Author Interviews, Dermatology, Immunotherapy / 29.03.2017 Interview with: Emma Guttman, MD, PhD Professor, Dermatology, Medicine and Clinical Immunology Vice Chair of Research in the Dermatology Department Director of the center for Excellence Eczema in the Occupational/Contact Dermatitis clinic Director of the Laboratory of Inflammatory Skin Diseases Icahn School of Medicine at Mount Sinai Medical Center New York Would you briefly explain what is meant by atopic dermatitis? How many people are affected by this disorder? Response: Atopic dermatitis or eczema as most people know it is an itchy red scaly skin disorder characterized by a very severe itch, that disrupts daily activities, and sleep and severely impairs the quality of life of patients. In the US 30 million people are affected by it, and 1/3 of these we expect to be moderate to severe. What is the background for Dupilumab therapy? How does it differ from emollients, steroids or topical immunomodulator treatments for eczema ie Protopic? Response: The background is that we currently do not have good treatments for long term use for our moderate to severe patients. The only approved drug by the FDA for atopic dermatitis in the US is oral prednisone, that has many long term side effects and causes disease rebound upon discontinuation. Other treatments with many side effects are broad immune suppressants--Cyclopsorin A, Mycophenolate mofetyl and phototherapy that is not feasible for most patients. Thus there is a large unmet need for safer and better treatments for moderate to severe atopic dermatitis patients. Dupilumab is different since it only targets one immune axis--Th2 axis, providing a safer alternative, with high efficacy, that is equal or even better than cyclosporin A, that is the current gold standard immune suppressant, and harbors many side effects including permanent effects on the kidneys after long term use. Topical treatments, while useful for mild patients, are often not adequate or sufficient to control moderate to severe patients that usually have more than 10% body surface area involved and need a systemic treatment. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Dermatology, Pediatrics / 26.03.2017 Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois What is the background for this study? Response: Stevens-Johnson syndrome and Toxic Epidermal Necrolysis (SJS/TEN) are relatively rare and potentially life-threatening disorders. There have been some recent advances in our understanding of the epidemiology and risk factors of SJS/TEN in adults. However, little is known about the epidemiology of pediatric SJS/TEN. (more…)
Author Interviews, Dermatology, UCLA / 19.03.2017 Interview with: Madalene Heng MD, FRACP, FACD, FAAD Professor of Medicine/Dermatology UCLA School of Medicine What is the background for this study? What are the main findings? Response: Curcumin, the active ingredient in the spice, turmeric, is an excellent anti-inflammatory agent with unique healing properties. However, this is only observed with our preparation of topical curcumin but not with oral curcumin. This is because curcumin is not absorbed and does not cross cell membranes - low bioavailability. The biochemical basis for the efficacy of topical curcumin is based on the fact that it is a phosphorylase kinase inhibitor. Phosphorylase kinase is an enzyme released by injured tissue 5 mins following injury, and is responsible for activating the transcription activator (NF-kB), resulting in turning on over 200 genes responsible for inflammation, and scarring among others, resulting in redness, swelling, pain, and eventually scarring. By blocking phosphorylase kinase activity early in the injury pathway, topical curcumin (curcumin gel) results in rapid healing with minimal or no scarring following many types of healing, including burns and scalds. The unique healing properties are also due to the fact that curcumin induces cell death (apoptosis) to damaged cells, resulting in the "space" for replacement by new healthy cells, resulting in normal appearing skin following burns and scalds. The salutary result depends on when the curcumin gel is applied - the earlier the better. We observed that when curcumin gel was applied within 4 days to second degree burns- hourly applications, tapering after the patient is improved - we observed rapid healing within 5 days, with the skin returning to normal within 6 weeks to 2 months without redness or visible scarring. Minor burns and scalds heal even more rapidly. Pain was improved within hours. What should readers take away from your report? Response: If the readers happen to have curcumin gel (Psoria-Gold) in their first aid kit, they should apply curcumin gel multiple times as soon as possible. Within the first hour, they should apply it every 5-10 mins, tapering off when the pain and swelling is improved. If they do this, it is possible that blistering may be aborted. The scarring is also minimal. The curcumin gel should be applied twice daily until the skin returns to normal (no redness, swelling, pigmentation etc) and no visible scarring is seen. (more…)
