ASDS: Skin Cancer Treatments Among Most Frequently Performed Procedures in 2015

Dermatologic surgeons performed nearly 10 million medical and cosmetic procedures in 2015—up five percent since 2014 and 27 percent since 2012, according to the 2015 American Society for Dermatologic Surgery (ASDS) Survey on Dermatologic Procedures.

For the fourth year in a row, skin cancer treatments ranked as the most-performed procedure (3.17 million) by ASDS members. Treatments for melanoma were up five percent over 2014. Since 2012, skin cancer treatments have risen 18 percent, the survey showed.

Members also performed 6.7 million cosmetic treatments in 2015—with the largest year-to-year growth seen in soft-tissue fillers (35 percent) and body sculpting (11 percent), the survey found.

The top cosmetic treatments in 2015 were:

• 2.62 million laser, light and energy-based procedures
• 1.79 million neuromodulators
• 1.36 million soft-tissue fillers
• 596,000 chemical peels
• 230,000 body sculpting treatments

New Case Study Highlights Black Henna Tattoo Risks

Black henna tattoos should be avoided, especially during foreign travel, doctors warn in BMJ Case Reports. Researchers from the University of Sheffield, Sheffield, UK report on a 10-year-old boy who developed an allergic reaction to a tattoo painted on his arm while vacationing in Spain. The young boy presented with redness, itching, and small inflammatory irritated spots on his partially crusted skin lesion, which followed the outline of the tattoo on his right upper arm. The surrounding skin was red, hot and painful to touch.

The rash had started four days after application of a temporary black henna tattoo. The reaction may have been caused by paraphenylenediamine (PPD), a textile dye that is commonly added to henna to blacken the pigment and speed up drying time. PPD, a known contact allergen, can lead to a reaction based on its concentration and the duration of exposure.

The boy was treated with antibiotics and topical corticosteroid, local anesthetic, and moisturizing creams. An improvement was noted after 48 hours with rapid resolution of surrounding inflammation, the researchers report.

Global Derm Market Set to Soar Through 2022

The global dermatology market is set to grow from $20 billion in 2015 to $33.7 billion by 2022—a compound annual growth rate of 7.7 percent, GBI Research reports.

This rise will occur despite the patent expirations of many marketed monoclonal antibodies (mAbs). Growth will be driven by a strong late-stage pipeline, which includes several highly targeted therapies for major skin disorders, including atopic dermatitis, acne vulgaris, and rosacea. Specifically, Regeneron/Sanofi’s dupilumab is expected to bring about a paradigm shift in the treatment of moderate-to-severe atopic dermatitis. At the same time, the use of older systemic immunosuppressants in dermatology is likely to decrease once biologics for other key indications besides psoriasis enter the market in 2016 and beyond, the report states.

Key market players, namely Johnson & Johnson, Abide, Amgen, Novartis, and Roche, are expected to maintain their strong market shares throughout the forecast period, despite the fact that many of the approaching patent expiries—especially AbbVie’s Humira and Johnson & Johnson’s Remicade—will affect these companies directly, GBI reports.

Lilly’s Taltz Now Available; US Psoriasis Registry to Track Safety

Eli Lilly and Company’s Taltz (ixekizumab) injection 80mg/mL for the treatment of moderate-to-severe plaque psoriasis is now available by prescription order through a contracted network of specialty pharmacies in the US. Lilly is also offering patient support programs to help ensure eligible patients have access to Taltz and available resources.

The Taltz Together program will provide interested patients with injection training, guidance on navigating insurance benefits, and working with a contracted network of specialty pharmacies to help fill Taltz prescriptions. Patients will also have access to a Companion in Care, a personal patient representative to answer questions and concerns, with each patient receiving attention from the same specialist during each call. For more information about Taltz Together, patients can contact 1-844-TALTZ-NOW.

Taltz was FDA-approved in March 2016 for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systematic therapy or phototherapy. Taltz is contraindicated in patients with previous hypersensitivity reaction, such as anaphylaxis, to ixekizumab or to any of the excipients. Taltz is designed to specifically target IL-17A.

The Corrona Psoriasis Registry will track drug safety reporting for ixekizumab. The registry is a joint collaboration between the National Psoriasis Foundation (NPF) and Corrona, LLC, the leading sponsor of registries in autoimmune disease.

The registry will enroll at least 4,000 people with psoriasis on ixekizumab and follow their treatment for at least eight years. More than 1,200 people on various psoriasis medications from 100 sites have joined within the first year of the registry. Registry participation numbers are expected to grow to more than 10,000 people with moderate-to-severe psoriasis on biologics or systemic medications and 200 sites. By collecting and analyzing data from thousands of people over many years, the registry will help researchers compare the safety and effectiveness of psoriasis therapies, study other diseases and medical conditions associated with psoriasis, and better understand the natural course of the disease.

“This is an exciting time for patients with psoriasis as new treatments become available, and this registry will provide the long-term data we need to understand the safety and effectiveness of these therapies,” said Dr. Bruce Strober, professor and chair of University of Connecticut Health Center Department of Dermatology and scientific co-director of the registry. “The information collected will also provide valuable insights into the relationship between psoriasis and other diseases, as well as the impact of psoriasis and its treatments on quality of life.”

Study IDs Mechanism That Controls Skin and Hair Color

A pair of molecular signals controls skin and hair color in mice and humans—and could be targeted by new drugs to treat skin pigment disorders like vitiligo, according to a report out of NYU Langone Medical Center in New York City.

