A newsletter that delivers the latest in dermatology research directly to you.
seventy-SEVENTH issue
January 22, 2025
Unpacking the flakes and frustrations of psoriasis in Latine lives
Latine populations with psoriasis are more likely to be undiagnosed and experience severe disease with systemic comorbidities, yet they are underrepresented in psoriasis clinical research. This qualitative interview study of 30 Latine adults with psoriasis explored patient experiences with psoriasis and their perceptions of treatment and research.
What did they find?
Main Takeaway: Psoriasis profoundly affects the lives of Latine patients, many of whom face numerous barriers to treatment. Nonetheless, patients express favorability towards biologic treatments and remain interested in participating in research.
Latine populations with psoriasis are more likely to be undiagnosed and experience severe disease with systemic comorbidities, yet they are underrepresented in psoriasis clinical research. This qualitative interview study of 30 Latine adults with psoriasis explored patient experiences with psoriasis and their perceptions of treatment and research.
What did they find?
- Most participants expressed frustration with psoriasis, citing unfamiliarity with its symptoms, work-related irritant exposure, and subsequently limited job opportunities as significant challenges.
- Regarding treatment, patients often sought guidance from family and friends, engaged in alternative medicine practices, obtained medication outside the US, and favored systemic biologics; however, they faced notable barriers, including language, insurance, and socioeconomic factors.
- Although no participants had experience with research, many expressed openness to participation in future studies but expressed confusion regarding the influence of research on their care.
Main Takeaway: Psoriasis profoundly affects the lives of Latine patients, many of whom face numerous barriers to treatment. Nonetheless, patients express favorability towards biologic treatments and remain interested in participating in research.
Screening guidelines for secondary adenocarcinoma in patients with extramammary Paget’s disease
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
No better way to ring in the new year with guidelines for Extramammary Paget’s disease!
Extramammary Paget’s disease (EMPD) is a cutaneous malignancy confined to the vulvar, penoscrotal, and perianal skin. Roughly 1 in 5 published cases of EMPD are associated with a secondary internal adenocarcinoma, though this rate is not well established. Furthermore, cancer screening guidelines for those with EMPD are underdeveloped. This systematic review of 122 studies containing over 14,000 patients with EMPD aimed to quantify the rate of secondary adenocarcinoma and create an evidence-based cancer screening algorithm for EMPD based on the anatomic subtype.
What did they find?
Main Takeaway: Perianal EMPD requires comprehensive screening due to its higher risk of secondary adenocarcinoma. For penoscrotal and vulvar EMPD, targeted testing based on individual risk factors and symptoms is appropriate. The proposed screening algorithm provides a structured approach to optimize early cancer detection in EMPD patients.
Extramammary Paget’s disease (EMPD) is a cutaneous malignancy confined to the vulvar, penoscrotal, and perianal skin. Roughly 1 in 5 published cases of EMPD are associated with a secondary internal adenocarcinoma, though this rate is not well established. Furthermore, cancer screening guidelines for those with EMPD are underdeveloped. This systematic review of 122 studies containing over 14,000 patients with EMPD aimed to quantify the rate of secondary adenocarcinoma and create an evidence-based cancer screening algorithm for EMPD based on the anatomic subtype.
What did they find?
- The rate of secondary adenocarcinoma was 18%. Perianal EMPD conferred a rate of 25%, penoscrotal 6%, and vulvar 6%.
- Perianal EMPD Guidelines: Annual colonoscopy, urine cytology, and chest/abdomen/pelvis CT are recommended for high-risk cases and biennially for low-risk cases within the first 5 years post-diagnosis.
- Penoscrotal EMPD Guidelines: PSA testing, urine cytology, and fecal occult blood tests are suggested every other year for 5 years.
- Vulvar EMPD Guidelines: Mammography and urine cytology are advised on a similar timeline.
Main Takeaway: Perianal EMPD requires comprehensive screening due to its higher risk of secondary adenocarcinoma. For penoscrotal and vulvar EMPD, targeted testing based on individual risk factors and symptoms is appropriate. The proposed screening algorithm provides a structured approach to optimize early cancer detection in EMPD patients.
Itching for answers: Quantifying the global prevalence of scabies
Scabies, a contagious parasitic disease, affects an estimated 200 million people globally, with the highest burden in Asia, Oceania, and Latin America. It disproportionately impacts children, the elderly, and immunocompromised individuals, causing severe itching, skin lesions, and complications such as bacterial infections, glomerulonephritis, and acute rheumatic fever. Despite its significant health and socio-economic impacts, data on its global prevalence and distribution remain limited. This meta-analysis aimed to assess the prevalence of scabies and associated risk factors.
