Recent Developments

Six Percent of Children Have Eczema Symptoms Worldwide

Approximately 6% of children and adolescents have some form of eczema, according to research recently published in Clinical & Experimental Allergy.¹ In addition, 0.6% of children and 1.1% of adolescents across the globe report symptoms of severe eczema. The results come from an analysis of data from 14 countries involving 74,361 adolescents aged 13 to 14 years and 47,907 children aged 6 to 7 years.

The investigators estimated an average increase in the prevalence of current eczema symptoms over 27 years of 0.98% per decade in adolescents and 1.21% per decade in children and of 0.26% and 0.23% per decade, respectively, in severe eczema symptoms. There was substantial variation, however, in changes in eczema prevalence over time by income and region.

“Eczema remains a big public health problem around the world,” said corresponding author Sinéad Langan, PhD, of the London School of Hygiene & Tropical Medicine, in a news release.² “Global research efforts are needed to address the burden related to eczema with continued international efforts to identify strategies to prevent the onset of eczema and to better manage the impact on individuals, their families, and health service.”

1. Langan SM, Mulick AR, Rutter CE, et al. Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study. Clinical & Experimental Allergy. Published online February 8, 2023. doi:10.1111/cea.14276

2. Eczema in young individuals remains a substantial public health burden in most countries. News release. News Medical Life Sciences. February 8, 2023. Accessed February 9, 2023. https://www.news-medical.net/news/20230208/Eczema-in-young-individuals-remains-a-substantial-public-health-burden-in-most-countries.aspx

MTX Use May up Risk for Three Types of Skin Cancer

Methotrexate (MTX) may increase the risk for three types of skin cancer, according to a nationwide Danish case-controlled study published in the British Journal of Cancer.¹

The study, based on Danish health care registers, identified patients who, between 2004 and 2018, were diagnosed with one of three types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (cSCC), and cutaneous malignant melanoma (CMM). Every patient with skin cancer was compared with 10 age- and sex-matched controls.

At a group level, it was more common for patients who developed any of the three types of skin cancer to have been treated with MTX previously. The increase in risk was presented as a range: 20% to 38% for BCC, 37% to 89% for cSCC, and 13% to 61% for CMM. The researchers also found that patients who had used higher doses of MTX were at greater risk of cSCC and BCC, whereas no distinct dose-response relationship was observed for CMM.

The study’s findings should not be used at an individual level, said study author Sam Polesie, an associate professor (docent) of dermatology and venereology at Sahlgrenska Academy, University of Gothenburg, and dermatologist at Sahlgrenska University Hospital.

“MTX is an effective and important medicine that helps lots of patients.” Polesie said in a news release.² “The absolute risk for an individual patient of developing any of these skin cancer types remains small even if they use the drug. However, since MTX is a quite frequently used drug, our results may imply a rise in the number of skin cancer cases at the population level.”

When the researchers confined the study to patients with psoriasis, they found no statistical correlation linking MTX to a raised cSCC or CMM risk, but an increase in BCC risk remained.

“You could interpret this as a weakness in the study,” Polesie said. “It’s possible that the statistical analyses conceal some type of bias that was evident among patients with psoriasis, but we can only speculate about that. These results might also be interpreted as reassuring to dermatologists who mainly use MTX as the first-line therapy of systemic drugs to treat patients with moderate to severe psoriasis.”

“Patients with psoriasis probably have divergent sun exposure habits,” Polesie continued. “Moreover, historically light therapy used to be a common treatment to treat psoriasis. Sun exposure habits and use of light therapies were examples of important factors we weren’t able to include in the study.”

1. Polesie S, Gillstedt M, Schmidt SAJ, Egeberg A, Pottegård A, Kristensen K. Use of methotrexate and risk of skin cancer: a nationwide case-control study. Br J Cancer. Published online February 4, 2023. doi:10.1038/s41416-023-02172-7

2. Use of methotrexate is associated with an increased risk of skin cancer. University of Gothenburg. News release. February 7, 2023. Accessed February 9, 2023. https://www.gu.se/en/news/use-of-methotrexate-is-associated-with-an-increased-risk-of-skin-cancer

New Biomarkers May Help Advance Melanoma Detection

New biomarkers to improve skin cancer detection and avoid delays in treatment are being developed by researchers at the University of South Australia (UniSA).

“Melanomas exhibit a wide range of sizes, shapes, and growth, which can resemble numerous benign and other malignant skin lesions,” said UniSA PhD candidate Giang Lam in an article published in Molecular Diagnosis and Therapy.¹

“It can make accurate detection difficult, even for expert dermatologists and pathologists,” he continued. “The current markers used in clinical practice to identify cancerous cells and distinguish them from normal cells are not always sensitive or specific. Melanomas are sometimes missed, and this can have fatal consequences.”

Lam and supervisor Dr. Jessica Logan, a research fellow in UniSA’s clinical and health sciences unit, are identifying new detection methods based on abnormal markers in the endosomal system, which flags melanoma growth.

With melanomas, this system is hyperactivated and plays an important part in initiating melanomas and encouraging their growth. Developing markers that can label these cells in a dark brown color would allow pathologists to be 100% accurate, Lam and Logan wrote.

