Dr. Reck Atwater[/caption]
Amber Reck Atwater, M.D.
Dermatology Residency Program Director
Associate Professor of Dermatology
Director, Contact Dermatitis Clinic
Duke Dermatology
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We completed an evaluation of our Duke Dermatology patients who underwent patch testing for possible allergy to their cardiac devices - pacemakers and defibrillators.
From March 1, 2012 to September 15, 2017 we saw 11 patients with suspected allergy to their devices. Concern for allergy, skin eruption, skin symptoms, and concern for infection were common. 73% of patients had erythema at their implant scars; pruritus and pain were also noted. Six of our patients had relevant reactions, and the most common allergies were metals, silicone and rubber accelerators.
Dr. Kim[/caption]
Seoyoung C. Kim, MD, ScD, MSCE
Director, Program in Rheumatologic, Immunologic, and Musculoskeletal PharmacoEpidemiology
Associate Professor of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Division of Rheumatology, Immunology and Allergy
Brigham and Women's Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: Given a high cardiovascular (CV) risk among patients with psoriasis and psoriatic arthritis, it is important to have more information with regard to potential effect of different treatment agents on CV risk.
As the number of treatment options for psoriasis and psoriatic arthritis has been rising over the few decades, it is even more crucial to have high-quality evidence on comparative safety of different treatment options so physicians and patients can choose an agent based on the benefit-risk profile of each drug they are considering.
Dr. Abuabara[/caption]
Dr. Katrina Abuabara, MD, MA, MSCE
Department of Dermatology Program for Clinical Research, University of California, San Francisco
MedicalResearch.com: What is the background for this study?
Response: The wellbeing and development of children is strongly influenced by parents’ physical and psychosocial health. Parents of children with chronic illness, in particular, are susceptible to poor sleep, and previous studies have found major sleep impairments among parents of children with ventilator dependency and cystic fibrosis, but few studies have examined sleep patterns among parents of children with more common chronic illnesses like atopic dermatitis (also known as eczema).
Dr. Jonathan Silverberg[/caption]
Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern, Chicago, Illinois
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Atopic Dermatitis is characterized by chronic and often severe and debilitating itch, skin pain, sleep disturbances, skin lesions and multiple comorbid health conditions. The signs, symptoms and comorbidities of atopic dermatitis can lead to significant psychosocial distress and mental health burden
We performed a cross-sectional, population-based study of 2893 US adults. We found that adults with atopic dermatitis had more severe symptoms scores for anxiety and depression (Hospital Anxiety and Depression anxiety). Adults with atopic dermatitis also had higher prevalences of anxiety and depression. Mean symptom scores and prevalences of anxiety and depression were even higher in adults with moderate and severe atopic dermatitis compared to those with mild atopic dermatitis. All respondents with severe PO-SCORAD, POEM and PO-SCORAD-itch scores had elevated anxiety and depression scores.
Many adults with atopic dermatitis that had elevated anxiety and depression scores reported no diagnosis of anxiety or depression.
Anna Benevente[/caption]
Anna Benevente
Director of product, labeling, and ingredient review at Registrar Corp (registrarcorp.com), an FDA consulting firm that helps companies comply with FDA regulations.
She has been assisting companies with U.S. FDA regulations since 2009.
She and her team have researched thousands of products to determine whether they meet FDA requirements for compliance.
In February 2019, the U.S. Food and Drug Administration (FDA) published a proposed rule to put into effect a final monograph for over-the-counter (OTC) sunscreen drug products. If finalized, the rule will update conditions under which OTC sunscreen products may be marketed in the United States. Given the effect this rule could have on the pharmaceutical and cosmetic industries, MedicalResearch.com sat down with Anna Benevente, Director of Product, Labeling, and Ingredient Review at FDA consulting firm Registrar Corp, to dig deeper into the article they recently published on the rule.
MedicalResearch.com: What is the background for this announcement?
