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One-third of Americans lack a basic understanding of skin cancer and sun protection, according to a recent survey of 1,000 US adults from the American Academy of Dermatology. And 53 percent of adults are unaware that shade can protect them from the sun’s harmful ultraviolet rays.

Additional survey findings include:

  • 47 percent either incorrectly believe or are unsure that having a base tan will prevent sunburns
  • 35 percent either incorrectly believe or are unsure that as long as you don’t burn, tanning is safe
  • 31 percent are unaware that tanning causes skin cancer.

“These findings surprised us and demonstrate that misperceptions about skin cancer and sun exposure are still prevalent,” says board-certified dermatologist Kenneth J. Tomecki, MD, FAAD, president of the AAD, in a news release. “As dermatologists who see firsthand the impact that skin cancer, including melanoma—the deadliest form of skin cancer—has on our patients and their families, it’s concerning to see that so many individuals still do not understand how to protect themselves from ultraviolet exposure.”

In the survey, Gen Z (those born after 1996) appeared to have the biggest misunderstanding of the dangers of sun exposure and skin cancer, followed closely by Millennials (those born between 1981-1996).

“These are striking results when it comes to younger generations’ knowledge about basic sun exposure,” says Dr. Tomecki. “Gen Z and Millennials have a lifetime of potential damaging sun exposure ahead of them, so now is the time to close the knowledge gap and ensure they are aware of how easy it is to practice sun-safe behavior.”

Gen Z survey findings:

  • 42 percent are unaware that tanning causes skin cancer
  • 41 percent are unaware that the sun’s ultraviolet (UV) rays are reflected by snow, water, and sand
  • 33 percent are unaware that they can get sunburned on a cloudy day.

Millennial survey findings:

  • 42 percent are unaware that the sun’s ultraviolet (UV) rays can penetrate clothing
  • 37 percent are unaware that tanning causes skin cancer
  • 23 percent are unaware that sunburn increases the risk of getting skin cancer.

Salary Survey: Pediatric Dermatology

Median total compensation for pediatric dermatologists has increased 37 percent since 2014, according to results of The Society for Pediatric Dermatology’s (SPD) 2020 Pediatric Dermatology Physician Compensation Report. Median total compensation in the field is $335,395.

The latest compensation report from the SPD, based on a survey administered by ECG Management Consultants, uses the single largest data set of compensation and production information for pediatric dermatologists in the history of the specialty.

Findings show that pediatric dermatologists working in an independent medical group have the highest compensation at $495,833, followed by those employed in non-academic hospital/health system settings, at $440,000. Median compensation for private practice pediatric dermatologists is $300,000.

The response rate of 35 percent is impressive and makes the current survey fairly representative of the state of pediatric dermatology practice, says Mercedes E. Gonzalez, MD, Chair, SPD Practice Management Committee. She notes that the findings point to a need to continue to attract physicians to pediatric sub-specialization. “We found that 57 percent of the respondents practice within eight states. That leaves 43 percent of respondents to cover the other 42 States,” she says. “Over 50 percent of pediatric dermatologists work in groups with two or fewer pediatric dermatologists.”

While nearly 80 percent of respondents reported the patient relationship as the most fulfilling aspect of the profession, findings show that pediatric dermatologists are affected by burnout. “About 25 percent of the respondents say that they felt burnout often or always, and about 48 percent said sometimes,” Dr. Gonzalez observes. “This was somewhat surprising to me, but does speak to what’s happening, especially in the last year to physicians in general where the feelings of burnout are increasing.” She says burnout seems to be related to the fact that 80 percent of respondents reported that paperwork and regulatory burdens were the least satisfying aspects of their job.

