Oral lichen planus treated with JAK inhibitor

The first reported case of oral lichen planus responsive to baricitinib ads to a growing body of evidence supporting the use of JAK inhibitors for the treatment of the condition, according to Australian dermatologists.

The drug was proved effective in the treatment of 63-year-old woman who had  mixed erosive and reticular lichen planus in addition to chronic alopecia areata, Melbourne dermatologists report in a letter to the Australasian Journal of Dermatology.

The woman who was already being treated with longterm prednisolone and intralesional corticosteroid injections for her alopecia also showed near complete resolution of the oral irritation and discomfort in oral lichen planus that was sustained with four months of treatment with the JAK inhibitor.

They said baricitinib’s potential to impair IFN-c signalling through JAK-2/STAT-1 pathway could explain its effect in the condition that was believed to be related to auto-cytotoxic CD8+ T-cells triggering apoptosis of the basal cells of the oral epithelium.

Male doctors won’t shave facial hair to suit N95 masks

Almost half the male hospital staff required to wear a P2/N95 respirator during the COVID-19 pandemic have beards or facial hair that would potentially render them ineffective, an audit carried out in a Victorian tertiary centre has found.

Despite successfully completing fit testing with a clean shaven face in the preceding year, 45% of the 110 male staff working in three critical areas of a hospital (ICU, ED and operating theatres) were observed to have beards or to not be clean shaven in the face seal zone of their respirators.

The study authors said it was imperative that clinical staff were clean shaven in the face seal zone of their respirators so they are fit-for-purpose and ready to respond during periods of significant community transmission of COVID-19.

“Health care organisations allowing employees to have facial hair where N95 protection is required may be breaching their duty of care under OHS laws,” they said.

Male staff “experiencing a loss of identity or significant skin irritation with daily shaving should be supported so that their respiratory protection is optimised, not only to protect themselves from harm, but also to safeguard those they work with and care for,” they added.

Read more in Infection, Disease & Health

Checkpoint inhibitors promising in cSCC with PNS

A Queensland case series adds to the growing evidence for immunotherapy in the management of challenging head and neck cutaneous squamous cell carcinoma (cSCC) with large nerve perineural spread (PNS).

A retrospective review of 13 patients with PNS at the Princess Alexandra Hospital found an objective response to anti-PD-1 checkpoint inhibitor therapy in nine patients (69%), with complete response in 46% and a partial response in 23%.

Median time to response was 2.1 months while median time to progression in non-responders was 3.5 months.

“With appropriate patient selection, immunotherapy has potential to minimise surgical morbidity and the challenges of reconstruction,” the study said.

“However, this must be considered against the risks and benefits, including disease progression if given prior to surgery.”

Read more in Head & Neck