eightY-Third issue
April 16, 2025
From screening to surveillance – how risk factors can guide targeted skin cancer surveillance in bone marrow transplant patients
Although cutaneous malignancies are the most common solid neoplasms after bone marrow transplants (BMTs), comprehensive evaluations of associated risk factors remain limited. This cohort study utilized data from the Bone Marrow Transplant Survivor Study (BMTSS) to assess the long-term risk of developing cutaneous malignancies among BMT recipients.
What did they find?
Main Takeaway: This large-scale cohort study offers one of the most comprehensive evaluations of cutaneous malignancy risk after BMT to date. The findings highlight key patient- and treatment-related factors that can guide individualized post-transplant skin cancer surveillance and early detection strategies.
Although cutaneous malignancies are the most common solid neoplasms after bone marrow transplants (BMTs), comprehensive evaluations of associated risk factors remain limited. This cohort study utilized data from the Bone Marrow Transplant Survivor Study (BMTSS) to assess the long-term risk of developing cutaneous malignancies among BMT recipients.
What did they find?
- The 30-year cumulative incidence of cutaneous malignancy after BMT was 27.4%, including BCC (18.0%), SCC (9.8%), and melanoma (3.7%).
- Risk was higher among patients aged ≥50 years at transplant (BCC: SHR=1.76; SCC: SHR=3.37), males (BCC: SHR=1.39; SCC: SHR=1.85), and those with pre-BMT monoclonal antibody exposure (BCC: SHR=1.71).
- Allogeneic BMT with chronic GVHD was associated with increased risk compared to autologous BMT (BCC: SHR=1.48; SCC: SHR=2.61).
- Post-BMT immunosuppression elevated risk for BCC (SHR=1.63), SCC (SHR=1.48), and melanoma (SHR=1.90).
- Among patients under 50, total body irradiation was linked to higher BCC risk (SHR=1.92).
- Race and ethnicity other than non-Hispanic White were protective, particularly for Hispanic patients (BCC: SHR=0.27; SCC: SHR=0.28).
Main Takeaway: This large-scale cohort study offers one of the most comprehensive evaluations of cutaneous malignancy risk after BMT to date. The findings highlight key patient- and treatment-related factors that can guide individualized post-transplant skin cancer surveillance and early detection strategies.
The current state of lichen planus treatment patterns
Journal of the American Academy of Dermatology
Journal of the American Academy of Dermatology
Pushin’ past the 5 P’s of lichen planus
Lichen planus (LP) is a chronic inflammatory condition with multiple clinical variants affecting the skin and/or mucous membranes. While topical corticosteroids are the mainstay of treatment, disease relapse and treatment resistance remain common. This cross-sectional study analyzed U.S. adult health record data from the Explorys database to determine the prevalence of LP and evaluate treatment patterns.
What did they find?
Main Takeaway: This study highlights that most LP cases are not initially treated by dermatologists, and patients who begin treatment with systemic agents are more likely to require therapy changes, underscoring the need for optimized, long-term treatment strategies
Lichen planus (LP) is a chronic inflammatory condition with multiple clinical variants affecting the skin and/or mucous membranes. While topical corticosteroids are the mainstay of treatment, disease relapse and treatment resistance remain common. This cross-sectional study analyzed U.S. adult health record data from the Explorys database to determine the prevalence of LP and evaluate treatment patterns.
What did they find?
- Among 566,851 eligible patients, 1,098 were diagnosed with LP, yielding a prevalence of 0.19%.
- Women were 1.8 times more likely to be diagnosed with LP than men, though no significant differences were observed across racial groups.
- In a treatment-focused cohort, 53% of patients received no therapy within one year of diagnosis, while 38.3% were initially treated with topical corticosteroids.
- Among patients started on systemic steroids or hydroxychloroquine, 46% and 39%, respectively, switched therapies during management.
Main Takeaway: This study highlights that most LP cases are not initially treated by dermatologists, and patients who begin treatment with systemic agents are more likely to require therapy changes, underscoring the need for optimized, long-term treatment strategies
Can roflumilast cream effectively and safely treat atopic dermatitid in children aged 2-5 years?
Pediatric Dermatology
Pediatric Dermatology
Little rash, big relief–Roflumilast to the rescue!
Atopic dermatitis (AD) affects up to 20% of children globally, often resulting in pruritus, discomfort, and reduced quality of life. Current topical therapies are limited by irritation, frequent dosing, age restrictions, and boxed warnings. Roflumilast cream, a once-daily, non-irritating topical PDE4 inhibitor, has shown efficacy across several inflammatory skin diseases and was recently evaluated in the INTEGUMENT-PED trial for children aged 2–5 years.
What did they find?
Atopic dermatitis (AD) affects up to 20% of children globally, often resulting in pruritus, discomfort, and reduced quality of life. Current topical therapies are limited by irritation, frequent dosing, age restrictions, and boxed warnings. Roflumilast cream, a once-daily, non-irritating topical PDE4 inhibitor, has shown efficacy across several inflammatory skin diseases and was recently evaluated in the INTEGUMENT-PED trial for children aged 2–5 years.