What did they find?
Main Takeaway: Scabies prevalence appears to be driven more strongly by geographic and behavioral factors than socioeconomic status. Targeted health promotion programs addressing these risk factors are essential to reduce its prevalence and mitigate its impact.
Scabies, a contagious parasitic disease, affects an estimated 200 million people globally, with the highest burden in Asia, Oceania, and Latin America. It disproportionately impacts children, the elderly, and immunocompromised individuals, causing severe itching, skin lesions, and complications such as bacterial infections, glomerulonephritis, and acute rheumatic fever. Despite its significant health and socio-economic impacts, data on its global prevalence and distribution remain limited. This meta-analysis aimed to assess the prevalence of scabies and associated risk factors.
What did they find?
- The meta-analysis included 70 studies, with 10,324,381 participants from diverse global regions with sample sizes ranging from 118 to over 9 million.
- The global pooled prevalence of scabies was 11.9% (95% CI: 9.60%–14.7%), with the highest prevalence in the Western-Pacific (17.8%) followed by Africa (12.9%) and South-East Asia (11.4%).
- Higher prevalence was observed in hospitals (13.1%) compared to community-based studies (12.3%).
- Upper-middle-income countries had the highest prevalence (15.2%), followed by lower-middle, low, and high-income countries.
- Higher prevalence was observed in hospitals (13.1%) compared to community-based studies (12.3%).
- Significant risk factors included contact with household members with itch, non-use of soap, bed and cloth sharing, infrequent bathing, and presence of pets.
Main Takeaway: Scabies prevalence appears to be driven more strongly by geographic and behavioral factors than socioeconomic status. Targeted health promotion programs addressing these risk factors are essential to reduce its prevalence and mitigate its impact.
Maternal history of seborrheic dermatitis has been shown to be a risk factor for the development of infantile and childhood-onset seborrheic dermatitis
British Journal of Dermatopathology
British Journal of Dermatopathology
The apple doesn’t fall far from the tree!
Seborrheic dermatitis (SD) is a common, chronic skin condition that typically affects the scalp but can occur in other areas, like the face and chest. Infantile SD, aka “cradle cap,” appears within the first few months of life; in older children and adults, SD is often linked to dandruff. The relationship between infantile SD, childhood-onset SD (onset after 5 years of age), and adult SD is poorly understood. To investigate the genetic component of SD, researchers used IQVIA Medical Research Data to analyze 1,023,140 children with linked maternal data.
What did they find?
Limitation: This study is unable to attribute the increased risk to only maternal genetics as the child’s environment can play a role.
Main Takeaway: Children of mothers with SD are more likely to develop the condition themselves as an infant, after 5 years of age, and as an adult, but having SD as an infant does not increase their risk of childhood-onset SD.
Seborrheic dermatitis (SD) is a common, chronic skin condition that typically affects the scalp but can occur in other areas, like the face and chest. Infantile SD, aka “cradle cap,” appears within the first few months of life; in older children and adults, SD is often linked to dandruff. The relationship between infantile SD, childhood-onset SD (onset after 5 years of age), and adult SD is poorly understood. To investigate the genetic component of SD, researchers used IQVIA Medical Research Data to analyze 1,023,140 children with linked maternal data.
What did they find?
- Mothers with SD were more likely to have children with SD in adulthood [HR 1.99, (1.91–2.09)].
- Maternal history of SD increased the risk for infantile SD [HR 1.86, (1.74–1.99)].
- Maternal history of SD increased the risk for childhood-onset SD [HR 2.12, (1.97–2.29)].
- Infantile SD did not increase the risk of childhood-onset SD [HR 0.91, (0.82–1.01)].
Limitation: This study is unable to attribute the increased risk to only maternal genetics as the child’s environment can play a role.
Main Takeaway: Children of mothers with SD are more likely to develop the condition themselves as an infant, after 5 years of age, and as an adult, but having SD as an infant does not increase their risk of childhood-onset SD.
Is it safe to administer live attenuated vaccines to children treated with methotrexate or dupilumab?
Pediatric Dermatology
Pediatric Dermatology
No ‘Reactions’ to Live Vaccines in Kids on Methotrexate or Dupilumab
The common recommendation to avoid live virus vaccines in patients on immunosuppressive medications has largely been based on theoretical concerns rather than specific clinical data for individual drugs. This retrospective review analyzed electronic medical records from a pediatric tertiary care center, focusing on patients who received a live attenuated vaccine within six weeks before or after starting treatment with methotrexate or dupilumab.
What did they find?
