SEventh issue
APRIL 5TH, 2022
Sun safety behaviors vary by race
JAMA Dermatology
Asian Americans encompass a rapidly growing population, but little research has been done on this group. More specifically, the sun safety behaviors and skin phenotype vary among the subgroups that compromise Asian Americans and can be used to further characterize their skin cancer risk. A cross-sectional study from the The National Health Interview Survey from years 2000, 2005, 2010, and 2015 was conducted. Of the 124,631 pooled respondents from 2000 to 2015, 5,694 identified as Asian American and 78,336 identified as non-Hispanic White. Self-reported Asian Indian, Chinese, Filipino, and Other Asian participants, regardless of Hispanic or non-Hispanic ethnicity, were included for specificity. Non-Hispanic White individuals were included as a reference group. In multivariable models adjusting for sociodemographic variables, health behaviors, photosensitivity, and skin cancer history, all Asian American subgroups were less likely than non-Hispanic White individuals to sunburn, apply sunscreen, tan indoors, and receive TBSE. Asian American individuals were more likely to seek shade, wear long-sleeved shirts, and wear long clothing to the ankles. Asian Indian individuals were less likely than Chinese participants to apply sunscreen (aOR, 0.55; 95% CI, 0.41-0.74) or wear a hat (aOR, 0.53; 95% CI, 0.37-0.76) and more likely to wear long-sleeved shirts (aOR, 1.43; 95% CI, 1.06-1.93) or long clothing to the ankles (aOR, 1.70; 95% CI, 1.30-2.23). This knowledge can be used to alter skin cancer screening recommendations to Asian American patients.
How safe is Guselkumab over a 5 year period for treating psoriasis?
Journal of American Academy of Dermatology
It used to be if we could manage psoriasis, now it’s a matter of how. This is thanks to many new approved biologics that have flooded the market to treat moderate-to-severe psoriasis, which gives physicians a choice of therapeutic options. One of these options includes Guselkumab (brand name=Tremfaya), which is a fully human monoclonal antibody selectively targeting the p19 subunit of interleukin (IL) 23. Early clinical trials have shown efficacy and safety for Guselkumab, however, the question of long-term safety of these biologics must be evaluated. In this pooled analysis of VOYAGE 1 and VOYAGE 2 clinical trials (combined n=1721), authors sought to determine the cumulative safety experience of Guselkumab through 5 years. Safety results were reported in patient-years (PY), and patients were followed for a total of 7,166 PY. The rate of adverse events was 149/100 PY (95% CI: 147,152), but rate of discontinuation due to adverse events was 1.45/100 PY. The rate of serious adverse events was 5.01/100 PY (95% CI: 4.50,5.56). While adverse events and serious adverse events fluctuated from year to year, they found no increasing trend in either outcome. What are the serious adverse events to be aware of? The main ones include serious infections (e.g. appendicitis, cellulitis, pneumonia) (0.85/100 PY), nonmelanoma skin cancer (0.34/100 PY), malignancies other than nonmelanoma skin cancer (0.45/100 PY), and major adverse cardiovascular events (0.29/100 PY). While it is important to continue to collect long-term safety data for these biologics, this study provides reassurance that the side effect profile does not vary significantly with longer duration of Guselkumab use up to 5 years.
Investigating our fungal microbiome
Journal of Investigative Dermatology
The elusive microbiome is all the buzz these days as scientists try to suss out the symbiotic relationships we have with microscopic creatures. Little is known about the microbiome of healthy skin; but, scientists are trying to learn more. This study was interested in the fungal microbiota that live on healthy skin. Specifically, researchers wanted to determine if different organisms preferred specific areas of the skin, and if the fungal microbiota changed throughout the year for people living in areas with temperate climates. Eleven unrelated Caucasian participants were enrolled in the study, and fungal samples from four skin sites (dorsal neck, vertex, glabella, and antecubital crease) were collected monthly for one year. The Malasseziomycetes class of organisms predominated at all sites but was more frequently found in sebaceous sites over moist areas (89.9 ± 9.6 and 70.7 ± 18.8 respectively). Other classes of note were Saccharomycetes, Dothideomycetes, and Agaricomycetes. The most abundant organisms found were M. restricta, M. globose, and M. sympodialis, and levels of each remained relatively stable throughout the year. However, levels of other fungal classes were unique to each participant, thereby creating an individual fungal fingerprint. A small sample size and lack of gender, age, and racial backgrounds were limitations to this study. This research is significant because it adds to our understanding of the microbiome of healthy skin, and it may just be part of the early steps in our journey to learning more about how the microbiome changes in pathological conditions.