Response: FDA issues monographs for specific types of over-the-counter (OTC) drug products, which establish conditions under which a drug may be marketed without FDA approval of a New Drug Application (NDA) or Abbreviated New Drug Application (ANDA). The conditions that are established by the monograph include the active ingredients that have been deemed generally recognized as safe and effective (GRASE) and statements that must appear on the labeling in the form of a Drug Facts panel. Sunscreens have never had an effective final monograph. Instead, they have been largely regulated under enforcement discretion since 2001, when FDA issued a stay on a final monograph for OTC sunscreen drug products.
The Sunscreen Innovation Act (SIA) of 2014 calls for FDA to establish a final monograph for OTC sunscreen by November 26, 2019. If finalized, the rule proposed in February would lift the stay on the final monograph and amend certain regulations for OTC sunscreen drug products.
MedicalResearch.com: What is enforcement discretion?
Response: FDA rulemaking can take a considerable amount of time. During this process, FDA may issue guidance or an enforcement policy that specifies stipulations under which the Agency permits the marketing of certain products in the absence of codified regulations. While these documents are not legally-binding, they often outline provisions where FDA states that the Agency does not intend to take regulatory action. These provisions are often incorporated into an FDA rule, as we are seeing in the case of this new rule for sunscreen.
MedicalResearch.com: Would you explain what GRASE ingredients are?
Response: When FDA establishes a monograph for an OTC drug product, the Agency reviews scientific data on ingredients used for that product and classifies them into three categories:
Category I: The ingredient is generally recognized as safe and effective for its intended use.
Category II: The ingredient is not generally recognized as safe and effective for its intended use. This ingredient may be not safe as a whole, may be not be safe for the specific intended use, or may not be effective for the specific intended use relative to its health risk.
Category III: There is insufficient scientific data to determine whether the ingredient is safe and effective for its intended use.
While a monograph is still in the rulemaking stage, FDA permits the marketing of products formulated with active ingredients that are deemed Category I or Category III. At this time, industry may submit data to support a Category I designation for a Category III ingredient. When the final monograph is published, FDA no longer uses the terms "Category I", "Category II", and "Category III." Those ingredients that were deemed Category I become "monograph conditions," while Category II and III ingredients become "nonmonograph conditions" and may not be marketed after the compliance date identified in the final rule.
Q: What are the main products that would require a label change?
Response:The statement of identity for all sunscreen products would be required to list the sunscreen active ingredients in alphabetical order followed by “Sunscreen” and the product’s dosage form (e.g. “Titanium Dioxide, Zinc Oxide Sunscreen Lotion”). Additionally, the rule proposes formatting changes to sunscreen labels that would make SPF, broad spectrum, and water resistance statements more prominent.
The rule would require all products over 15 SPF to satisfy broad spectrum testing requirements and the associated labeling requirements for broad spectrum products. Products under 15 SPF that do not satisfy broad spectrum requirements would be required to include “*See Skin Cancer/Skin Aging Alert” next to the SPF value as a reference to the warning required under 21 CFR 201.327(d)(2).
Dr. Geronemus[/caption]
Roy G. Geronemus, M.D.
Director, Laser & Skin Surgery Center of New York
Clinical Professor of Dermatology
New York University Medical Center
New York, NY 10016
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We made the observation in clinical practice that port wine stain birthmarks can be safely and effectively treated in early infancy without the need for general anesthesia. This observation is particularly important because of the FDA warnings regarding multiple exposures to general anesthesia under the age of 3 and the potential impact on neurocognitive development as these patients require multiple treatments.
Dr. Robinson[/caption]
Anne Robinson, Pharm D
Executive Scientific Director
AbbVie
MedicalResearch.com: What is the background for the risankizumab data presented at the American Academy of Dermatology 2019 Annual Meeting?
Response: Abstracts presented by AbbVie at the American Academy of Dermatology (AAD) 2019 Annual Meeting highlight additional data from the Phase 3 clinical trial program evaluating the safety and efficacy of risankizumab, an investigational interleukin-23 (IL-23) inhibitor. The registrational program for risankizumab evaluated more than 2,000 adult patients with moderate to severe plaque psoriasis across four pivotal studies.
