Concern About Zika Virus in US Set to Escalate

By Denise Mann

Dermatologists in the US may start to receive calls from patients—particularly pregnant ones—who are concerned about infection with Zika virus.

Zika is now spreading rapidly across Latin America and the Caribbean. So far, one case has been identified in Houston, but the possibility that this virus will find its way to these shores has been generating much media coverage recently. The person diagnosed in Texas had recently traveled from Latin America. US health officials are now considering a travel warning about Zika virus.

“There does not seem to be evidence of transmission in Houston or the Gulf Coast Area, but it is quite possible that this could happen in the Spring or Summer, so we have to be on the lookout for it,” says Peter J. Hotez, MD, PhD, the Founding Dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston.

Common symptoms of Zika virus are fever, rash, joint pain, and conjunctivitis. A possible connection between Zika virus infection in pregnant women and risk for microcephaly is now being investigated in Brazil.  

“The main fear is the possible connection between Zika and microcephaly. This is being investigated and the link is not definitive at this time,” adds Matthew D. Sims, MD, PhD, the Director of Infectious Diseases Research at Beaumont Hospital in Royal Oak, MI.

“It’s one thing if the Zika rash and fever occur in a non-pregnant adult, but if it happens in a woman who could be pregnant, she must see her obstetrician,” Dr. Hotez says. “If a pregnant woman or a woman planning to become pregnant is considering travel to parts of the world where Zika is endemic, she should be counseled on the risks associated with such travel.”

In terms of diagnosis, Dr. Hotez says, “There is nothing specific about the rash with Zika compared to other virus transmitted by insects.” It is similar in appearance to rashes associated with Dengue and Chikungunya. “Zika rash is morbilliform, can be itchy, and heals with desquamation.”

Skin hemorrhaging has been seen with the Dengue virus, and could potentially occur with Zika as well.

Patients may present with a very mild rash, general viral prodome along with history of travel to endemic areas, Dr. Sims explains. “If the patient is not coming from an endemic area it is not likely to be Zika at this time.” The Federal Centers for Disease Control and Prevention provides a map of where Zika virus can be found.

There are specialty tests that can be done through state health departments. “If you have a patient who you suspect is infected with Zika, contact your local or state health departments about the best way to process blood samples or other specimens,” he advises.

There’s no vaccine against Zika and no treatment for it, which means that prevention is the key. “Avoid mosquities if traveling to endemic areas,” Dr. Sims says. This includes use of repellents containing DEET, picaridin and IR3535. Patients should be told that they should apply sunscreen before repellent. “Mesh mosquito nets can also be helpful,” he says.

Study Highlights Risk Factors for cSCC Recurrence, Metastasis, Death

Tumor depth confers the highest risk of local recurrence and metastasis of cutaneous squamous cell carcinoma (cSCC), and tumor diameter exceeding 20mm is associated with the highest risk for disease-specific death, a new study published in JAMA Dermatology suggests.

In a review of 36 studies comprising 17,248 patients with 23,421 cSCCs, significant risk factors for recurrence were Breslow thickness >2mm, invasion beyond subcutaneous fat, Breslow thickness >6mm, perineural invasion, diameter >20mm, location on the temple, and poor differentiation. Significant risk factors for metastasis were invasion beyond subcutaneous fat, Breslow thickness >2mm, Breslow thickness >6mm, diameter >20mm, poor differentiation, perineural invasion, immunosuppression, and location on the temple, ear, or lip. Significant risk factors for disease-specific death were diameter >20mm, poor differentiation, location on the ear or lip, invasion beyond subcutaneous fat, and perineural invasion.

Skin of Color Society: Media Day Emphasizes The Needs of Patients

Focusing attention on the challenges of managing skin of color, the first-ever media day for the Skin of Color Society (SOC) brought together media and skincare specialists to discuss advancements in management and some common myths.

According to current SOC president Amy McMichael, MD, the program, which received support from Bayer Dermatology, Merz, and Proctor and Gamble, helped to showcase the role of dermatologists as “specialists with documented expertise” in the diagnosis and management of skin diseases in patients with skin of color. Expert speakers, included Seemal Desai, MD; Marta Rendon, MD—pervious SOC president and originator of the media day plan; Babar Rao, MD; Maritza Perez, MD; and Andrew Alexis, MD.

Beyond the medical consequences of skin disease, Dr. Desai emphasized that providers and patients “should not underestimate the psychological impact” of skin diseases, especially those that affect pigmentation.

Drs. Perez and Alexis addressed the challenges of managing skin cancers in non-white patients. “Every dermatologist in reality should treat the skin of color population the same way as they treat their Caucasian population, as every single patient should be submitted to a complete skin exam including the toes, in between the toes, nails and mucosal surface,” Dr. Perez said. “We know in the African-American population, the Japanese and Puerto Ricans, there is more acral lentiginous melanoma.”