Author Interviews, Dermatology, JAMA / 17.03.2017 Interview with: Dr. Alex M. Glazer MD National Society for Cutaneous Medicine New York, New York What is the background for this study? What are the main findings? Response: We had previously studied the geographic distribution of dermatologists throughout the United States which revealed that dermatologists are unevenly geographically distributed throughout the country, with many regions having fewer than the 4 providers per 100,000 people needed to adequately care for a population. Because of the influx of PAs and NPs into the healthcare workforce throughout the past decade, we wanted to see how these providers were supplementing dermatologic care. The main finding of our study is that dermatology PAs are helping to supplement dermatologists and together are providing broader, more uniform coverage across the United States (more…)
Author Interviews / 11.03.2017 Interview with: Prof. Dr. med. Kristian Reich Dermatologie, Allergologie Psoriasis- und Neurodermitis-Trainer Hamburg What is the background for this study? What are the main findings? Response: The IXORA-S study compared the efficacy and safety of Taltz® (ixekizumab) and Stelara®* (ustekinumab) for the treatment of moderate-to-severe plaque psoriasis at 24 weeks. In this study, patients were randomized to receive either Stelara (45 mg or 90 mg weight-based dosing per label) or Taltz (80 mg every two weeks followed by 80 mg every four weeks), following an initial starting dose of 160 mg. At 24 weeks, patients treated with Taltz achieved significantly higher response rates compared to patients treated with Stelara, including 83 percent of patients who achieved Psoriasis Area Severity Index (PASI) 90—the study’s primary endpoint—compared to 59 percent of patients who achieved PASI 90 after treatment with Stelara. Results at 24 weeks also found: • 91.2 percent of patients treated with Taltz achieved PASI 75 compared to 81.9 percent of patients treated with Stelara (p=0.015) • 49.3 percent of patients treated with Taltz achieved PASI 100 compared to 23.5 percent of patients treated with Stelara (p=0.001) • 86.6 percent of patients treated with Taltz achieve static Physician’s Global Assessment score (sPGA) 0 or 1 compared to 69.3 percent of patients treated with Stelara (p<0.001) The majority of treatment-emergent adverse events were mild or moderate. There were no statistically significant differences between treatment groups in overall treatment-emergent adverse events. The safety profile for Taltz was consistent with previous clinical trials. (more…)
Author Interviews, Dermatology / 11.03.2017 Interview with: Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator Director of the NIHR Health Technology Assessment Programme Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology, University of Nottingham Queen’s Medical Centre Nottingham University Hospitals NHS Trust, Nottingham, UK What is the background for this study? What are the main findings? Response: Pemphigoid is a potentially serious skin condition characterised by the appearance of large tense blisters appearing on the skin. These blisters are itchy and eventually burst, leaving raw areas of skin that can become infected. Pemphigoid is much commoner in the elderly, and is on the increase. It is due to the body’s own immune system attaching certain structures in the skin ie an auto-immune disease. The main treatment for pemphigoid is oral steroids (prednisolone). Prednisolone is usually quite good at clearing the blisters, but when given for long periods as is needed for people with pemphigoid, they cause serious side effects such as diabetes, infection, raised blood pressure and fractures, so safer oral treatments are needed for this disease. Tetracycline antibiotics are one such possible treatment – they have been used by some for pemphigoid for many years, but our Cochrane review did not find any good evidence to show that it works. So we applied to the UK National Institute of Health Research Health Technology Programme to do a definitive evaluation of treating pemphigoid with one of the tetracyclines called doxycycline. We tested the strategy of staring patients with pemphigoid with doxycycline versus standard treatment with oral prednisolone. If those starting on doxycycline did not achieve good enough control, they could switch to prednisolone as would happen in clinical practice. Our main outcomes were blister control at 6 weeks, and severe, life threatening and fatal treatment related adverse events at 52 weeks. The study was designed as a non-inferiority study – by that we mean that we never expected doxycycline to be as good as prednisolone for blister control, so we agreed to put up with a degree of lower effectiveness provided that there were clear long term safety gains. (more…)
