Great outcomes for urticaria (“hives”) patients with new injectable medication!

 

Spontaneous urticaria (hives) is such a common condition but can be difficult to manage. Patients describe itchy welts, swollen and red skin, and sometimes swollen eyes and lips too. The rash typically resolves within 24 hours but then the cycle repeats itself and new rash appears on other areas of the body. It can be incredibly itchy or even painful and can be frustrating to treat.

I myself suffer from urticaria too but mine is set off by temperature changes (“cold-induced urticaria”) and friction (“delayed-pressure urticaria”).  Any of my urticaria patients will attest to my empathy with their skin rash; as I have first hand knowledge of how frustrating it can be to manage! When patients present with urticaria, it is important to find out the triggers (heat, sweat, friction, stress, medication etc) and also exclude any other underlying medical conditions that can contribute to their urticaria flaring. This means taking a detailed history for other symptoms and blood tests may be needed. Typically urticaria treatments might involve creams, UV therapy and tablets.

Now a new injectable biologic medication, Omalizumab, is available under the PBS for our patients with chronic spontaneous urticaria since late 2017. Only some dermatologists are able to prescribe this medication (Dr Georgina Lyons and myself satisfy PBS criteria to prescribe this medication). Omalizumab works by binding to circulating IgE; a molecule responsible for setting off an inflammatory cascade, leading to the symptoms of itch and rash. Omalizumab has been on the PBS for a while for the indication of asthma but has been a recent addition to the PBS under dermatology for the indication of Chronic Spontaneous Urticaria (or CSU for short). In the past, patients with CSU have used various combinations of H1 (histamine 1) blockers and H2 blockers, UV therapy, Plaquenil (an anti-malarial tablet that acts to reduce inflammation), mast-cell stabiliser medications and then immunosuppression – all in a bid to control their rash and itching. Now we are finding that patients are able to transition straight from the H1 and H2 blocker combination, to Omalizumab straight away and these patients are reporting great outcomes.

Omalizumab is given as a monthly injection and PBS gives patients 3 months worth of medication at a time. After the 3-month period of medication is up, patients then make an assessment as to whether they need another round of injections or they can take a trial period off the injections and monitor their symptoms to see if there is a flare. If they need another period of treatment, then their dermatologist can apply for another 3 months.

It is a well tolerated medication and some patients with a history of very difficult to control urticaria have had a great response to this medication. We would be happy to offer you an appointment with our team to fully assess and manage your urticaria.

Acne and early treatment

In this blog we would like to discuss one of our lovely patient’s journey with acne and share with you some very impressive before and after photo’s.

Our patient is a 25yo gentleman who has been struggling with cystic acne since the age of 14. Over the course of 11 years he experienced large cystic lesions to his chest, back, face and neck that are typically associated with significant atrophic (pitted) scarring. He found his acne would increase with consumption of certain foods and had tried many different types of skincare with little change to his skin.

The lesions were painful, red and visible.

He came to us with a pre-conceived notion of treatment options and their side effects and efficacy and had avoided medical treatment for many years because of this.  After a thorough consultation, with skin education and encouragement he was happy to try treatment and commenced on oral isotretinoin, oral antibiotic cover and anti-inflammatories to reduce flare-up which can occur with this type of acne. He received a detailed consultation regarding appropriate skincare and acne aetiology (causal factors).

The images pictured are only 4 weeks post commencement of treatment and this gentleman is so thrilled with his results he has provided his very own ‘before and after’ images that he has previously shared on social media personally and was more than happy for us to share on this platform for the benefit of others. We are thrilled to join him on his journey to great skin!

He told us he wanted to share his images as (in his own words) “I put up with my acne for so long and if my “before and after” pictures can help patients make the decision to see a dermatologist and get treatment early, then I’m happy to help.”

 

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