Speaking about increased demand for cosmetic procedures in patients of color, Dr. Rendon noted that there is more data available—and forthcoming—about treatments in different patient populations. “The FDA now has required a lot of companies to go back and do studies including skin types four, five and six. As a matter of fact I’m involved in a multi-centered trial now with a product that’s been on the market, but the FDA has required them to do some further testing on darker skin types,” Dr. Rendon said. “I think not only are we going to have more data and by having that additional data, I think we’re going to be able to have a higher patient population that would want to get these procedures done once you know we can really good results and be safe at the same time.”

Read more about the Skin of Color Media day in this issue’s online edition at PracticalDermatology.com and in future editions of Practical Dermatology®.

Allergan Expands Neurotoxin Pipeline with Anterios Acquisition

Allergan plc has acquired Anterios, Inc. for an upfront payment of $90 million and potential development and commercialization milestone payments related to NDS™, Anterios’ proprietary platform delivery technology that enables local, targeted delivery of neurotoxins through the skin without the need for injections. In addition to NDS™, Allergan has acquired global rights to ANT-1207, an investigational topical formulation botulinum toxin type A in development for the potential treatment of hyperhidrosis (excessive sweating), acne, and crow’s feet lines. Prior to the closing, Anterios spun out certain assets to a new company, Eirion Therapeutics, Inc., funded by Anterios shareholders. The new entity also retains certain non-exclusive rights to ANT-1207.

Almirall to Acquire ThermiGen

Barcelona pharma company Almirall, S.A., is exercising its call option to acquire 100 percent of the share capital of ThermiGen LLC. In September 2015, Almirall acquired a minority stake in ThermiGen for USD $5 million representing 7.7 percent of the share capital of the company and paid $2.5 million in exchange of a call option right to acquire up to 100 percent of the company for an Enterprise Value of C. $80m. The closing is conditional, but the transaction will be fulfilled during the month of January 2016. n

Take 5

With Brent Saunders, CEO, Allergan

Once at the helm of the $66 billion Allergan/Activis merger, Allergan CEO Brent Saunders is again in the spotlight, as a $160 billion Pfizer/Allergan merger takes shape. Mr. Saunders spoke with Practical Dermatology® about the industry, Allergan, and the probable Pfizer deal.

1. Physician relationships matter, and Allergan/Pfizer will continue to focus on customers.

“I think one of the most important aspects of any integration or merger is making sure you stay connected with customers. And I think our track record in doing integration and putting customers at the forefront of our combinations is best in class. When you look at the last merger of Actavis-Allergan and you talk to dermatologists or plastic surgeons or even ophthalmologist and other physicians, I think that our survey data and our work with them has shown that there was no impact on customer connectivity and, in fact, where there was impact, it was positive where they saw greater investment in medical education and training, they saw greater investment in product and innovation. The combined companies had an exponentially larger R&D budget to continue to invest in innovation.”

2. The Allergan legacy lives on.

“I think it really is the dedication to the broader physician community. I think it’s a commitment to innovation and R&D and it’s a commitment to education and training. I look at the pending Pfizer deal—this is going to be arguably the most resourced global biopharmaceutical company in the world with an R&D budget approaching approximately $9 billion with operations in virtually every country in the world, and a strong track record of being dedicated to their customers. So we’re going to take those attributes from legacy Allergan from the current Allergan and really not only preserve them in the new company but try to enhance and invest behind them.”

3. The Allergan-Activis merger opened doors for R&D.

“As I took over the new Allergan, one of the things that was clear to me was we are a leader in aesthetic medicine, we are committed and a leader in facial aesthetics and a new treatment like Kybella can be best developed by a leader in that space. We know how to train and educate doctors, we know how to launch and build market and develop markets for our physician communities, but most importantly we can invest. Because our R&D budget is nearly twice as large as the legacy Allergan, we can invest in developing a drug like Kybella for other aesthetic indications, but also therapeutic indications, as well as advance our own internal pipeline of new products and new innovations. That would’ve been difficult for the old Allergan to do—not impossible but difficult.”

4. Hurdles to innovation exist, but so do opportunities.

“One [hurdle] is just basic science, making sure that some of our basic science resources fall to not only curing people for serious medical need or treating serious medical need, but also for helping people feel and look better, which are very important. I think in a stronger more resourced company like the combined Allergan and Pfizer, I think we just have more opportunity to do things like that and our commitment to the category is unquestionable, and our ability to invest in a combined Allergan-Pfizer will be profoundly larger…

I believe that if we find the right opportunities to invest behind… use basic science and discovery science to find the right targets to go after, this should create a new frontier over time for innovation and aesthetic medicine.”

5. Regulation is essential, but change may be beneficial.

“I think what would be helpful is for our regulators to try to understand that we are trying to do good things that we are trying to support a variety of different parts of the environment whether that be innovation, whether that be jobs and productivity, whether that be building markets for our physicians, partners, and customers and recognize that we are trying to do things that are positive for patients and positive for the economy.”