Author Interviews, Dermatology, JAMA, Race/Ethnic Diversity, Transplantation / 10.03.2017 Interview with: Christina Lee Chung, MD, FAAD Associate Professor of Dermatology Director, Center for Transplant Patients Drexel University College of Medicine What is the background for this study? What are the main findings? Response: It’s long been recognized immunosuppressed organ transplant recipients are at significantly increased risk for skin cancer and other types of skin disease. But despite advances to improve skin cancer prevention for these patients, little is known about how skin conditions affect African-American, Asian and Hispanic transplant recipients. This is problematic given that, according to the U.S. Department of Health and Human Services, more than half of the 120,000 Americans on the waiting list for organs identify as nonwhite. We compared medical records of 412 organ transplant recipients — including 154 white patients and 258 nonwhite (black, Asian or Hispanic) — who were referred to the Drexel Dermatology Center for Transplant Patients between 2011 and 2016. As one of the only models of its kind in the country, the center provides post-transplant dermatological care to every patient who is transplanted by and/or followed by the Drexel University and Hahnemann University Hospital Transplant Programs. That means that every patient, regardless of race, is screened annually for skin cancer, which provided a unique dataset for us to analyze. Two hundred eighty-nine transplant recipients exhibited malignant, infectious or inflammatory conditions during their evaluation, but their primary acute diagnoses differed greatly by race. In 82 white patients, skin cancer was the most common acute problem requiring attention at first visit. Black and Hispanic patients, by contrast, were most often diagnosed with inflammatory or infectious processes, such as fungal infections, warts, eczema, psoriasis, and rashes that required immediate medical attention. Overall, squamous cell carcinoma in situ was the most common type of skin cancer diagnosed in each racial or ethnic group. But the location of the cancerous lesions again depended on the race of the patient. Most lesions in white and Asian patients occurred in sun-exposed areas of the body, like the scalp, neck, chest and back. For black patients, the lesions were primarily found in the groin.  Moreover, six of the nine lesions found on black patients tested positive for high-risk HPV strains, suggesting an association between the virus and skin cancer for African Americans. We also provided questionnaires to 66 organ transplant recipients to find out more about the patients’ awareness of skin cancer prevention. Seventy-seven percent of white patients were aware their skin cancer risk was increased, compared to 68 percent of nonwhites. Only 11 percent of nonwhite patients reported having regular dermatologic examinations, compared to 36 percent of whites. Finally, 45 percent of white patients but only 25 percent of nonwhite reported knowing the signs of skin cancer. (more…)
Author Interviews, Boehringer Ingelheim, Dermatology, Pharmacology / 08.03.2017 Interview with: Andrew Blauvelt, M.D., M.B.A. President and Investigator Oregon Medical Research Center What is the background for this study? What are the main findings? Response: Findings from the Phase 3 VOYAGE 1 study showed that patients with moderate to severe plaque psoriasis receiving guselkumab, an human anti-interleukin (IL)-23 monoclonal antibody, achieved significant improvement in skin clearance and in comparison with Humira® (adalimumab), a TNF blocker.  The Phase 3 study and head-to-head analysis of guselkumab vs. adalimumab showed the significant and durable efficacy of guselkumab as maintained through one year when compared with adalimumab, and the robust efficacy of this novel IL-23 targeted therapy in meeting all primary and major secondary endpoints. (more…)