“Our research at UniSA is primarily focused on developing more effective biomarkers for melanoma but also understanding how the disease progresses and the multiple causes,” Dr. Logan said.

“The sun and subsequent UV damage are mainly responsible for causing skin cancer, so wearing sunscreen and getting regular skin checks is a must, but genetics also plays a role,” she said. “If some of your family members have skin cancer, you also have a higher chance of getting the disease.”

1. Lam GT, Prabhakaran S, Sorvina A, et al. Pitfalls in cutaneous melanoma diagnosis and the need for new reliable markers. Mol Diagn Ther. 2023;27(1):49-60.

STUDY: RACIALIZED BEAUTY NORMS HARM WOMEN OF COLOR

A survey conducted as part of a community-based participatory research project indicated that racialized beauty norms may motivate some people’s use of chemical hair straighteners and skin lighteners linked to poor health outcomes.¹ Data analysis was led by researchers at Columbia University Mailman School of Public Health in close partnership with the environmental justice group We Act for Environmental Justice, which also led the design and execution of the study. The researchers surveyed 297 women and femme-identifying individuals in Northern Manhattan and the South Bronx.

Participants answered questions on their use of chemical straighteners and skin lighteners, the messages they received about hairstyles and skin tone from peers and family members, and their sentiments toward and perceptions of societal beauty norms.

Forty-four percent of female respondents and 34% of femme-identifying respondents reported having ever used chemical straighteners. Current use of these products was lower at 15% and 13%, respectively. Black respondents were most likely to use chemical straighteners. Among non-Hispanic Black respondents, 60% and 19% reported ever and currently using the products, respectively. Among Hispanic Black respondents, 48% and 24% reported ever and currently using the products, respectively. Half of all respondents said they think others believe straight hair makes women more beautiful; 36% of respondents said they personally felt this way.

Twenty-five percent of female respondents and 22% of femme-identifying respondents reported having ever used skin lighteners. Current use was lower at 16% and 9%, respectively. Asian respondents reported the highest frequency of skin lightener use. Skin lightener use among Asian and Hispanic respondents was higher for those born outside the United States. Half of respondents said others find light skin more beautiful; 33% percent of respondents reported personally feeling this way.

Chemical straighteners, such as relaxers, can contain harmful chemicals such as phthalates, parabens, and formaldehyde. Studies have linked relaxer use with earlier age at menarche and increased risk of uterine fibroids and breast and uterine cancers.2-6 Skin lighteners can contain corticosteroids, which can disrupt cortisol regulation and lead to metabolic problems,7 and mercury, which can cause kidney and nervous system damage.8

“Programs and policies are needed to counteract natural hair discrimination and colorism and transform the markets that depend on racist beauty norms,” said Ami Zota, PhD, an associate professor of environmental health sciences at Columbia Mailman School of Public Health and an author of the study, said in a news release. “Educating consumers about racialized beauty norms could motivate them to advocate for legislation, such as the Safer Beauty Bill package, which ensures safer products for all.”

1. Edwards L, Ahmed L, Martinez L, et al. Beauty Inside Out: examining beauty product use among diverse women and femme-identifying individuals in Northern Manhattan and South Bronx through an environmental justice framework. Environ Justice. Published online January 18, 2023. doi:10.1089/env.2022.0053

2. Pierce JS, Abelmann A, Spicer LJ, et al. Characterization of formaldehyde exposure resulting from the use of four professional hair straightening products. J Occup Environ Hyg. 2011;8(11):686-699.

3. Helm JS, Nishioka M, Brody JG, Rudel RA, Dodson RE. Measurement of endocrine disrupting and asthma-associated chemicals in hair products used by Black women. EnvironRes. 2018;165:448-458.

4. McDonald JA, Tehranifar P, Flom JD, Terry MB, James-Todd T. Hair product use, age at menarche and mammographic breast density in multiethnic urban women. EnvironHealth. 2018;17(1):1.

5. Rao R, McDonald JA, Barrett ES, et al. Associations of hair dye and relaxer use with breast tumor clinicopathologic features: findings from the Women’s Circle of Health Study. Environ Res. 2022;203:111863.

6. Wise LA, Palmer JR, Reich D, Cozier YC, Rosenberg L. Hair relaxer use and risk of uterine leiomyomata in African-American women. Am J Epidemiol. 2012;175(5):432-440.

7. Masub N, Khachemoune A. Cosmetic skin lightening use and side effects. J Dermatolog Treat. 2022;33(3):1287-1292.

8. Weldon MM, Smolinski MS, Maroufi A, et al. Mercury poisoning associated with a Mexican beauty cream. West J Med. 2000;173(1):15-8; discussion 19.

Legislative Update

By Kimberly Campbell and Ron Lebow, Esq

The Federal Trade Commission (FTC) is proposing a new rule that could have significant implications for dermatologists and other physicians. The rule would ban employers from entering into, enforcing, or threatening to enforce noncompete clauses with any physician whose job is classified as nonexempt under the Fair Labor Standards Act. Additionally, no employer would be permitted to enter into a noncompete agreement with any health professional if the employer receives federal funding. This includes physicians and other health care professionals such as nurses and pharmacists.