VCS, MCS Bookend Summer Hybrid Education Programs

With the start of the Vegas Cosmetic Surgery and Aesthetic Dermatology program (VCS) next month, a series of aesthetically-focused meetings kicks off with both live, in-person and virtual options for attendees. The multispecialty VCS meeting will be held June 9 to 12 at the Bellagio in Las Vegas; followed by The Aesthetic Show (TAS), July 8 to 11 at the Wynn in Las Vegas; and Miami Cosmetic Surgery and Aesthetic Dermatology (MCS), August 26 to 28 at the Miami Beach Convention Center.

After going virtual last year, VCS returns live to its Las Vegas home with four tracks, sponsored workshops, and special functions. “It’s Vegas! And great content as always—live injections, controversial topics, hot debates—but what VCS is also famous for is the outstanding networking,” says meeting co-director Steve Dayan, MD.

“VCS is the first and most amazing, dynamic, and interactive multidisciplinary meeting in this country, possibly the world,” adds co-director Renato Saltz, MD. “It offers not only aesthetic education at multiple levels but also many networking possibilities among faculty, attendees, office staff, and industry.”

The available tracks are Minimally-invasive—Injectables; Minimally-invasive—Devices, Cosmeceuticals, and Specialty; Surgical; and Practice Management.

Calling VCS the “Grandaddy” of multispecialty shows, Dr. Dayan says, “It always attracts the latest in devices, products, and practice management. So if you are interested in seeing cutting edge treatments, dialoging with experts, and having fun, Vegas Cosmetic Surgery should be an event you don’t miss.”

MCS, chaired by Dr. Dayan, kicks off at the end of August at the Miami Beach Convention Center. The program offers a focus on the latest trends in aesthetic medicine, along previews of promising pipeline therapies and procedures, organizers say. Oculofacial plastic and cosmetic surgeon John P. Fezza, MD of Sarasota, FL directs MCS’s Oculoplastic Surgery section, San Diego-based dermatologist Sabrina G. Fabi, MD directs the Dermatology section, and Mark Tager, MD directs the Practice Management section at MCS.

Registration and information are available online.

VCS : vegascosmeticsurgery.info/en/home.html

TAS: aestheticshow.com/en/home.html

MCS: miamicosmeticsurgery.info/en/home.html

UCB: Bimekizumab PDUFA Date Set for October

The FDA’s Prescription Drug User Fee Act (PDUFA) date for UCB’s Biologics License Application (BLA) for bimekizumab for the treatment of adults with moderate to severe plaque psoriasis is October 15, 2021, UCB has indicated.

In addition to the FDA BLA under review, bimekizumab is also under review for the treatment of adults with moderate to severe plaque psoriasis by the European Medicines Agency (EMA) for the Marketing Authorization Application (MAA) and by regulators in Japan, Australia, and Canada.

Subject to respective approvals, UCB says it will bring bimekizumab to patients starting in the second half of 2021.

TAKE 5 Lloyd S. Miller, MD, PhD, Janssen

With the approval of Janssen’s Tremfya (guselkumab) last year as the first IL-23 inhibitor FDA-approved for the treatment of active psoriatic arthritis (PsA)—its psoriasis (PsO) indication dates to 2017—have come new data about the biologic’s clinical effects.

Lloyd S. Miller, MD, PhD, Vice President, Immunodermatology Disease Area Stronghold (DAS) Leader at Janssen, spoke with Practical Dermatology® magazine.

Janssen will “redefine” treatment of immune mediated diseases.

“Janssen is redefining the treatment of immune mediated diseases at the intersection of unmet need, deep disease insights, and novel pathway science. And this really means that we are dissatisfied by that status quo and we’re working to target novel immune pathways to help patients live their best, healthy, and productive lives through restoring immune balance,” says Dr. Miller.

Tremfya exemplifies a “Pathway approach.”

“Our science regarding Tremfya in PsO and PsA is an excellent example of our pathway approach,” Dr. Miller says. It is the first biologic to inhibit IL-23, a pathway implicated in PsO, PsA, and other immune diseases.