Author Interviews, CDC, Dermatology, Environmental Risks, JAMA, Melanoma / 07.03.2017 Interview with: Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC What is the background for this study? What are the main findings? Response: The incidence of skin cancer is increasing in the United States, and individuals who indoor tan are at an increased risk of skin cancer. Treating skin cancer costs $8.1 billion annually. The number of high school students who indoor tan dropped by half from 2009 to 2015. In 2015, 1.2 million high school students indoor tanned, down from 2.5 million in 2009. This is a much bigger decrease than we have seen in the past and is an encouraging finding. We also found that 82% of indoor tanners reported sunburn in the past year compared with 54% of those who did not engage in indoor tanning. (more…)
Author Interviews, Dermatology, Global Health, JAMA / 07.03.2017 Interview with: Chante Karimkhani, MD University Hospitals Case Western Medical Center, Cleveland, Ohio now with Department of Dermatology University of Colorado, Denver What is the background for this study? What are the main findings? Response: Ranging from benign inflammatory to infectious, autoimmune, and malignant conditions, skin diseases cause significant disfigurement, pain, and psychological morbidity. The Global Burden of Disease (GBD) Study 2013 is a large-scale epidemiological assessment of burden from 306 diseases in 195 countries, both sexes, and 14 age groups. Disease burden is measured by combining morbidity and mortality into a single metric of disability-adjusted life years (DALYs), where one DALY is equivalent to one year of healthy life lost. Skin diseases contributed 1.79% of the total global burden from all diseases. The skin diseases arranged in order of decreasing global DALYs are: dermatitis (atopic, contact, seborrheic), acne vulgaris, urticaria, psoriasis, viral skin diseases, fungal skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, keratinocyte carcinoma (basal and squamous cell carcinomas), decubitus ulcer, and alopecia areata. Younger populations had the greatest burden from infectious skin conditions, while acne caused the greatest burden in the second and third decades of life. Elderly populations had the greatest DALY rates from melanoma and keratinocyte carcinoma. Skin conditions also exhibit distinct geographical patterns of disease burden. (more…)
Author Interviews, Dermatology / 17.02.2017 Interview with: Neelam A. Vashi, MD Assistant Professor of Dermatology Boston University Center of Ethnic Skin  and Mayra B. C Maymone, MD, DSc Doctor of Science, Dermatology Boston University School of Medicine Boston, MA What is the background for this study? What are the main findings? Response: Disorders of hyperpigmentation are common in clinical practice and frequently observed in dark-skinned individuals, a subset of the population that reportedly engages less with sunscreen use and other sun-protective behaviors. With the expected shift in US demographics to become a more racially and ethnically diverse population, there is growing interest in finding out more about the sun-protective habits in those with cutaneous hyperpigmentation. In this cross-sectional study, we found a surprisingly high rate of sunscreen use (67.5%). This is much higher than that observed in the general population and similar to rates observed in individuals with photosensitive disorders and skin cancer. However, the frequency of sunscreen reapplication and other sun-protective measures such as seeking shade and wearing hats were less commonly adopted in our study participants, emphasizing that even in a highly motivated population there is still room for improvement. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Dermatology, Diabetes, Melanoma / 13.02.2017 Interview with: Bin Zheng, PhD Assistant Professor Cutaneous Biology Research Center Massachusetts General Hospital Harvard Medical School Charlestown, MA 02129 What is the background for this study? What are the main findings? Response: Melanoma is the most deadly form of skin cancer with more than 75,000 newly diagnosed cases in the US each year. Over the years, various genetic driver mutations have been identified that cause melanoma, including mutations in the genes BRAF and NRAS. Recent genetic insights into the development of melanoma showed that also mutations in NF1 can lead to melanoma. While there are targeted therapies available for BRAF-mutant melanoma, thus far no such therapies are available for NF1-mutant melanoma. We identified that using a combination of an ERK inhibitor, SCH772984, and the antidiabetic drug phenformin could provide a novel therapeutic strategy for NF1-mutatnt melanomas. (more…)
