THIRTY-SECOND ISSUE
april 19, 2023
What is the Prevalence of Contact Allergy to Methylchloroisothiazolinone/Methylisothiazolinone in North America versus Europe?
JAMA Dermatology
Got contact dermatitis? Let’s “patch” it up!
Preservatives in personal care products are both necessary to prevent microbial growth and a common cause of allergic contact dermatitis globally. However, there are differences in the concentrations of isothiazolinone preservatives like methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) between Europe, Canada, and the United States. This retrospective cohort study sought to determine the prevalence of allergic contact dermatitis due to different combinations of MCI/MI in Europe versus North America via patch testing.
What did they find?
Limitations: Patch testing protocol varies between North America and Europe, making standardization challenging.
Main Takeaway: Allergic contact dermatitis prevalence due to isothiazolinone preservatives is decreasing in Europe but increasing in North America, likely due to the strict government regulation of preservatives in European personal care products.
Q: Boards fodder: what is MCI/MI found in?
A: Lots of things, but a commonly tested answer includes WET WIPES (common cause of perianal allergic contact dermatitis)
Preservatives in personal care products are both necessary to prevent microbial growth and a common cause of allergic contact dermatitis globally. However, there are differences in the concentrations of isothiazolinone preservatives like methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) between Europe, Canada, and the United States. This retrospective cohort study sought to determine the prevalence of allergic contact dermatitis due to different combinations of MCI/MI in Europe versus North America via patch testing.
What did they find?
- Isothiazolinone allergy peaked in Europe in 2013-2014 and has been declining ever since due to increasing awareness of contact allergies and new consumer regulations decreasing the percentage of MCI/MI allowed in consumer products
- MCI/MI use in North America has increased from 2009 to 2018, due to lack of government regulations restricting the use of MCI/MI
- In Europe in 2017-2018, 3.4% to 5.5% of the population studied had allergic reactions to products containing MCI/MI
- In North America in 2017-2018, 15% of the population studied had allergic reactions to products containing MCI/MI
Limitations: Patch testing protocol varies between North America and Europe, making standardization challenging.
Main Takeaway: Allergic contact dermatitis prevalence due to isothiazolinone preservatives is decreasing in Europe but increasing in North America, likely due to the strict government regulation of preservatives in European personal care products.
Q: Boards fodder: what is MCI/MI found in?
A: Lots of things, but a commonly tested answer includes WET WIPES (common cause of perianal allergic contact dermatitis)
Disparities in stage IV melanoma survival rates between adolescents and older adults
Journal of the American Academy of Dermatology
Getting old has its perks!
Melanoma is one of the most common cancers among adolescents and young adults (AYAs) aged 15-39 years old. Few studies have specifically investigated the factors that contribute to poor survival rates in this group.
Researchers conducted a population-based registry study of 81,597 cases of cutaneous melanoma (12,505 AYAs, 69,092 older adults) that aimed to identify the factors associated with differences in melanoma survival between AYAs and older adults. The primary outcome was survival rate.
What did they find?
Limitations: Registry data did not contain information about family history of melanoma or environmental exposures.
Main Takeaway: AYA patients with Stage IV melanoma, thicker tumors (>4 mm), and public insurance had worse survival outcomes compared to older adults.
Melanoma is one of the most common cancers among adolescents and young adults (AYAs) aged 15-39 years old. Few studies have specifically investigated the factors that contribute to poor survival rates in this group.
Researchers conducted a population-based registry study of 81,597 cases of cutaneous melanoma (12,505 AYAs, 69,092 older adults) that aimed to identify the factors associated with differences in melanoma survival between AYAs and older adults. The primary outcome was survival rate.
What did they find?
- AYA patients with Stage IV melanoma had worse survival outcomes [HR 20.39 (95% CI: 13.30-31.20)] than older adults [HR 10.79 (95% CI: 9.33-12.48)]
- Thicker tumors, greater than 4 mm, were associated with worse survival outcomes in AYAs [HR 5.58 (95% CI: 3.56-8.73)], compared to older adults [HR 2.87 (95% CI: 2.49-3.31)]
- Public health insurance was associated with a higher risk of death in both age groups, with greater hazard ratios among young patients [HR 2.47 (95% CI: 1.96-3.12) compared to older adults [HR 2.07 (95% CI: 1.89-2.27)]
- AYAs experienced better survival than older adults when melanoma was detected at Stage I (P<0.0001), Stage II (AYA males P = 0.007, AYA females P = 0.129), or Stage III (P < 0.0001)
Limitations: Registry data did not contain information about family history of melanoma or environmental exposures.
