PracticalDermatology

AAD Issues New Guidelines for Treatment of NMSC Emphasizing Patient Engagement

The American Academy of Dermatology (AAD) has addressed the growing health concern about non-melanoma skin cancers (NMSC) with the release of its guidelines of care for the management of basal cell carcinoma and cutaneous squamous cell carcinoma, published online in the Journal of the American Academy of Dermatology. Developed by a work group composed of board-certified dermatologists and other experts in the field, the evidence-based guidelines cover best practices for the management of NMSC.

According to the guidelines, surgical treatment—excision, Mohs surgery, or curettage and electrodessication—is the most effective option for most cases of NMSC. In some cases, however, doctors may consider other treatments, such as cryotherapy, radiation, or topical therapy. The guidelines do not include recommendations for treating NMSC with laser therapy or electronic brachytherapy, as there was not enough evidence available for the work group to make an informed decision.

“Board-certified dermatologists have the training, knowledge and experience to provide NMSC patients with the highest-quality care,” says Murad Alam, MD, FAAD, co-chair of the guidelines work group. “If you are diagnosed with BCC or SCC, a board-certified dermatologist can work with you to determine the treatment option that’s best for you.”

To emphasize the importance of considering the patient perspective in determining how to treat BCC and SCC, the AAD’s work group included patient advocate Kristi Schmitt Burr, who has been dealing with NMSCs for more than five decades due to the genetic condition basal cell nevus syndrome (also known as Gorlin-Goltz syndrome). Ms. Burr says it’s important for patients to understand their available treatment options and to have input in their medical care.

“I sincerely appreciate the AAD’s including patient engagement as an integral component in developing these guidelines, as it is vital for patients and their families to have a voice in their care,” Ms. Burr says. “Over the decades, trained dermatologists have provided my family with ample resources and counseling to help us achieve optimal outcomes. I hope these guidelines encourage further dialogues between expert doctors, their skilled staff, and the patients in their care.”

In addition to providing recommendations on NMSC treatment, the guidelines also provide follow-up recommendations for patients who have been diagnosed with BCC or SCC. For more on the guidelines, see the Oncology Watch column.

FDA Accepts Ortho Dermatologics’ Filing for IDP-121 Acne Treatment In Lotion Form

The FDA has accepted Ortho Dermatologics’ New Drug Application for IDP-121 (tretinoin 0.05%) lotion (Altreno) with a PDUFA action date of Aug. 27, 2018. If approved, Altreno will be the first tretinoin product in lotion form rather than a gel or cream.

“More than four million patients make appointments with dermatologists each year for acne. It is our goal to be the go-to resource for doctors and patients for all dermatological conditions, and if approved, Altreno will be a valuable addition to the Ortho Dermatologics portfolio,” said Joseph C. Papa, chairman and CEO, Valeant. Ortho Dermatologics is a division of Valeant Pharmaceuticals International, Inc.

New Ceramide-Infused Skin Barrier Product Reduces Costs for Ostomy Care

Ostomy patients using a new type of skin barrier product infused with ceramides may experience lower costs of care, according to a randomized trial published in the Journal of Wound, Ostomy and Continence Nursing.

An estimated 800,000 Americans live with an ostomy, with up to 80 percent experiencing high rates of peristomal skin complications (PSCs)—skin inflammation, injury, or damage occurring around the ostomy—that can lead to pain, reduce life satisfaction, and increase health care costs. The ceramide-infused skin barriers used in the study were designed to protect the skin around the ostomy and reduce moisture loss from damaged skin.

The cost savings included reduced use of skin barriers and other ostomy care accessories, medications, emergency department and hospital visits, as well as “social costs” such as missed work or appointments.

The study enrolled 153 adult ostomy patients from 25 sites in the Unites States, Canada, and Europe. Patients were randomly assigned to use ceramide-infused or conventional (placebo) skin barrier products for 12 weeks. Costs of care, evidence of PSCs, and other outcomes were compared between groups.