Allergies, Author Interviews, Dermatology, Pediatrics / 10.02.2017 Interview with: Esther van Zuuren MD on behalf of the authors Department of Dermatology Leiden University Medical Center Leiden, Netherlands What is the background for this study? What are the main findings? Response: In view of the high prevalence of eczema and the exponential increase in number of clinical trials over recent years, the NIHR designated this clinical topic, emollients and moisturisers for eczema, as a high priority. Widely prescribed as the basis of eczema management the treatment strategy is often supported by a mixed array of reviews and guidelines. Evidence for the effectiveness of emollients and moisturisers is also of variable quality. Eczema is a chronic skin disorder, the main symptoms being dry skin and intense itching with a significant impact on quality of life. As dry skin is an important feature, moisturisers are a cornerstone of eczema treatment, but there was uncertainty about their efficacy and whether one moisturiser is preferable to another. The main finding of our review is that indeed moisturisers are effective. (more…)
Author Interviews, Dermatology / 24.01.2017 Interview with: Hao Ou-Yang, PhD Johnson & Johnson Consumer Inc Skillman, New Jersey What is the background for this study? What are the main findings? Response: This is the first-ever published study to evaluate UV protection value of shade in a real-world setting. Eighty-one subjects with Fitzpatrick skin type I to III were divided into two groups: one using only a commercially available beach umbrella (round-shaped, 80” diameter, 75” high) and the other using only Neutrogena® Ultra Sheer® SPF 100+ sunscreen. Sunscreen subjects were monitored applying the product to all exposed areas following the label directions 15 minutes before beach exposure and were instructed to re-apply at least every 2 hours or as needed. Subjects were instructed to stay at the beach for 3.5 hours but could leave or stay under a shade for up to 30 minutes for cooling or rest. Shade subjects were instructed to stay under the umbrella without wearing clothes that could block the evaluated areas during the study duration. They were allowed to leave the umbrella after covering up for up to 30 minutes. There were significant differences between the two groups in clinically evaluated sunburn protection for all seven body sites measured. The Ultra Sheer SPF 100+ sunscreen provided excellent sunburn protection for all the body sites, as demonstrated by no significant changes in sunburn grading before and after UV exposure in any sites except for face. Of the subjects in the shade group, there were a total of 142 sunburn areas across all parts of the body in 78% of the umbrella group (vs. 17 areas among 10 people in the sunscreen group – 25%). Sunburn incidence within the sunscreen group may be due to uneven application (missed spots), failure to re-apply after sweating, and under-application. Most subjects in the sunscreen group applied roughl yhalf of the amount of sunscreen recommended to achieve the SPF value on the label. High SPF products provide a margin of safety for consumers who under-apply, as shown here and in other studies. (more…)
Author Interviews, Dermatology, University of Pittsburgh / 20.01.2017 Interview with: Westley Mori, fourth-year medical student (MSIV) University of Pittsburgh Medical School What is the background for this study? What are the main findings? Response: Tattooed skin represents an important diagnostic challenge for the dermatologist performing a skin cancer screening. Several case reports have described melanoma being hidden in tattoos. To our knowledge, our study is the first of its kind investigating the approach of the tattoo artist to skin with melanocytic nevi (moles) or other skin lesions. We found that the approach to tattooing skin spots is highly variable, with some artists tattooing around moles and others simply tattooing over them. The final cosmetic outcome—not the potential for skin cancer—is often the paramount concern for artists. Those artists with a personal or family history of skin cancer were more likely to refuse inking over a skin spot and recommend the client see a dermatologist. (more…)
Author Interviews, Dermatology, Gastrointestinal Disease / 15.01.2017 Interview with: Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Denmark What is the background for this study? What are the main findings? Response: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Inflammatory bowel disease (IBD) has been associated with increased prevalence of HS, but data has been limited to small studies and even less is known about the concurrence and risk of new-onset IBD in patients with pre-existing HS. In our study, we found a higher prevalence of Crohn’s disease and ulcerative colitis in patients with HS. Notably, there was a more than two-fold increased risk of new-onset Crohn’s disease and a 63% increased risk of new-onset ulcerative colitis in patients with Hidradenitis suppurativa compared with the general population. (more…)