Dr. Del Rosso[/caption]
Dr. James Q. Del Rosso, D.O., FAOCD, Dermatologist
Research Director and Principal Investigator
Del Rosso Dermatology Research Center, Las Vegas, NV
Galderma Consultant
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Khorasani[/caption]
Hooman Khorasani, M.D.
Cosmetic Surgeon & Mohs Skin Cancer Surgeon
Icahn School of Medicine at Mt. Sinai
MedicalResearch.com: What is the background for this study?
Response: Lipomas are tumors composed of mature fat cells located just beneath the skin surface. They are the most common soft tissue tumor and are estimated to occur in 1% of the population. These benign tumors are more common in overweight individuals, diabetics, patients with elevated serum cholesterol, and those suffering from familial multiple lipomatosis. Most of these tumors are treated for cosmetic reasons; however, large lipomas can also cause significant functional impairment. Traditional treatment includes surgical removal and / or liposuction.
Deoxycholic acid is a member of the bile acid family that assists in the breakdown of fat. We investigated the use of deoxycholic acid injections to reduce the size of large lipomas prior to surgical removal.
Dr. Alenghat[/caption]
Francis Alenghat, MD, PhD
Assistant Professor of Medicine
Section of Cardiology
University of Chicago
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Psoriasis has been associated with higher rates of atherosclerotic cardiovascular disease (ASCVD), potentially due to higher-than-normal levels of systemic inflammation. Whether this association varies by race was unknown. Also, it was unclear whether patients with psoriasis have more frequent ASCVD because of higher rates of traditional cardiovascular risk factors (smoking, diabetes, hypertension, hyperlipidemia) or because of components intrinsic to psoriasis itself.
We found that, amongst a large population of patients with psoriasis, patients of both sexes and most ages had elevated ASCVD rates compared to those without psoriasis. Overall, African American patients with psoriasis had a 15% ASCVD prevalence, whereas it was 10% in white patients with psoriasis. Increased ASCVD associated with psoriasis occurred at earlier ages in African American patients compared to white patients.
Traditional cardiovascular risk factors were common in patients with psoriasis and appeared to play a large role in the driving the higher rates of ASCVD in these patients, but even in patients with psoriasis but without any documented traditional risk factors, ASCVD rates were elevated compared to patients without psoriasis.
Dr. Roth[/caption]
William I. Roth MD
Dermatology and Dermatological Surgery
Boynton Beach, FL
MedicalResearch.com: What is the background for this study?
Cicatricial Alopecia
Dr. Mallbris[/caption]
Lotus Mallbris, MD PhD
Dermatologist and Vice President, Head of Global Immunology Drug Development
Platform Team Leader at Lilly
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by atopic dermatitis? How common is this condition?
Response:The BREEZE-AD1 and BREEZE-AD2 clinical trials are multicenter, randomized, double-blind, placebo-controlled, Phase 3 studies to evaluate the efficacy and safety of baricitinib monotherapy in adult patients with moderate to severe atopic dermatitis. These are two of five studies that will be part of the placebo-controlled data program intended to support global registrations.
Atopic dermatitis, a serious form of eczema, is a chronic, relapsing skin disease characterized by intense itching, dry skin and inflammation that can be present on any part of the body. It affects approximately 1-3 percent of adults worldwide.
Dr. Garza[/caption]
Luis Garza, MD-PhD
Associate Professor
Department of Dermatology
Johns Hopkins School of Medicine
Baltimore, MD 21287
MedicalResearch.com: What is the background for this study? What are the main findings? Do you think these findings would be similar with other antibiotics (oral or topical) or with isotretinoin for acne?
Response: We prescribe antibiotics frequently for acne. We certainly know it affects our normal and abnormal bacteria on our skin. But we don’t fully understand how well or not people recover from antibiotics.
Donal J. Sexton, MD, PhD
Department of Nephrology and Kidney Transplantation
Beaumont Hospital
Royal College of Surgeons in Ireland
Dublin, Ireland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients who receive a kidney transplant as treatment for end stage kidney disease are at risk of malignancy due to immunosuppression. In contrast to
other solid organ transplant types, when kidney transplants fail it is possible for recipients to return to dialysis. Immunosuppression is usually reduced or completely stopped when the allograft fails due to the risk of infection on dialysis.
