical study was conducted to evaluate the clinical efficacy and tolerance of this
device. Fifty-one women (40-65 years old with moderate facial wrinkles and sagging)
used the device twice every day (3 mins per use) with a placebo moisturizer for 12
weeks. Before starting use of the device, all subjects used the placebo moisturizer
(twice daily) for a 4-week phase-in period. The parameters measured in this study
included clinical grading, Cutometer readings, tolerance assessments, VISIA-CR
photos, and self-assessment questionnaires at baseline, after 1st use, weeks 4, 8, and
12.
Results: After 12 weeks of device use, there was a statistically significant
improvement in a no. of clinical grading parameters such as facial fine lines,
wrinkles, and radiance; facial and neck sagging; decolletage radiance (P \ .001,
Wilcoxon signed-ranks test for all the measured attributes). Cutometer readings
showed a statistically significant improvement in skin extensibility (R0), pure
elasticity (R5), and biological elasticity (R7) [paired t test P ¼.015, P ¼.004, P ¼.012,
respectively]. The device treatment was well tolerated. Several other clinical studies
have also confirmed the clinical efficacy of this device in visibly improving signs
associated with skin aging.
Commercial support: 100% supported by L’Oreal.
AB18 J AM ACAD DERMATOL
5742
A novel case of hydrochlorothiazide-associated cutaneous gam-
ma/delta T-cell lymphoma
Allison Pye, MD, University of Texas Health Science Center; Janet Li,
MD, University of Texas McGovern Medical School at Houston; Vineet
Mishra, MD, University of Texas Health Science Center; Madeleine Duvic, MD,
M.D. Anderson Cancer Center
Primary cutaneous gamma/delta T-cell lymphoma (CGDTCL) is rare, with a
frequency of 1% and a 5-year survival rate of less than 5%. Patients present with
rapidly progressive disease; however, several indolent cases have been described
and suggest possible heterogeneity within this entity. Hydrochlorothiazide (HCTZ)
is a culprit in many drug reactions and has been implicated as an antigenic trigger in
CTCL. To our knowledge, HCTZ has not been previously associated with more rare
and aggressive variants such as CGDTCL. We report a case of a 45-year-old woman
who presented with an intermittent, asymptomatic rash consisting of erythematous
plaques, papules and subcutaneous nodules on her anterior upper chest and arms.
Biopsy with immunohistochemistry revealed CGDTCL. She was taking HCTZ at the
time and was advised to discontinue this medication given its previous association
with MF and SS variants of CTCL. Her CGDTCL resolved completely after HCTZ was
discontinued. This case demonstrates that not all patients with the rare CGDTCL
variant have aggressive disease, and indolent cases may be initiated by or may mimic
antigen stimulation provided by drugs or infections. A careful thorough history may
save the patient from unnecessary aggressive therapy.
Commercial support: None identified.
5241
A novel dosing schedule for vismodegib fails in an attempt to
limit side effects and control BCC
Jason Meeker, MD, West Virginia University; Donald Bennett, BS, West
Virginia University; Zachary Zinn, MD, West Virginia University;
Roxann Powers, MD, West Virginia University; Erica Ghareeb, MD, West
Virginia University
We present the case of a 73-year-old female with a large, sclerotic BCC on the right
cheek and extending across the bridge of the nose. She was not a surgical candidate
due to comorbidities and extent of involvement of the BCC. She also declined
treatment with radiation. She was started on vismodegib (hedgehog pathway
inhibitor) and responded well for 8 months with clinical shrinkage of the tumor. At
this point she developed intolerable, expected side effects of alopecia and dysgeusia
with subsequent poor appetite and weight loss. After discussion with the patient she
was started on alternating vismodegib therapy with 2 months off the medication,
then 2 months back on the medication. The time intervals were altered in an attempt
to limit side effects. Dosing intervals of 4 weeks and 6 weeks were also attempted.
She underwent several rounds of alternating dosing for a total of 11 months, until a
recurrence was noted. Dosing intervals of 4 weeks off the medication allowed for
improvement in side effects, but intervals on the medication shortened as to time of
onset for side effects as the treatment course progressed. This case highlights a failed
attempt at lengthening the use of vismodegib to limit side effects and control the
BCC. Upon progression of the tumor, the patient was referred for radiation therapy,
which at this stage is still ongoing.
Commercial support: None identified.
JUNE 2017