Author Interviews, Dermatology, Environmental Risks, Melanoma / 10.01.2017 Interview with: Sophie Seite, Ph. D La Roche-Posay Dermatological Laboratories Asnières, France. What is the background for this study? What are the main findings? Response: The survey included nearly 20,000 men and women in 23 countries, ages 16-65, and was primarily conducted online. The questionnaire collected data regarding demographics, sun exposure, behaviors regarding prevention and tanning, risk knowledge, self-examination, medical advice seeking, and social attitude. This unprecedented international survey on sun exposure behaviors and skin cancer detection found that there are many imperfections and geographical inequalities in primary and secondary prevention of skin cancer. The study was published in the Journal of the European Academy of Dermatology & Venereology by researchers from La Roche-Posay and the George Washington University (GW) Department of Dermatology. Survey results indicate that 88 percent of those questioned were aware of the risks of developing skin cancer when exposed without protection to the sun. However, just 1 in 2 respondents has ever consulted a dermatologist for a mole screening and 4 in 10 people don’t think to protect themselves from the sun outside of vacation. (more…)
Addiction, Author Interviews, Dermatology / 10.01.2017 Interview with: Dr Anthony Bewley FRCP Consultant Dermatologist Whipps Cross University Hospital & The Royal London Hospital What is the background for this study? Response: Delusional infestation (DI) is a very disabling condition, whereby patients hold a fixed, unshakeable false belief of being infested with insects or other inanimate objects such as fibres and threads. Previous studies have indicated a high rate of recreational drug use amongst patients with delusional infestation (DI). The aim of our pilot study was to look at the prevalence of recreational drug use in patients with delusional infestation who attended clinic over a three year period (Group 1). We also prospectively offered a urine drugs test to 24 consecutive patients over a three month period (Group 2). (more…)
Author Interviews, Boehringer Ingelheim, Dermatology / 05.01.2017 Interview with: Andrew Blauvelt, M.D., M.B.A. President and Investigator Oregon Medical Research Center Portland, OR 97223 What is the background for this study? What are the main findings? Response: Findings from the guselkumab Phase 3 VOYAGE 1 study showed that patients with moderate to severe plaque psoriasis receiving the anti-interleukin (IL)-23 monoclonal antibody (mAb) achieved significant improvements in skin clearance compared with patients receiving placebo and patients receiving Humira® (adalimumab), a TNF blocker. The Phase 3 study and head-to-head analysis of guselkumab vs. adalimumab in the treatment of moderate to severe plaque psoriasis also showed the significant efficacy of guselkumab maintained through week 48 compared with adalimumab, and the robust efficacy of guselkumab in meeting all primary and major secondary endpoints. (more…)
Author Interviews, Dermatology, JAMA, Melanoma / 02.01.2017 Interview with: Jessica S. Mounessa, BS Robert P. Dellavalle, MD, PhD, MSPH Dermatology Service, Denver Veterans Affairs Medical Center, Denver, Colorado Department of Dermatology, University of Colorado School of Medicine, Aurora What is the background for this study? What are the main findings? Response: Skin cancer remains the most common cancer in the U.S., despite ongoing efforts to address this major public health problem. Over 9,000 deaths occur annually, and mortality rates continue to increase faster than those associated with any other preventable cancer. Malignant melanoma, the deadliest type of skin cancer, accounts for the overwhelming majority of these deaths. Our study identified regional and state differences in the incidence and mortality rates of melanoma in the United States. We found that the Northeast, specifically New England, represents the only U.S. region in which the majority of states experienced a reduction in both incidence and death rates over the ten-year period between 2003 and 2013. (more…)
Author Interviews, Dermatology, Orthopedics / 02.01.2017 Interview with: Hsien-Yi Chiu, MD/ Tsen-Fang Tsai, MD Department of Dermatology, National Taiwan University Hospital Taipei, Taiwan What is the background for this study? What are the main findings? Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities. Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN. Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group. (more…)
