A newsletter that delivers the latest in dermatology research directly to you.
eightY-First issue
March 19, 2025
How does residence in a disadvantaged neighborhood influence the thickness of melanoma at diagnosis?
JAMA Dermatology
JAMA Dermatology
How do ZIP codes shade skin cancer risk? MAPping Melanoma with ADI
Lower socioeconomic status has been associated with thicker cutaneous melanomas at diagnosis, directly impacting survival. The Veterans Health Administration cares for a population with a high proportion of rural residence, low socioeconomic status, and low educational attainment. This retrospective cohort study utilizes the area deprivation index (ADI) to measure neighborhood-level social disadvantage, investigating its relationship with thickness of melanoma at diagnosis.
What did they find?
Main Takeaway: Residence in disadvantaged neighborhoods is associated with an increased risk and probability of a thicker melanoma (>2mm) at diagnosis, underscoring the role of social and economic factors in melanoma diagnosis.
Lower socioeconomic status has been associated with thicker cutaneous melanomas at diagnosis, directly impacting survival. The Veterans Health Administration cares for a population with a high proportion of rural residence, low socioeconomic status, and low educational attainment. This retrospective cohort study utilizes the area deprivation index (ADI) to measure neighborhood-level social disadvantage, investigating its relationship with thickness of melanoma at diagnosis.
What did they find?
- There was an 18% (95% CI=0.15-0.22) probability of having a thick melanoma (>2mm) at diagnosis among veterans in the first ADI quintile (least disadvantaged areas). This was 23% (95% CI=0.20-0.25) and 24% (95% CI=0.21-0.28) in the fourth and fifth quintiles respectively (most disadvantaged areas).
- Compared to the first quintile, the risk of thicker melanoma at diagnosis was higher in the fourth (adjusted risk ratio=1.24; 95% CI=0.99-1.55) and fifth quintiles (adjusted risk ratio=1.33; 95% CI=1.05-1.68).
- Veterans in the fifth quintile had a higher proportion (29.2%) of melanomas on the head and neck, while veterans in the first quintile had higher proportions of melanomas in the lower extremities (11.1%).
- Nodular (10.9%) and superficial spreading (29.2%) melanomas were more common in the fifth ADI quintile, while acral lentiginous (1.9%) and lentigo maligna (10.9%) melanomas were more common in the first quintile.
Main Takeaway: Residence in disadvantaged neighborhoods is associated with an increased risk and probability of a thicker melanoma (>2mm) at diagnosis, underscoring the role of social and economic factors in melanoma diagnosis.
How does diet impact the development of seborrheic dermatitis?
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
No more big feasts can help get rid of the yeast!
Seborrheic dermatitis (SD) is a common inflammatory skin condition characterized by erythematous patches with greasy yellow scale in sebum-rich areas. While SD is traditionally linked to an overgrowth of Malassezia furfur, diet is being investigated as a potential contributing factor. This prospective, single-center, case-control study examined the role of metabolic factors, including antioxidants and glycemic load, in SD development and severity.
What did they find?
Main Takeaway: Dietary factors, including glycemic load and antioxidant levels, may influence SD development and severity. Exploring dietary modifications could be a potential adjunctive approach to SD management.
Seborrheic dermatitis (SD) is a common inflammatory skin condition characterized by erythematous patches with greasy yellow scale in sebum-rich areas. While SD is traditionally linked to an overgrowth of Malassezia furfur, diet is being investigated as a potential contributing factor. This prospective, single-center, case-control study examined the role of metabolic factors, including antioxidants and glycemic load, in SD development and severity.
What did they find?
- Among 49 patients diagnosed with SD and 40 healthy age-matched controls, total antioxidant capacity was lower in SD than control (P < 0.001).
- Higher glycemic load was observed in SD patients compared to controls, even after adjusting for BMI and metabolic syndrome risk factors (P < 0.001).
Glycemic index and glycemic load were significantly higher in severe SD compared to mild SD (P = 0.014, 0.017, respectively).