What did they find?
- At Week 4, 25.4% of children treated with roflumilast cream achieved vIGA-AD success, compared to 10.7% with vehicle (P < 0.0001).
- EASI-75 was achieved by 39.4% of roflumilast-treated patients vs. 20.6% with vehicle (P < 0.0001).
- WI-NRS success (improvement in itch) was reached by 35.3% of patients in the treatment group vs. 18.0% in the vehicle group (P = 0.0002).
- Pruritus improvement was observed as early as 24 hours after first use (P = 0.0014), with low adverse event rates and good tolerability.
What are the dermatologic conditions and barriers faced by migrant populations in the US?
Global Dermatology
Global Dermatology
Where the dermis meets the divide: Dermatologic challenges among migrant populations
The U.S. has experienced a steady rise in its migrant population, with immigrants comprising 13.9% of the total population in 2022 and a marked increase in refugee admissions in early 2023. Migrants face unique dermatologic challenges shaped by environmental exposures, occupational hazards, and migration-related trauma. Social determinants, including limited healthcare access, language barriers, and socioeconomic disparities, further compound these issues. This scoping review of 87 articles involving 12,633 participants aimed to characterize dermatologic considerations for migrant populations in the U.S.
What did they find?
Main Takeaway: This review underscores the multifaceted factors affecting migrant skin health in the U.S., including a wide spectrum of dermatologic conditions, significant environmental and occupational exposures, and persistent structural barriers to care.
The U.S. has experienced a steady rise in its migrant population, with immigrants comprising 13.9% of the total population in 2022 and a marked increase in refugee admissions in early 2023. Migrants face unique dermatologic challenges shaped by environmental exposures, occupational hazards, and migration-related trauma. Social determinants, including limited healthcare access, language barriers, and socioeconomic disparities, further compound these issues. This scoping review of 87 articles involving 12,633 participants aimed to characterize dermatologic considerations for migrant populations in the U.S.
What did they find?
- The most commonly reported dermatologic conditions were infections (51.7%) and inflammatory skin diseases (37.9%).
- The most frequent countries of origin included Mexico (43%), Guatemala (21.5%), and Vietnam (12.3%).
- Environmental exposures and migration-related violence were linked to conditions such as leishmaniasis, leprosy, and scabies, noted in 35.6% of articles.
- Occupational risks at destination, especially among farmworkers, nail salon workers, and poultry processors, were reported in 43.6% of articles and often associated with contact dermatitis, infections, and chemical exposures.
- Structural barriers to dermatologic care, such as lack of insurance and limited provider access, were highlighted in 10% of studies.
Main Takeaway: This review underscores the multifaceted factors affecting migrant skin health in the U.S., including a wide spectrum of dermatologic conditions, significant environmental and occupational exposures, and persistent structural barriers to care.
Not Laser Hair Removal, but CO2 Laser Hair Regrowth
Central centrifugal cicatricial alopecia (CCCA) is a progressive, scarring alopecia that typically begins at the vertex of the scalp and expands outward, most commonly affecting women of African descent. Due to its scarring nature, regrowth is often limited, and hair transplantation yields poor outcomes. In mouse models, fractionated CO₂ laser therapy has been shown to promote hair neogenesis through controlled skin injury and upregulation of molecular signaling. When combined with retinoic acid, this effect may be further enhanced. This study evaluated the efficacy of CO₂ laser with and without topical retinoic acid in promoting hair regrowth in patients with treatment-resistant CCCA.
What did they find?
Central centrifugal cicatricial alopecia (CCCA) is a progressive, scarring alopecia that typically begins at the vertex of the scalp and expands outward, most commonly affecting women of African descent. Due to its scarring nature, regrowth is often limited, and hair transplantation yields poor outcomes. In mouse models, fractionated CO₂ laser therapy has been shown to promote hair neogenesis through controlled skin injury and upregulation of molecular signaling. When combined with retinoic acid, this effect may be further enhanced. This study evaluated the efficacy of CO₂ laser with and without topical retinoic acid in promoting hair regrowth in patients with treatment-resistant CCCA.
What did they find?
- 13 African American women (ages 38–70) with moderate-to-severe, treatment-resistant CCCA were enrolled.
- After a 30-day washout, each patient received a single treatment:
- One side of the scalp: 0.1% tretinoin + CO₂ laser
- Other side: CO₂ laser alone
- One side of the scalp: 0.1% tretinoin + CO₂ laser
- Hair growth was assessed by dermatoscopic hair counts and a 0–5 visual scale rated by both patients and dermatologists.
- CO₂ laser (with or without tretinoin) led to a mean increase of 29.6 hairs (P=0.00105).
- Adding tretinoin resulted in a non-significant additional increase of 2.75 hairs (P=0.178).
- Dermatologists rated greater visual improvement on the tretinoin-treated side (2.08 vs. 1.33, P=0.0210), while patient ratings showed no significant difference (1.92 vs. 1.58, P=0.166).
DERMLITE Dermoscopy QUESTION OF THE WEEK
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Copyright © 2023 - All Rights Reserved.