We decided to investigate what the trajectory of risk for non-melanoma skin cancer and invasive cancers overall (composite group) looked like for patients who have received multiple consecutive kidney transplants with intervening periods of graft failure. We compared cancer risk during periods of allograft failure and periods of functioning kidney transplants.
Example of one type of melanoma[/caption]
Dr. Catherine M. Olsen
Associate Professor
Cancer Control Group
QIMR Berghofer Medical Research Institute
MedicalResearch.com: What is the background for this study?
Response: Melanoma incidence and mortality rates are increasing globally. Public health campaigns aiming to reduce sun exposure and use of sunbed have been implemented in many parts of the world, but there is significant variability in terms of the history and reach of these campaigns across countries. We examined melanoma incidence rates in eight different countries with different patterns of sun exposure and varying approaches to melanoma control.
Dr. Hall[/caption]
Dr Sarah Hall PhD
Senior Lecturer in Forensic Science
Anglia Ruskin University
MedicalResearch.com: What is the background for this study?
Response: We initially started the study in collaboration with Essex Fire and Rescue Services, as we were already doing some research on the recovery of evidence from fire scenes. During a visit to their cold fire scene facility, they described a tragic fatality with extensive fire damage, which didn’t link with the main fuel in the room. Therefore they questioned if a skin cream, regularly used by the victim, could have contributed as a fuel or ignited to initiate the fire and asked if we would do some initial research. Now we are also working with West Yorkshire and Cambridgeshire Fire and Rescue Service, the London Fire Brigade, St Andrews Centre for Plastic Surgery and Burns and the National Fire Chiefs Council.
We initially started the study in collaboration with Essex Fire and Rescue Services, as we were already doing some research on the recovery of evidence from fire scenes. During a visit to their cold fire scene facility, they described a tragic fatality with extensive fire damage, which didn’t link with the main fuel in the room. Therefore they questioned if a skin cream, regularly used by the victim, could have contributed as a fuel or ignited to initiate the fire and asked if we would do some initial research. Now we are also working with West Yorkshire and Cambridgeshire Fire and Rescue Service, the London Fire Brigade, St Andrews Centre for Plastic Surgery and Burns and the National Fire Chiefs Council.
MedicalResearch.com Interview with:
[caption id="attachment_47332" align="alignleft" width="200"]
Dr. Callaghan[/caption]
Dr. Martina Callaghan PhD Head of Physics & Senior Lecturer Wellcome Centre for Human Neuroimaging Institute of Neurology University College London London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As mirrors the situation in the general population, we found that an increasing number of volunteers who were seeking to enter cognitive neuroscience studies at our Centre had tattoos. However, the magnetic fields used in magnetic resonance imaging (MRI) pose a potential safety risk for people with tattoos. A number of case reports have described such incidents. However, as these describe isolated cases retrospectively, there was not enough information to objectively assess the risk of tattoo-related adverse reactions for persons having an MRI scan. Therefore, in 2011, we decided to embark upon this first prospective study to quantitatively assess this risk.
Dr. Wen Quan Zou[/caption]
Wenquan Zou, MD, PhD
Associate Professor
Departments of Pathology and Neurology
Director of CJD Skin Project
Associate Director
National Prion Disease Pathology Surveillance Center
Institute of Pathology
Case Western Reserve University School of Medicine
Cleveland, Ohio 44106
MedicalResearch.com: What is the background for this study?
Would you briefly explain the significance of prion-induced diseases and why they have been difficult to diagnosis?
Response: Our previous study has demonstrated that infectious prions are detectable in the skin samples of patients with sporadic Creutzfeldt-Jakob disease (sCJD), the most common form of human prion disease, at the terminal stage by the highly sensitive real-time quaking-induced conversion (RT-QuIC) assay and animal-based bioassay.