JAMA Dermatology
Asian Americans encompass a rapidly growing population, but little research has been done on this group. More specifically, the sun safety behaviors and skin phenotype vary among the subgroups that compromise Asian Americans and can be used to further characterize their skin cancer risk. A cross-sectional study from the The National Health Interview Survey from years 2000, 2005, 2010, and 2015 was conducted. Of the 124,631 pooled respondents from 2000 to 2015, 5,694 identified as Asian American and 78,336 identified as non-Hispanic White. Self-reported Asian Indian, Chinese, Filipino, and Other Asian participants, regardless of Hispanic or non-Hispanic ethnicity, were included for specificity. Non-Hispanic White individuals were included as a reference group. In multivariable models adjusting for sociodemographic variables, health behaviors, photosensitivity, and skin cancer history, all Asian American subgroups were less likely than non-Hispanic White individuals to sunburn, apply sunscreen, tan indoors, and receive TBSE. Asian American individuals were more likely to seek shade, wear long-sleeved shirts, and wear long clothing to the ankles. Asian Indian individuals were less likely than Chinese participants to apply sunscreen (aOR, 0.55; 95% CI, 0.41-0.74) or wear a hat (aOR, 0.53; 95% CI, 0.37-0.76) and more likely to wear long-sleeved shirts (aOR, 1.43; 95% CI, 1.06-1.93) or long clothing to the ankles (aOR, 1.70; 95% CI, 1.30-2.23). This knowledge can be used to alter skin cancer screening recommendations to Asian American patients.
How safe is Guselkumab over a 5 year period for treating psoriasis?
Journal of American Academy of Dermatology
It used to be if we could manage psoriasis, now it’s a matter of how. This is thanks to many new approved biologics that have flooded the market to treat moderate-to-severe psoriasis, which gives physicians a choice of therapeutic options. One of these options includes Guselkumab (brand name=Tremfaya), which is a fully human monoclonal antibody selectively targeting the p19 subunit of interleukin (IL) 23. Early clinical trials have shown efficacy and safety for Guselkumab, however, the question of long-term safety of these biologics must be evaluated. In this pooled analysis of VOYAGE 1 and VOYAGE 2 clinical trials (combined n=1721), authors sought to determine the cumulative safety experience of Guselkumab through 5 years. Safety results were reported in patient-years (PY), and patients were followed for a total of 7,166 PY. The rate of adverse events was 149/100 PY (95% CI: 147,152), but rate of discontinuation due to adverse events was 1.45/100 PY. The rate of serious adverse events was 5.01/100 PY (95% CI: 4.50,5.56). While adverse events and serious adverse events fluctuated from year to year, they found no increasing trend in either outcome. What are the serious adverse events to be aware of? The main ones include serious infections (e.g. appendicitis, cellulitis, pneumonia) (0.85/100 PY), nonmelanoma skin cancer (0.34/100 PY), malignancies other than nonmelanoma skin cancer (0.45/100 PY), and major adverse cardiovascular events (0.29/100 PY). While it is important to continue to collect long-term safety data for these biologics, this study provides reassurance that the side effect profile does not vary significantly with longer duration of Guselkumab use up to 5 years.
Investigating our fungal microbiome
Journal of Investigative Dermatology
The elusive microbiome is all the buzz these days as scientists try to suss out the symbiotic relationships we have with microscopic creatures. Little is known about the microbiome of healthy skin; but, scientists are trying to learn more. This study was interested in the fungal microbiota that live on healthy skin. Specifically, researchers wanted to determine if different organisms preferred specific areas of the skin, and if the fungal microbiota changed throughout the year for people living in areas with temperate climates. Eleven unrelated Caucasian participants were enrolled in the study, and fungal samples from four skin sites (dorsal neck, vertex, glabella, and antecubital crease) were collected monthly for one year. The Malasseziomycetes class of organisms predominated at all sites but was more frequently found in sebaceous sites over moist areas (89.9 ± 9.6 and 70.7 ± 18.8 respectively). Other classes of note were Saccharomycetes, Dothideomycetes, and Agaricomycetes. The most abundant organisms found were M. restricta, M. globose, and M. sympodialis, and levels of each remained relatively stable throughout the year. However, levels of other fungal classes were unique to each participant, thereby creating an individual fungal fingerprint. A small sample size and lack of gender, age, and racial backgrounds were limitations to this study. This research is significant because it adds to our understanding of the microbiome of healthy skin, and it may just be part of the early steps in our journey to learning more about how the microbiome changes in pathological conditions.