Author Interviews, Dermatology, Infections, Transplantation, UT Southwestern / 02.01.2017 Interview with: Richard Wang, M.D., Ph.D. Assistant Professor UT Southwestern Medical Center What is the background for this study? What are the main findings? Response: Currently, there are 13 polyomaviruses known to infect humans. Several members of this family of double-stranded DNA viruses—including Merkel Cell Polyomavirus, Trichodysplasia Spinulosa Polyomavirus, Human Polyomavirus 6 (HPyV6), and Human Polyomavirus 7 (HPyV7)—can be shed from skin of healthy individuals. While most polyomavirus infections are common and subclinical, several polyomaviruses have been associated with debilitating diseases in immunocompromised individuals. Most recently, HPyV7 was discovered in a pruritic and dyskeratotic eruption in two immunosuppressed transplant patients. A closely related polyomavirus, Human Polyomavirus 6, has not yet been strongly linked to any infectious diseases. Using the previously described, characteristic histologic pattern, we identify 3 additional cases of skin eruptions associated with infections of HPyV6 and HPyV7. The association of the dermatoses with highly active infections were confirmed through electron microscopy, immunohistochemistry, quantitative PCR, and complete sequencing. HPyV7 infects keratinocytes and affects their normal differentiation. In addition, next generation sequencing revealed that HPyV6 could persist in a latent state in the skin of a previously infected patient. (more…)
Author Interviews, Cost of Health Care, Dermatology, Melanoma / 28.12.2016 Interview with: Isabelle Hoorens, MD, PhD Department of Dermatology Ghent University Hospital Ghent, Belgium What is the background for this study? What are the main findings? Response: In this study we questioned whether a population-based screening for skin cancer is cost-effective. In addition we compared the cost-effectiveness of two specific screening techniques. The first technique, a lesion-directed screening being a free-of-charge skin cancer check of a specific lesion meeting 1 or more of the following criteria: ABCD rule (asymmetry, border irregularity, color variation, and diameter >6 mm), “ugly duckling” sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions. The second screening technique consisted of a systematic total body examination in asymptomatic patients. A clinical screening study was performed in Belgium in 2014. (more…)
Author Interviews, Cancer Research, Dermatology, Surgical Research / 15.12.2016 Interview with: Hywel C. Williams DSc, FMedSci, NIHR Senior Investigator Director of the NIHR Health Technology Assessment Programme Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology, University of Nottingham, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham UK What is the background for this study? What are the main findings? Response: Our clinical trial of 5% imiquimod cream versus surgery for low risk basal carcinoma (BCC) of the skin was first prompted by a shocking lack of randomised controlled clinical trials for what is the commonest form of human cancer. We had conducted a Cochrane systematic review prior to starting the study and found very few long term studies. An emerging literature on imiquimod cream at the time suggested that it might have a clinically useful effect for low risk BCC. All the studies were short term and industry supported, so with the support of Cancer Research UK (UK largest cancer charity), we undertook a large independent study to see how the cream compared to the reference standard of excision surgery with a 4mm margin for low risk superficial and nodular BCC. Our three year results, published in Lancet Oncology, showed that surgery is clearly superior to imiquimod cream, with a success rate (absence of initial failure and no signs of recurrence at 3 years) of 98.4% compared to 83.6% for imiquimod. Nevertheless, the 83.6% success rate is still potentially useful, so we wanted to see whether these 3 year results were sustained. So we followed up your study participants for a total of 5 years and found that the response rates at 5 years were almost the same as those at 3 years (97.7% and 82.5% for surgery and imiquimod respectively). Most treatment failures with imiquimod occurred early on ie in the first year of treatment. Our study shows that if initial treatment works, the benefits are sustained. (more…)
Author Interviews, Dermatology, Electronic Records, JAMA, Outcomes & Safety, Surgical Research / 08.12.2016 Interview with: Sophia Akhiyat M.D. Candidate, Class of 2017 The George Washington University School of Medicine and Health Sciences METEOR Fellowship What is the background for this study? What are the main findings? Response: Our study was inspired by one of Choudhry et al,1 in which patients' preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients' preferences at a general dermatology clinic at an academic center. Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal. 1Choudhry A, Hong J, Chong K, et al. Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521. (more…)