Main Takeaway: In this small cohort of pediatric patients, no adverse events were reported following the MMRV vaccine while on dupilumab or methotrexate; however, further research is needed to confirm the safety and efficacy of live attenuated vaccines in children receiving these immunomodulating treatments.
The common recommendation to avoid live virus vaccines in patients on immunosuppressive medications has largely been based on theoretical concerns rather than specific clinical data for individual drugs. This retrospective review analyzed electronic medical records from a pediatric tertiary care center, focusing on patients who received a live attenuated vaccine within six weeks before or after starting treatment with methotrexate or dupilumab.
What did they find?
- 313 pediatric patients were treated with methotrexate and/or dupilumab over the 7 years analyzed.
- 5 received the MMRV (measles, mumps, rubella, and varicella) vaccine while on dupilumab and 4 while on methotrexate.
- No adverse events were noted in any of these patients within 6 months after vaccination.
Main Takeaway: In this small cohort of pediatric patients, no adverse events were reported following the MMRV vaccine while on dupilumab or methotrexate; however, further research is needed to confirm the safety and efficacy of live attenuated vaccines in children receiving these immunomodulating treatments.
Could UVSD be the new way of detecting MAY globules in BCC?
Journal of Cosmetic Dermatology
Journal of Cosmetic Dermatology
MAY the UVFD be with you
Aggressive forms of basal cell carcinoma (BCC) may contain multiple aggregated yellow-white (MAY) globules, a characteristic that can aid detection and diagnosis but is often overlooked. These globules can be visualized using ultraviolet-induced fluorescence dermatoscopy (UVFD) at 365 nm UV light. A retrospective study conducted at seven institutions analyzed biopsy-proven BCCs to evaluate the presence of MAY globules using UVFD, polarized light, and nonpolarized light.
What did they find?
Main Takeaway: UVFD is a promising modality for visualizing MAY globules, significantly enhancing physician confidence in identifying BCCs.
Aggressive forms of basal cell carcinoma (BCC) may contain multiple aggregated yellow-white (MAY) globules, a characteristic that can aid detection and diagnosis but is often overlooked. These globules can be visualized using ultraviolet-induced fluorescence dermatoscopy (UVFD) at 365 nm UV light. A retrospective study conducted at seven institutions analyzed biopsy-proven BCCs to evaluate the presence of MAY globules using UVFD, polarized light, and nonpolarized light.
What did they find?
- 142 BCC were evaluated, with 16 cases showing MAY globules.
- The 16 cases were evaluated by 3 dermoscopic experts with a polarized and UVFD image.
- 39/48 (81.3%) polarized images identified MAY globules compared to 46/48 (95.8%) were identified in UVFD images.
- The dermoscopic experts ranked their confidence in identifying MAY globules using a 5-point visual analog scale. The mean confidence score was 3.8 (SD = 1.3) with polarized light, compared to 4.6 (SD = 0.8) when using UVFD images.
Main Takeaway: UVFD is a promising modality for visualizing MAY globules, significantly enhancing physician confidence in identifying BCCs.
Figure 1. Micronodular type basal cell carcinoma under polarized light (A) and UVFD (B) with black arrows denoting MAY globules and red arrows indicating MAY globules not seen under polarized light.
DERMLITE Dermoscopy QUESTION OF THE WEEK
Hidradenitis suppurativa (HS) is a chronic, multifactorial condition marked by cycles of inflammation, healing, and scarring, which severely impact quality of life. Systemic medications and surgical therapies can reduce active lesions and inflammation but may not consistently prevent recurrences or disease progression. This systematic review assessed the efficacy of intense pulsed light (IPL) and laser hair treatments in reducing lesions and flare frequency in HS patients.
What did they find?
Main Takeaway: These findings moderately support the effectiveness of IPL and laser hair removal as adjunct therapies for HS treatment. However, further long-term studies are needed to establish optimal treatment durations and intervals for sustained disease control.
What did they find?
- Significant reductions in the overall count of inflammatory lesions were observed in all studies, with percentages ranging from 50% to 75%, and in some cases, achieving complete resolution.
- Duration of disease remission varied.
- At the end of treatment with the Nd: YAG laser and at least one month after treatment, a significant reduction in the number of lesions was seen.
- At the 30-week evaluation of the Alexandrite Laser, 70% of patients in the laser-treated group and 20% (p<0.001) in the control showed reduction.
- All 3 studies investigating intense pulsed light showed significant reductions in HS-associated lesions.
Main Takeaway: These findings moderately support the effectiveness of IPL and laser hair removal as adjunct therapies for HS treatment. However, further long-term studies are needed to establish optimal treatment durations and intervals for sustained disease control.
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Copyright © 2023 - All Rights Reserved.