Main Takeaway: Dietary factors, including glycemic load and antioxidant levels, may influence SD development and severity. Exploring dietary modifications could be a potential adjunctive approach to SD management.
Is inpatient monitoring necessary for propanolol initiation in infantile hemangiomas?
Journal of Pediatric Dermatology
Journal of Pediatric Dermatology
Beta (blocker) safe than sorry? Assessing propranolol monitoring in infants!
Infantile hemangiomas (IH) are common vascular tumors affecting 2% to 10% of the pediatric population and can lead to complications such as ulceration, hemorrhage, and scarring. Oral propranolol is the FDA-approved treatment for complicated IH, with specific dosing and inpatient monitoring recommended for infants under 5 weeks old, those with low birth weight, or prematurity. This retrospective chart review evaluated propranolol initiation, inpatient monitoring, and complications during admission.
What did they find?
Main Takeaway: Inpatient propranolol initiation for infants under 5 weeks corrected age or weighing <5 kg is associated with few complications, suggesting that less intensive monitoring may be needed than currently recommended.
Infantile hemangiomas (IH) are common vascular tumors affecting 2% to 10% of the pediatric population and can lead to complications such as ulceration, hemorrhage, and scarring. Oral propranolol is the FDA-approved treatment for complicated IH, with specific dosing and inpatient monitoring recommended for infants under 5 weeks old, those with low birth weight, or prematurity. This retrospective chart review evaluated propranolol initiation, inpatient monitoring, and complications during admission.
What did they find?
- 78 pediatric patients (<1 year old) with IH or PHACE syndrome diagnosis admitted for propranolol initiation and monitoring were identified.
- After propranolol initiation, there were statistically significant decreases in blood pressure (systolic: P=0.005, diastolic: P=0.002) and heart rate (P=0.002).
- However, average BP and HR remained above the lower limit of normal and were not clinically significant.
- No patients experienced symptomatic hypoglycemia during monitoring.
Main Takeaway: Inpatient propranolol initiation for infants under 5 weeks corrected age or weighing <5 kg is associated with few complications, suggesting that less intensive monitoring may be needed than currently recommended.
Increased risk of bullous pemphigoid associated with drugs commonly prescribed in older patients
British Journal of Dermatology
British Journal of Dermatology
The blistering truth about common medications given to older patients…
Bullous pemphigoid (BP) is a rare autoimmune blistering disorder that primarily affects older adults. While certain medications have been identified as risk factors for developing BP, a better understanding of drugs commonly used in this population could lead to earlier recognition and more conservative management. This population-based nested case-control study (1998–2021) used electronic medical records to investigate drug exposure in BP patients.
What did they find?
Main Takeaway: Penicillins, gliptins, and second-generation antipsychotics are associated with an increased risk of BP in older patients. While clinicians should be aware of this risk when prescribing these medications, they should not be avoided solely to prevent BP.
Bullous pemphigoid (BP) is a rare autoimmune blistering disorder that primarily affects older adults. While certain medications have been identified as risk factors for developing BP, a better understanding of drugs commonly used in this population could lead to earlier recognition and more conservative management. This population-based nested case-control study (1998–2021) used electronic medical records to investigate drug exposure in BP patients.
What did they find?
- Antibiotics had the highest risk of BP [OR 4.60, CI 4.40–4.80], even after accounting for protopathic bias [OR 2.08, CI 1.99–2.17]. Penicillins [OR 3.44, CI 3.29–3.60] and penicillinase-resistant penicillins [OR 7.56, CI 7.15–8.00] had the strongest associations.
- Gliptins were strongly associated with increased risk of BP [OR 2.77, CI 2.37–3.23].
- Second-generation antipsychotics also showed an increased risk of BP [OR 2.58, CI 2.20–3.03].
Main Takeaway: Penicillins, gliptins, and second-generation antipsychotics are associated with an increased risk of BP in older patients. While clinicians should be aware of this risk when prescribing these medications, they should not be avoided solely to prevent BP.
Don't wait to ~take a shot~ at protection from Mpox - vaccines can get the “jab done”!