QUESTION OF THE WEEK
NEJM CHALLENGE QUESTION
A 48-year-old woman who lived in rural India presented with diarrhea, weight loss, and a rash. Physical examination showed well-demarcated areas of hyperpigmentation on the sun-exposed areas of her neck, chest, and forearms. What is the most likely diagnosis?
1. Cobalamin (vitamin B12) deficiency
2. Pellagra
3. Phytophotodermatitis
4. Porphyria cutanea tarda
5. Zinc deficiency
1. Cobalamin (vitamin B12) deficiency
2. Pellagra
3. Phytophotodermatitis
4. Porphyria cutanea tarda
5. Zinc deficiency
Answer: Pellagra
The patient lived in rural India, had a vegetarian diet, and did not use alcohol. On physical examination, there were well-demarcated areas of hyperpigmentation on the sun-exposed areas of her neck and anterior chest (Panel A) and forearms (Panel B), with skin fissures in the antecubital fossa. Serum niacin testing was unavailable, however clinical diagnosis of pellagra was made based on diarrhea and symmetric, photosensitive dermatitis, including a typical Casal’s necklace rash. Pellagra that is caused by dietary deficiency persists in resource-limited countries, whereas it is associated more with alcohol use, bariatric surgery, or malabsorptive conditions in resource-rich countries. After the patient was treated with intravenous vitamin B complex followed by oral supplementation, the diarrhea resolved and the skin hyperpigmentation was reduced at follow-up 4 weeks later
Other answers:
1. Cobalamin (vitamin B12) deficiency- presents with anemia and neurologic symptoms. Cutaneous findings include hyperpigmentation (especially hands, nails, face, palmar creases, intertriginous areas), glossitis, angular cheilitis, hair depigmentation. This is seen with malabsorption disorders
3. Phytophotodermatitis- a phototoxic drug reaction in which furocoumarins in certain plants (e.g. parsley, celery, lime, fig and yarrow) react with UVA causing erythema +/- blistering (24-72 hours post contact) followed by hyperpigmentation (1 to 2 weeks later)
4. Porphyria cutanea tarda- skin condition due to decreased hepatic uroporphyrinogen decarboxylase activity and presents with vesicles, bullae, erosions, milia, scarring, hyperpigmentation and hypertrichosis in photodistributed areas, especially the dorsal hands
5. Zinc deficiency- typically presents with vesiculopustular eczematous lesions involving the diaper area, face (periorificial) and acral areas, along with diarrhea and alopecia. Can be inherited or acquired (alcoholics, anorexia, malabsorption)
The patient lived in rural India, had a vegetarian diet, and did not use alcohol. On physical examination, there were well-demarcated areas of hyperpigmentation on the sun-exposed areas of her neck and anterior chest (Panel A) and forearms (Panel B), with skin fissures in the antecubital fossa. Serum niacin testing was unavailable, however clinical diagnosis of pellagra was made based on diarrhea and symmetric, photosensitive dermatitis, including a typical Casal’s necklace rash. Pellagra that is caused by dietary deficiency persists in resource-limited countries, whereas it is associated more with alcohol use, bariatric surgery, or malabsorptive conditions in resource-rich countries. After the patient was treated with intravenous vitamin B complex followed by oral supplementation, the diarrhea resolved and the skin hyperpigmentation was reduced at follow-up 4 weeks later
Other answers:
1. Cobalamin (vitamin B12) deficiency- presents with anemia and neurologic symptoms. Cutaneous findings include hyperpigmentation (especially hands, nails, face, palmar creases, intertriginous areas), glossitis, angular cheilitis, hair depigmentation. This is seen with malabsorption disorders
3. Phytophotodermatitis- a phototoxic drug reaction in which furocoumarins in certain plants (e.g. parsley, celery, lime, fig and yarrow) react with UVA causing erythema +/- blistering (24-72 hours post contact) followed by hyperpigmentation (1 to 2 weeks later)
4. Porphyria cutanea tarda- skin condition due to decreased hepatic uroporphyrinogen decarboxylase activity and presents with vesicles, bullae, erosions, milia, scarring, hyperpigmentation and hypertrichosis in photodistributed areas, especially the dorsal hands
5. Zinc deficiency- typically presents with vesiculopustular eczematous lesions involving the diaper area, face (periorificial) and acral areas, along with diarrhea and alopecia. Can be inherited or acquired (alcoholics, anorexia, malabsorption)