Finding ways to activate these pathways could lead to therapies that repigment skin cells damaged in vitiligo, they report. The same pathways could serve as targets for drug therapies that repigment grayed hair cells. In the future, such therapies might reinforce pigment to correct discoloration around scars.

Researchers found that control of these skin and early-stage hair cells, known as melanocyte stem cells, is regulated by cell-to-cell signaling reactions in experiments in mice and human cells. These reactions are part of the endothelin receptor type B (EdnrB) and the Wnt signaling pathways. Previous research had shown that endothelin proteins and the EdnrB pathway help control blood vessel development, as well as some aspects of cell growth and division.

The new findings, which appear in Cell Reports, are the first to outline the link between EdnrB and Wnt signaling, confirming that EdnrB coordinates the rapid reproduction of melanocyte stem cells, the researchers report.

Among the study’s key findings was that mice bred to be deficient in the EdnrB pathway experienced premature graying of their fur. In further experiments in mice, stimulating the EdnrB pathway resulted in a 15-fold increase in melanocyte stem cell pigment production within two months, producing hyperpigmentation. Wounded skin in normally white mice became dark upon healing.

In the latest study, blocking Wnt signaling stalled stem cell growth and the maturing of stem cells into normally functioning melanocytes, even when endothelin proteins were present. This led to mice with unpigmented grayish coats. The team now plans further investigations into how other cell repair and signaling pathways interact with EdnrB and melanocyte stem cells.

Tight Ponytails, Braids Linked to Traction Alopecia

New research published ahead of print in the Journal of the American Academy of Dermatology confirms a “strong association” between scalp-pulling hairstyles and the development of traction alopecia.

From a review of 19 studies, researchers at Johns Hopkins categorize hair practices into low-, moderate- and high-risk based on the degree to which follicles are exposed to tension, weight, heat and hair-altering chemicals, such as straighteners.

Moderate-risk styles include some of the same styles noted to be high risk, but because they are performed on natural, unprocessed hair, they are less likely to result in hair loss. Low-risk styles generally included low-tension styles, such as loose buns, and loose-hanging styles, such as wearing the hair down, as well as practices that decrease the amount of friction on the hair and scalp and avoid chemical relaxers. The highest-risk styles include braids, dreadlocks, weaves and extensions, especially when applied to chemically straightened hair. These styles are popular among African Americans because they are low maintenance and chemical-free, but the constant pulling of the hair in one direction, the tight-locking patterns and added weight can result in significant breakage and eventually traction alopecia. Damage can also be done if extensions are affixed with adhesive glue put directly on the scalp, especially when the glued-on hair is removed. Chemical straightening weakens the hair shaft, causing breakage.

In the more moderate-risk category are thermal straightening, permanent waving and use of wigs. Temporary thermal or heat-related straightening of the hair, such as the use of flat irons and blow drying the hair—while not by itself significantly associated with traction alopecia—can weaken shafts, leading to “significant” hair loss when traction is applied, the researchers conclude. Permanent waves made with ammonium thioglycolate to create or alter curl pattern, together with added tension from chemical treatment, do the same. And wigs attached with clips and adhesives to keep them in place can cause significant breakage. Cotton and nylon wig caps that rub the hairline may also weaken hair shafts, while satin ones are less likely to do so.

In their review, the investigators also offered guidelines for dermatologists and other care providers to prevent and manage hair loss from traction alopecia. The first line of therapy, they say, is to loosen braids and other high-tension styles, as well as weight on the follicle permanently or periodically. Braided hairstyles should be in place no longer than two to three months, and weaves and extensions should also be removed for a period of time after six to eight weeks.

The investigators also recommend people alternate styles, mainly reducing or avoiding updos, to allow follicles to recover from stress.

“Hair is a cornerstone of self-esteem and identity for many people,” says study author Crystal Aguh, MD assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore, “but ironically, some hairstyles meant to improve our self-confidence actually lead to hair and scalp damage.”

“Dermatologists need to be conscious of the fact that many high- and moderate-risk hairstyles greatly improve hair manageability, and simply telling patients to abandon them won’t work for everyone,” says Dr. Aguh. “Instead, physicians can educate themselves to speak with patients about making the best hairstyling choices to minimize preventable hair loss.”

New App Connects Patients and Dermatologists

The new Dermio app, developed by dermatologist David Soleymani, MD, allows users to confidentially send pictures and videos of rashes, acne, and other skin conditions to be diagnosed by a dermatologist in 24 hours or less, according to a recent article in Indiana University’s Indiana Daily Student.

Dr. Soleymani recognized the prevalence of sexually transmitted diseases and the demand that many sexually active Americans have for a dermatologist to help them get diagnosed for rashes and skin diseases—especially “sensitive” ones.

“Most of dermatology is a visual thing, so if we can get pictures, we can diagnose patients most of the time,” Dr. Soleymani told the school paper. “From there, I created the app.”

The app also helps individuals in rural communities access a dermatologist more quickly. The app benefits patients who are away and need help from a dermatologist. For example, college students may want their personal doctors to diagnose their condition.

Dr. Soleymani confirmed with the Indiana Daily Student, “that users should not fear their Dermio pictures being seen by anyone besides their dermatologist. The app is completely secure, private and legitimate.” n

—Zachary Thomas, Special Contributor