Mpox, a virus in the Orthopoxvirus genus, generally causes milder symptoms than smallpox but can be severe in people living with HIV (PLWH) due to a weakened immune system. The disease progresses from an incubation period to flu-like symptoms, followed by a widespread rash. Despite the higher risk of Mpox in PLWH, vaccine acceptance is influenced by factors such as personal beliefs, stigma, and healthcare access. This systematic review and meta-analysis examined Mpox vaccine acceptance among PLWH to guide targeted public health strategies and improve vaccination efforts.
What did they find?
Main Takeaway: This review highlights moderate Mpox vaccine acceptance and significant hesitancy among PLWH, emphasizing the need for targeted public health strategies and ongoing research to improve vaccine uptake and protect this high-risk population.
Mpox, a virus in the Orthopoxvirus genus, generally causes milder symptoms than smallpox but can be severe in people living with HIV (PLWH) due to a weakened immune system. The disease progresses from an incubation period to flu-like symptoms, followed by a widespread rash. Despite the higher risk of Mpox in PLWH, vaccine acceptance is influenced by factors such as personal beliefs, stigma, and healthcare access. This systematic review and meta-analysis examined Mpox vaccine acceptance among PLWH to guide targeted public health strategies and improve vaccination efforts.
What did they find?
- 17 studies with a total of 7,248 participants met the inclusion criteria.
- Mpox vaccine acceptance among PLWH varied widely, ranging from 24% to 84.1%, with a pooled prevalence of 61.1% (95% CI: 44.2–75.7%) and high heterogeneity (I² = 99%).
- Acceptance was highest in China (92%) and the Netherlands (86%), but lowest in Israel (27%) and France (24%).
- Mpox vaccine hesitancy had a pooled prevalence of 13.2% (95% CI: 2.4–48.6%), also showing considerable variability across studies (I² = 99%).
Main Takeaway: This review highlights moderate Mpox vaccine acceptance and significant hesitancy among PLWH, emphasizing the need for targeted public health strategies and ongoing research to improve vaccine uptake and protect this high-risk population.
The AI Complexion Connection: Is ChatGPT equipped for all Fitzpatrick Skin types?
Skin of color (SoC) is often underrepresented in medical education, leading to diagnostic challenges in clinical practice. This educational gap may also affect artificial intelligence (AI) models, which rely on diverse training data for accuracy. This study evaluated ChatGPT-4.0’s diagnostic performance on 17 dermatological conditions using images from both SoC (Fitzpatrick types V & VI) and non-SoC patients. Images were matched by location and severity and confirmed by three board-certified dermatologists before being analyzed.
What did they find?
Main Takeaway: ChatGPT shows promise as a diagnostic tool, but further training on SoC images is needed to improve equitable diagnostic accuracy. These findings underscore the underrepresentation of SoC in medical education and highlight the need for more diverse training datasets in AI development.
Skin of color (SoC) is often underrepresented in medical education, leading to diagnostic challenges in clinical practice. This educational gap may also affect artificial intelligence (AI) models, which rely on diverse training data for accuracy. This study evaluated ChatGPT-4.0’s diagnostic performance on 17 dermatological conditions using images from both SoC (Fitzpatrick types V & VI) and non-SoC patients. Images were matched by location and severity and confirmed by three board-certified dermatologists before being analyzed.
What did they find?
- 17 dermatological conditions were tested using 5 SoC and 5 non-SoC images per condition
- ChatGPT’s diagnostic accuracy was significantly lower for SoC images (71.8%) compared to non-SoC images (90.6%) (P=0.003).
- Correct disease was included in the differential diagnosis 95.3% of the time for non-SoC and 89.4% for SoC.
- Urticaria was difficult to diagnose in all skin types, while Atopic dermatitis, Contact dermatitis, and Alopecia Areata had lower SoC representation, contributing to diagnostic challenges.
Main Takeaway: ChatGPT shows promise as a diagnostic tool, but further training on SoC images is needed to improve equitable diagnostic accuracy. These findings underscore the underrepresentation of SoC in medical education and highlight the need for more diverse training datasets in AI development.
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