Patients using the ceramide-infused barriers were less likely to experience PSCs—40.5 percent versus 55.4 percent—but the difference was not statistically significant.

Seventy-five percent of patients using the ceramide-infused skin barrier said they were “very satisfied” with barrier performance, compared to 55 percent of those using conventional skin barriers. The ceramide-infused barriers were also rated higher for prevention of leakage and itching.

The study was sponsored by Hollister, Inc., manufacturer of the new skin barrier product.

New Hope for Severe AD: Anti-IL22 Therapy May Represent New Treatment

New research suggests that IL-22/Th22 targeting may offer a novel treatment alternative for patients with severe atopic dermatitis (AD). The findings, in the Journal of the American Academy of Dermatology, provide the first evidence in humans that shows similarly to the Th2 cytokines—IL-4 and IL-13 immune molecules that IL-22 is a key driver of AD.

Specifically, fezakinumab treatment in 60 adults with moderate to severe AD resulted in consistent improvements in clinical disease scores as compared to placebo. At week 12, significant clinical improvements in drug-treated patietns compared to placebo-treated patients were best seen in severe patients and progressive improvements in all outcome measures were observed until week 20, the study showed.

“This is a very exciting study because for the first time, Mount Sinai has identified that in humans there is a separate population of T-cells—that we termed Th22, which produces the cytokine IL-2,” says study author Emma Guttman-Yassky, MD, PhD, Sol and Clara Kest Professor of Dermatology and Vice Chair of the Department of Dermatology, Icahn School of Medicine at Mount Sinai in New York City.

Apple Brings Health Records to Phones

Apple has announced a significant update to the Health app with the iOS 11.3 beta introducing a feature that gives customers access to their medical records on their iPhone. The updated Health Records section within the Health app brings together hospitals, clinics, and the existing Health app to make it easy for consumers to see their available medical data from multiple providers whenever they choose, Apple says.

Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine, and other participating hospitals and clinics are among the first to make this beta feature available to their patients.

Acne Linked with Risk of Depression

In an analysis of one of the largest electronic medical records databases in the world, researchers found that patients with acne had a significantly increased risk of developing major depression, but only in the first five years after being diagnosed with acne.

The British Journal of Dermatology analysis included data from The Health Improvement Network (THIN, 1986-2012), a large primary care database in the United Kingdom. Investigators found that the risk for major depression was highest within one year of acne diagnosis—a 63 percent higher risk compared with individuals without acne—and decreased thereafter.

Results indicate that it is critical that physicians monitor mood symptoms in patients with acne and initiate prompt treatment for depression or seek consultation from a psychiatrist when needed, the researchers found.

“This study highlights an important link between skin disease and mental illness. Given the risk of depression was highest in the period right after the first time a patient presented to a physician for acne concerns, it shows just how impactful our skin can be towards our overall mental health” said lead author Dr. Isabelle Vallerand, of the University of Calgary, in Canada. “For these patients with acne, it is more than a skin blemish—it can impose significant mental health concerns and should be taken seriously.”

Assessing an App for PsO Adherence

Could a smartphone app improve adherence to corticosteroid/calcipotriol therapy? Researchers have unveiled a study to try to find out (BMC Dermatology). The investigator-initiated, single-center, single-blind, parallel-group, randomized controlled trial involves 134 patients 18 to 75 years of age with mild-to-moderate psoriasis, who own a smartphone and are candidates for the study drug calcipotriol and betamethasone dipropionate cutaneous foam once daily. The app synchronizes through Bluetooth® to an electronic monitor (EM) attached to the medication canister. The EM registers the amount of foam and day and time the patient uses the foam dispenser. The information is displayed in a diary that shows the amount of Cal/BD cutaneous foam used and the number of applied treatment sessions. The app has an optional diary with the patient’s rating of symptoms.