“Tremfya is a first-in-class, best-in-class IL-23 therapy with five-year efficacy and safety data in psoriasis and now in psoriatic arthritis. We will focus on this same pathway-type approach as we study new therapies in new disease indications, such as atopic dermatitis, hidradenitis suppurativa, and other immune mediated skin diseases.”

Rebalancing the immune system is a focus.

Rather than focusing on immune suppression, as has been done historically, “our approach is pivoting toward a goal of restoring immune balance or homeostasis of the immune response,” Dr. Miller says. “Our future therapies will be more effective in restoring this immune homeostasis by applying new and different mechanisms to block the accelerators of the immune system. IL-23 is a pro-inflammatory cytokine or immune ‘accelerator.’ In patients with PsO and PsA, there’s apparent overproduction and hyper-responsiveness to this IL-23 pathway. Tremfya blocks IL-23 and can balance the immune system, improve the symptoms of psoriasis or psoriatic arthritis, and other immune mediated diseases.

“We hope that this concept of focusing on immune balance and homeostasis can be translated to other diseases in dermatology, so we no longer suppress the immune system and have side effects of increased infections and other issues with immunosuppression.”

Holistic approaches benefit patients.

“It’s very important from a holistic standpoint to treat the patient’s symptoms,” says Dr. Miller. “If they have psoriasis and then develop psoriatic arthritis, we need to now treat the symptoms involved in PsA. The two are very, very connected. Fatigue is a really important symptom of psoriatic arthritis that patients complain about. They also have stress, depression, behavioral changes, body image issues, and reduced work productivity. And psoriasis also has symptoms that can cause feelings of embarrassment, self-consciousness, and depression. Patients with psoriasis can also feel rejection, shame, and guilt because of their disease.”

He notes that dermatologists have the ability to treat skin and joint symptoms, but should be prepared to refer to rheumatologists if needed.

Data tell the story.

“At the Coastal Dermatology meeting in October 2020, we presented nearly five years of data for psoriasis, showing 84 percent of patients achieved a PASI 90 response, which was very impressive over five years. Just having that long-term efficacy data is something that we’re very proud of. In addition, there were no new safety concerns over 264 weeks and no new safety signals.

“A key abstract at the EADV congress highlighted the Phase 3 DISCOVER-2 study for Tremfya and psoriatic arthritis, showing patients treated with Tremfya for joint pain had a greater likelihood of also becoming free of psoriasis symptoms at week 24; a greater proportion of psoriatic arthritis patients treated with Tremfya reported their skin disease no longer had any impact on their health-related quality of life as measured by the DLQI versus placebo,” Dr. Miller says.

“Data presented at the American College of Rheumatology meeting demonstrated Tremfya improves the symptom of fatigue in adult patients with PsA, a response maintained through 52 weeks of active treatment.”

“Data from a network meta-analysis published in Rheumatology showed Tremfya delivered the highest overall achievement of skin clearance, with joint symptom achievement comparable with IL-17A inhibitors and subcutaneous TNF inhibitors.”

“Key data at the recent AAD meeting highlighted the Phase 3 VOYAGE 2 study for Tremfya in PsO and Phase 3 DISCOVER-1 and DISCOVER-2 studies for Tremfya in PsA. VOYAGE 2 results showed skin clearance rates maintained at 5 years with 55.5 percent of patients achieving an IGA of 0 and 53 percent achieving PASI 100 response. Data from the studies showed robust joint symptom improvement through 52 weeks: Tremfya improved psoriatic disease activity in joints and across multiple domains through week 52 in both trials as measured by the Disease Activity Index for PsA, Minimal Disease Activity, Very Low Disease Activity and remission using Disease Activity Index for PsA.”

“Recent data published in Rheumatology show treatment with Tremfya in PsA resulted in higher proportions of resolved enthesitis by week 24, with maintenance of resolution rates through one year. This is an important finding as many patients with PsA are affected with an array of challenging symptoms like enthesitis when diagnosed with this multi-faceted disease.”