The proposed rule would benefit dermatologists in several ways. By blocking companies from imposing restrictive contracts on employees, the FTC’s new proposed rule would create more job opportunities for dermatologists—including by increasing their ability to start their own practices—and help them receive higher pay by allowing them to negotiate better deals with employers. The FTC estimates that US wages could increase by nearly $300 billion per year owing to increased competition.

It is important to point out, however, some of the proposed rule’s potential downsides for employers and employees. First, some employers might respond by reducing their workforce or cutting wages for those who remain employed. Second, some companies might be forced out of business by the increased competition. Third, companies might attempt to use other tactics to discourage employees from leaving such as delaying bonus payments and paying bonuses only if an employee remains for a certain minimum period of years.

The proposed rule, moreover, might make it even harder for small private practices to recruit dermatologists. It could also reduce the value of any practice being sold if assurances of protected postsale goodwill cannot be given to the buyer (ie, if anyone can move across the street and steal patients).

If implemented, the changes must be closely monitored so that workers can reap all the intended benefits and unintended consequences are avoided. In all likelihood, the final rule will contain additional exceptions, such as time-based limits for noncompetes or objective tests for reasonableness of the scope. This has been the state-level response to efforts by businesses to protect their investments.

Kimberly Campbell is the founder of Dermatology Authority, a communications and recruiting agency.

Ron Lebow, Esq, is a health law business attorney at Lebow Law, PC.

Phase 1 Study of EP262 Cleared by FDA

The FDA cleared Escient Pharmaceuticals’ investigational new drug application for EP262. The clearance allows initiation of a phase 1 first-in-human study for the company’s second drug candidate to be advanced into clinical development.

EP262 is a first-in-class, highly selective small-molecule antagonist of MRGPRX2, a receptor-mediating non-immunoglobulin E–driven mast cell degranulation. According to Escient, by blocking activation of MRGPRX2 and degranulation of mast cells, EP262 has the potential to treat a broad range of mast cell–mediated diseases effectively with an initial focus on chronic urticarias (hives) and atopic dermatitis. EP262 represents a novel, targeted approach to the treatment of these disorders with the potential for once-daily oral administration without the side effects observed with other approaches.

Escient plans to conduct a phase 1 study in the first half of 2023 to evaluate the safety, tolerability, and pharmacokinetics of EP262 in healthy volunteers. Following this study, in the second half of 2023, the company plans to initiate several clinical proof-of-concept studies evaluating EP262 in patients with chronic inducible urticaria, chronic spontaneous urticaria, and atopic dermatitis.¹

1. Escient Pharmaceuticals announces IND clearance by FDA to start phase 1 study of EP262, a first-in-class oral MRGPRX2 antagonist for mast cell mediated disorders. New release. Escient Pharmaceuticals. January 30, 2023. Accessed February 9, 2023. https://www.escientpharma.com/escient-pharmaceuticals-announces-ind-clearance-by-fda-to-start-phase-1-study-of-ep262-a-first-in-class-oral-mrgprx2-antagonist-for-mast-cell-mediated-disorders

Close up With Patricia M. Richey, MD

Boston dermatologist Patricia M. Richey, MD, and colleagues took a deep dive into the top 900 Instagram posts using the hashtags #dermalfillers, #injectables, #cosmeticinjectables, #expertinjector, #masterinjector, #fillers, #fillersinjection, #cheekfillers, and #lipfiller.

It turns out that most of these posts were written by nonphysicians and 84.6% of the posts that focused on off-label procedures were posted by nonphysicians. Dr. Richey, a physician-scientist at Massachusetts General Hospital’s Wellman Center for Photomedicine in Boston, chatted with Practical Dermatology® magazine about the results and their implications. The study appears in the December 2022 issue of Dermatologic Surgery.¹

What is the main takeaway message from your study?

Patricia M. Richey, MD: At a time when patients are increasingly turning to social media for health care recommendations and education, the vast majority of the “top” Instagram content related to soft tissue augmentation is being provided by nonphysicians, many of whom are performing off-label procedures.

How big a concern is it that most “top” content related to soft tissue augmentation is provided by nonphysicians, many of whom are performing off-label procedures?

Dr. Richey: It is quite concerning as, even when soft tissue augmentation is performed in US Food and Drug Administration–approved regions, it is certainly not a procedure without risk, and experience appears to provide benefit in terms of decreased occlusion incidence. Treatment at a medical spa has been shown to be associated with a higher risk of filler complications, with improper technique and training cited as the most common causes of the complications.

What should physicians tell patients regarding skincare advice on social media?

Dr. Richey: Patients should get advice and treatment from board-certified physicians. Numerous studies have demonstrated that the risks associated with soft tissue augmentation are reduced when the procedure is performed by an experienced board-certified dermatologist.

1. Richey PM, Hashemi DA, Avram MM. Social media in aesthetic dermatology: analysis of the users behind the top filler posts. Dermatol Surg. 2022;48(12):1328-1331.