Main Takeaway: AYA patients with Stage IV melanoma, thicker tumors (>4 mm), and public insurance had worse survival outcomes compared to older adults.
Is long-term use of Guselkumab for the treatment of psoriasis as safe as we all thought?
British Journal of Dermatology
Don’t be sore over long-term psoriasis– try guselkumab!
Psoriasis, inflammatoryan inflammatory disorder, is frequently treated with biologics for severe disease. Guselkumab, a human monoclonal antibody IL-23 inhibitor, has demonstrated efficacy in the treatment of psoriasis. Given the chronic nature of disease, determining the safety of medications over lengthy periods of time is important.
This study aimed to evaluate several Phase 2/3 studies to better classify the cumulative long-term effects of Guselkumab (median of 3.5 years). Seven randomized, double-blinded, studies in adults with moderate-to-severe psoriasis were included, which totaled 3708 patients with over 8600 exposure hours.
What did they find?
Limitations: Adverse events tend to be reported in lower frequencies over time so patients may have been less likely to report any AEs that they experienced with long-term treatment of guselkumab. Additionally, patient years of exposure varied amongst the studies leading to unequal contributions.
Main Takeaway: Long-term treatment with guselkumab, an IL-23 inhibitor, for moderate to severe psoriasis demonstrated a similar safety profile to shorter durations of the same treatment and to placebo.
Psoriasis, inflammatoryan inflammatory disorder, is frequently treated with biologics for severe disease. Guselkumab, a human monoclonal antibody IL-23 inhibitor, has demonstrated efficacy in the treatment of psoriasis. Given the chronic nature of disease, determining the safety of medications over lengthy periods of time is important.
This study aimed to evaluate several Phase 2/3 studies to better classify the cumulative long-term effects of Guselkumab (median of 3.5 years). Seven randomized, double-blinded, studies in adults with moderate-to-severe psoriasis were included, which totaled 3708 patients with over 8600 exposure hours.
What did they find?
- There was no difference between exposure-adjusted incidence rates (EAIRs) of adverse events between the guselkumab- and placebo-treated patients [346 (327-365) vs 341 (314-371)/100 PY]
- The EAIRs were low even after 5 years of treatment with guselkumab as compared to through 16 weeks [5.26 (4.79-5.77)/100 PY]
- Rates of infection and malignancy remained low through the long-term treatment with guselkumab
- No new safety concerns were identified
Limitations: Adverse events tend to be reported in lower frequencies over time so patients may have been less likely to report any AEs that they experienced with long-term treatment of guselkumab. Additionally, patient years of exposure varied amongst the studies leading to unequal contributions.
Main Takeaway: Long-term treatment with guselkumab, an IL-23 inhibitor, for moderate to severe psoriasis demonstrated a similar safety profile to shorter durations of the same treatment and to placebo.
The triple threat! Clindamycin phosphate/benzoyl peroxide/adapalene gel is effective for moderate to severe acne in children
Pediatric Dermatology
IDP-126 - a triple threat when it comes to treating acne!
Acne vulgaris is the most common skin condition in the U.S. Current first line acne treatments in children and adolescents include topical retinoids, benzoyl peroxide (BPO), or topical antibiotics with BPO, but efficacy, tolerability, and adherence to these therapies are variable. In addition, treatment options for patients under age 12 are limited.
In this study, the researchers conducted a randomized, double-blind study of 394 children between ages 9 and 17 with moderate-to-severe acne to evaluate the safety, efficacy, and outcomes of clindamycin phosphate 1.2%/BPO 3.1%/adapalene 0.15% gel (IDP-126), a novel fixed-dose, triple combination formulation for pediatric acne.
What did they find?