Author Interviews, Dermatology, JAMA, Pediatrics / 07.12.2016 Interview with: Steve Xu MD, MSc Resident Physician Department of Dermatology Northwestern Feinberg School of Medicine What is the background for this study? What are the main findings? Response: Given the limited data on the effectiveness or safety of the different moisturizers examined in the study, how much do you think parents should decide what to use on their babies based on the "cost-effectiveness" determined in this study? Would you just say cheapest is best since we don't know how well these things work? Or what's the message? Price. Petrolatum is an extremely effective moisturizer. It also happens to be one of the most affordable. Unlike adults, I don't suspect newborns will complain too much about the greasiness of petrolatum. They're less concerned that their work clothes will get ruined. They are less likely to care about cosmetic elegance. I also will say that petrolatum is less likely to include any artificial fragrances, preservatives that could serve as irritants or allergens in the future. That's an added bonus. (more…)
Author Interviews, Dermatology, Melanoma / 05.12.2016 Interview with: Shoshana M. Landow, MD, MPH FAAD Dermatoepidemiology Unit Providence Veterans Affairs Medical Center Providence, RI 02908. What is the background for this study? What are the main findings? Response: Interest for this study arose from a realization that a large number of deaths from thin melanomas have been documented in SEER. Since prognosis worsens with depth for thicker melanomas, we sought to evaluate whether it was the "thicker" of the thin melanomas that accounted for most of the deaths. We were surprised to find that when we restricted our study to melanomas diagnosed at Stage I and II, the greatest number of deaths at 10 years caused by these melanomas resulted from those 1.00mm and less in depth. We were also surprised to find that prognosis for ultra-thin melanomas, 0.01-0.25mm in depth, was not better than those 0.26-0.50mm, as we had expected. (more…)
Author Interviews, Dermatology, Genetic Research / 22.11.2016 Interview with: Prof. Dr. Regina Betz and Dr. Buket Basmanav Ünalan (first author) Institute of Human Genetics University of Bonn Bonn, Germany What is the background for this study? What are the main findings? Response: Up to know, the cause for uncombable hair was totally unknown. We identified now mutations in three genes, all being responsible for uncombable hair syndrome. Of interest, the corresponding proteins, namely, PADI3, TGM3 and TCHH, are all in the same cascade that is responsible for the formation and mechanical strengthening of the hair shaft. (more…)
Author Interviews, Cancer Research, Dermatology, JAMA, UCLA / 22.11.2016 Interview with: Albert Yoon-Kyu Han, PhD Class of 2017 Medical Scientist Training Program David Geffen School of Medicine at UCLA What is the background for this study? What are the main findings? Response: Squamous cell carcinoma (SCC) of the lip makes up a large portion of oral cancers (25%). Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series. Thus, we used the national cancer database (Surveillance, Epidemiology, and End Results, or SEER) to examine the incidence, treatment, and survival of patients with lip SCC. The main findings of this study were that lip Squamous cell carcinoma predominantly affects white men in their mid-60s. We also found that the determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. More specifically, on the primary site, SCC of the upper and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival. (more…)
Author Interviews, Dermatology, Infections / 22.11.2016 Interview with: Adam Friedman, MD, FAAD Associate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health Sciences What is the background for this study? What are the main findings? Response: This study was developed out of a session I and my colleague, Neal Bhatia, held at the 2016 Orlando Dermatology Aesthetic and Clinical Conference. As an interactive session which had the audience answer whether they clinically thought an image was representative of a fungal skin infection or not, we collected audience responses and were impressed by how even dermatologists struggle with making this diagnosis clinically. This is not so surprising given the protean nature and diverse presentations of these infections, not to mention the many mimics which are not due to infection. Only one of the thirteen images shown was appropriately diagnosed by 90% of the audience. This highlights that the importance of using bedside diagnostic techniques such as KOH preps and culture to identify underlying cause in order to appropriately use the right therapy for the right condition. (more…)