The prion-induced diseases are significant because they are infectious diseases that can be transmitted inter-species and intra-species. For instance, mad cow disease, a prion disease in cattle, has been documented to transmit to humans. Currently, there are no cures for these fatal diseases.
The definite diagnosis of prion diseases is difficult because it mainly depends on the availability of brain tissues obtained either by biopsy or autopsy for detection of prions. Brain biopsy is highly invasive and it is difficult to be accepted by patients and their families. Even for brain autopsy, it is not always feasible because of religious and cultural limitations in some regions or countries.
Keloid status of an individual may be indicative of a risk to be diagnosed with early-onset, late staged breast cancer....
Dr. Vallerand[/caption]
Isabelle Vallerand, PhD
Epidemiologist, MD Student
Department of Community Health Sciences
Cumming School of Medicine
University of Calgary
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that patients with alopecia areata, a form of autoimmune hair loss, are at a higher risk of suffering from depression than the general population. But in practice, we often hear patients tell us that they believe their hair loss developed as a result of stress or problems with mental health – certainly the phrase “so stressed your hair is falling out” is something most people have heard of. Despite this, there has actually been very little research investigating the role that mental health may have on development of alopecia areata.
Interestingly, depression has recently been associated with increased systemic inflammatory markers, so there is biologic plausibility that depression could increase the risk of alopecia areata. Our group was interested in addressing this question, and used a large population-level health records database with up to 26 years of follow-up to study it. We ultimately found that not only does depression increase one’s risk of alopecia areata, but that it increases their risk by nearly 90% compared to people who have never had depression. We also found that using antidepressants can significantly decrease the risk of developing alopecia areata in patients with depression. So there appears to be an important link between mental health and development of hair loss from alopecia areata.
Example of Bullous Pemphigoid
Yssra S. Soliman, BA
Division of Dermatology, Department of Internal Medicine
Albert Einstein College of Medicine
Bronx, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As the population of the United States becomes increasingly diverse, certain fields within medicine have not followed this trend. Dermatology is the least diverse field after orthopedics. We wanted to understand what barriers prevent medical students from applying to dermatology and whether these barriers differed based on students' racial, ethnic or socioeconomic backgrounds.
The main findings of this study are that certain groups are more likely to cite specific barriers than non-minority students. These barriers are significant deterrents to applying to dermatology and include the lack of diversity in dermatology, negative perceptions of minority students by residency programs, socioeconomic barriers such as lack of loan forgiveness and poor accessibility to mentors.
The lateral aspect of the left hand depicted here, reveals the presence of papules due to an infestation of the human itch mite, Sarcoptes scabiei var. hominis, in a case of what is commonly referred to as scabies.CDC image[/caption]
MedicalResearch.com: What is the background for this study?
MM: Scabies is extremely common. Globally in the region of 100-200 million people are believed to be affected by scabies annually.
Recently the WHO has recognised Scabies as a ‘Neglected Tropical Disease’ in response to this burden of disease. There has been increasing interest in using Mass Drug Administration (treating whole communities) as a strategy to control scabies in communities. In order to make this practical countries need an easy mechanism for establishing if scabies is a significant problem in their communities. In general when treating an individual, clinicians would conduct a full body examination to diagnose scabies – however this may not be practical or necessary when making decisions about whether to treat whole communities.
DE: Despite the fact that Scabies is a very common condition that causes a great deal of health problems, it has been largely neglected by health, research and funding agencies – but pleasingly, the WHO has now started to take action on scabies control, starting with the recognition of scabies as a "Neglected Tropical Disease"
Dr. Nicholas Soter[/caption]
Nicholas A. Soter, MD
The Ronald O. Perelman Department of Dermatology
New York University School of Medicine
New York, New York
MedicalResearch.com: What is the background for this study?
Response: Nearly 50% of patients with chronic spontaneous urticarial (CSU) (hives) incompletely respond to first-line therapy with H-1 antihistamines.
However, in the current literature, there is limited evidence to guide the treatment of CSU after maximal therapy with antihistamines fails. Two small, randomized, controlled trials suggest that dapsone, which is an antimicrobial therapeutic agent with anti-inflammatory properties, may be a useful second-line therapeutic agent.