Limitations: The study is limited by the low number of participants in each treatment arm and short treatment period of 12 weeks.
Main Takeaways: This study found that IDP-126 gel is an efficacious and safe topical acne treatment for children and adolescents with moderate-to-severe acne.
Acne vulgaris is the most common skin condition in the U.S. Current first line acne treatments in children and adolescents include topical retinoids, benzoyl peroxide (BPO), or topical antibiotics with BPO, but efficacy, tolerability, and adherence to these therapies are variable. In addition, treatment options for patients under age 12 are limited.
In this study, the researchers conducted a randomized, double-blind study of 394 children between ages 9 and 17 with moderate-to-severe acne to evaluate the safety, efficacy, and outcomes of clindamycin phosphate 1.2%/BPO 3.1%/adapalene 0.15% gel (IDP-126), a novel fixed-dose, triple combination formulation for pediatric acne.
What did they find?
- Randomized to IDP-126, one of three dyad combination gels, or vehicle gel for 12 weeks
- At week 12, 55.8% of patients treated with IDP-126 achieved a >2 grade reduction on the acne severity scale, compared to 30.8-33.9% of participants in the dyad groups
- 78.3% of IDP-126 treated patients experienced a >70% reduction from baseline in inflammatory lesions, significantly greater than the dyad (61.7-68.2%) or vehicle (45.1%) groups
- IDP-126 treated patients reported greater mean score improvements across most acne QoL domains (range: 5.5-8.2), compared to the dyad (3.5-7.5) or vehicle (2.1-4.0)
- Adverse effects in the IDP-126 group were mostly of mild to moderate severity, and included application site pain (6.7%) and dryness (6.7%)
Limitations: The study is limited by the low number of participants in each treatment arm and short treatment period of 12 weeks.
Main Takeaways: This study found that IDP-126 gel is an efficacious and safe topical acne treatment for children and adolescents with moderate-to-severe acne.
derm innovations
Wart’s new with wart treatment?
Needle-free injections of 5-fluorouracil (5-FU) may be more effective in curing patients of palmoplantar warts than typical cryosurgery. Needle-free injections are a non-invasive method to administer medications which are given at high velocity through the skin and have previously shown efficacy in treating a variety of dermatological diseases.
A randomized clinical trial of 76 patients aged 10-75 years old was conducted to compare the efficacy and tolerability of treatment with needle-free injections of 5-FU and cryosurgery.
What did they find?
Limitations: The study is limited by its smaller sample size and its inability to blind the participants.
Main takeaway: The use of needle-free injection of 5-FU is not only an effective therapy in treating palmoplantar warts in comparison to cryosurgery, but is also less painful for patients with no blistering at the site of injection.
Needle-free injections of 5-fluorouracil (5-FU) may be more effective in curing patients of palmoplantar warts than typical cryosurgery. Needle-free injections are a non-invasive method to administer medications which are given at high velocity through the skin and have previously shown efficacy in treating a variety of dermatological diseases.
A randomized clinical trial of 76 patients aged 10-75 years old was conducted to compare the efficacy and tolerability of treatment with needle-free injections of 5-FU and cryosurgery.
What did they find?
- 76 patients had warts superficially removed to the bleeding point
- Patients were randomized into receiving either 0.05-0.4mL of intralesional injections with the 5-FU injector or receiving 3 serial applications of liquid nitrogen
- Patients who received needle free injections reported a significant decrease in visual analog scale with a median of 3 compared to a median of 6.5 for cryotherapy (p<0.001)
- The needle free injection group had 63.16% of patients show complete response, 26.32% of patients showing greater than 50% response and only 10.53% of patients showing less than 50% response
- The cryosurgery group showed only 21.05% complete response, 63.16% showing greater than 50% and 15.79% showing less than 50%
- The injector caused mild bruising in some patients, however, most patients in the cryosurgery group experienced intense pain and blisters
- No recurrence of warts were seen in either group
Limitations: The study is limited by its smaller sample size and its inability to blind the participants.
Main takeaway: The use of needle-free injection of 5-FU is not only an effective therapy in treating palmoplantar warts in comparison to cryosurgery, but is also less painful for patients with no blistering at the site of injection.