Dr. Romine[/caption]
Dr. Kristine A. Romine MD
CEO and Founder of Camelback Dermatology & Skin Surgery
Phoenix, AZ
MedicalResearch.com: Would you give a brief overview of the different types of skin cancer?
Response: There are multiple types of skin cancer, including: melanoma, basal cell carcinoma, squamous cell carcinoma, and actinic keratosis. Known as the deadliest form of skin cancer, melanoma develops when irreparable DNA damage results in malignant transformation of melanocytes. This type of skin cancer is most commonly caused by intense UV exposure from the sun or tanning beds, which activate mutations that lead skin cells to rapidly multiply and form malignant tumors. Melanoma can range in color from dark brown to black and are rarely red or even skin colored. They are usually irregular and asymmetrical. In 2018, there were an estimated 91,270 new cases of melanoma (American Cancer Society, 2018).
Basal cell carcinoma (BCC) is the most common type of skin cancer and cancer diagnosed. BCCs arise in the skins’ outermost layers. BCCs resemble open sores, red or pink plaques, pearly nodules with telangiectasia, or scars. It is estimated that 4.3 million BCCs are diagnosed in the U.S. every year (Skin Cancer Foundation, 2018).
Squamous cell carcinoma (SCC), the second most common type of skin cancer, arises from the squamous cells in the skin that have been exposed to UV over long periods of time. SCCs appear as scaly red or pink macules, papules, or plaques. They can be crusted and appear eroded and can commonly arise within a solar keratosis. More than 1 million cases of SCC are diagnosed in the U.S. every year (Skin Cancer Foundation, 2018).
Lastly, actinic keratoses (AKs) are the most common pre-cancerous skin growth that can develop into a SCC if left untreated. Similar to all other types, AKs are caused by exposure to UV light and, in rare cases, high exposures to x-rays. AKs can appear on sun-exposed areas, including the face, scalp, ears, shoulders, and legs. They resemble pink, scaly rough patches on the skin.
Dr. Bollag[/caption]
Wendy Bollag, PhD, FAHA
Professor of Physiology
VA Research Career Scientist
Augusta University, Georgia
MedicalResearch.com: What is the background for this study?
Response: We have previously shown that the lipid (fat) phosphatidylglycerol (PG) is able to inhibit rapidly growing keratinocytes (skin cells) and promote their maturation. We also found that PG can suppress skin inflammation.
Since the common skin disease psoriasis is characterized by inflammation and excessive growth and abnormal maturation of skin cells, we believed that PG might be useful as a treatment. However, the mechanism of its anti-inflammatory effect was unknown. PG in the lung has been found to inhibit inflammation induced by microbes or their components, which work by activating the innate immune system via binding to proteins called toll-like receptors (TLRs); however, psoriasis is not considered to be an infectious disease.
We hypothesized that PG would also inhibit inflammation induced by anti-microbial peptides that activate TLRs. Anti-microbial peptides, produced normally by the skin to protect against infection, are known to be excessively up-regulated in psoriatic skin.
Dr. Narang[/caption]
Dr Tarun Narang MD MNAMS
Department of Dermatology, Venereology, and Leprology
Postgraduate Institute of Medical Education and Research
Chandigarh, India
MedicalResearch.com: What is the background for this study?
Response: Acne is one of the most common dermatological problem for which the patients seek medical care. Post acne scarring is a complication of acne, resulting in long lasting physical disfigurement and low self esteem in the affected individuals. Even though there are various methods like microneedling, chemical peeling, cryorolling and ablative lasers to address the post acne atrophic scarring, these procedures are office based hence physician dependent. A home based treatment modality that can treat post acne atrophic scarring with a comparable efficacy to the procedural modalities of treatment will be beneficial to the patient.
Our study was done to assess the efficacy of a topical modality of treatment, tazarotene gel, 0.1% in the management of post acne atrophic scarring in comparison to an established method, the microneedling.