Henry Ford Innovations, Google Cloud, and Miracle Software Systems to Fund Innovations Focused on Health Inequities

Entrepreneurs with ideas for reducing health inequities through the use of digital technology could garner $75,000 in cash and in-kind support toward developing their digital solution at Henry Ford Health System. Henry Ford Innovations, the innovations arm of Detroit-based Henry Ford Health System, is partnering with Google Cloud and Miracle Software Systems to launch an international competition to find the most promising new solution.

The Digital Inclusion Challenge kicks off May 19 and runs through the summer. Carladenise Edwards, PhD, Executive Vice President and Chief Strategy Officer of Henry Ford Health System will launch the challenge with a virtual conversation about the need for culturally sensitive and unbiased patient-centric solutions to be developed that bridge the gap between healthcare and technology.

All entries that address digital inclusion will be considered, with the focus on identifying those concepts that address the biggest pain points for digitally excluded patients. Among them:

  • How to make health care more affordable and accessible for digitally excluded patients
  • How to make it easier for these patients to learn about their health and health care services
  • How to empower care teams to deliver better services to these patients.

Entries are due by June 24, 2021—visit hfhs-challenge.miraclesoft.com to learn more.

CLOSE UP with Aaron Drucker, MD

To gain a better understanding of the risk of skin cancer associated with antihypertensive medication, researchers led by Aaron Drucker MD, ScM, FRCPC, a scientist at Women’s College Research Institute and a dermatologist at Women’s College Hospital in Toronto, Ontario, Canada, reviewed data of nearly 303,000 adults in Ontario over age 65 who were prescribed medications for hypertension and compared their skin cancer histories with those of more than 605,000 adults who weren’t taking antihypertensive drugs.

They found that higher cumulative exposure to thiazide diuretics was associated with higher rates of keratinocyte skin cancers, including basal cell carcinoma, squamous cell carcinoma, advanced keratinocyte carcinoma, and melanoma. However, there was no consistent evidence of association between other antihypertensive classes such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers, angiotensin II receptor blockers (ARBs), and calcium channel blockers and keratinocyte carcinoma or melanoma, according to the study that appears in CMAJ. Dr. Drucker discussed the new findings, their implications and the next steps with Practical Dermatology®.

Why is this topic important to study?

Aaron Drucker, MD: Skin cancer is very common, so identifying modifiable risk factors beyond UV radiation protection is important. Because some antihypertensive medications are photosensitizing, people have hypothesized that they might increase skin cancer risk. In particular, hydrochlorothiazide has been implicated as potentially increasing skin cancer risk, and regulators like the FDA have issued warnings about it.

Describe the research and your findings.

Dr. Drucker: We conducted a cohort study of older adults using population-based data for Ontario, Canada. We matched patients starting an antihypertensive medication with patients starting an unrelated medication and followed them over time to update their cumulative dose of each antihypertensive medication class and to see if they developed skin cancers, including keratinocyte carcinoma (basal and squamous cell carcinoma) and melanoma. We found that most antihypertensive classes, including ACE inhibitors, ARBs, calcium channel blockers and beta blockers, were not associated with increased skin cancer risk. Consistent with previous studies, we found that thiazide diuretics were associated with increased risk of both keratinocyte carcinoma and melanoma.

What is the next step?

Dr. Drucker: It is important to understand which patients may be most affected by the association between thiazides and skin cancer. We could not look at this in our study, but it is likely that patients with fair skin and a history of previous skin cancers or sun damage, such as actinic keratosis, are most at risk. For patients with skin cancer risk factors on or considering starting thiazides, they should discuss with their physician whether the benefits of those medications outweigh the risk of skin cancers.

Remembering Two Dermatology Leaders

The dermatology community is celebrating the lives of two pioneering women in the field. Read more at PracDerm.com/Remembrance

Melanie Grossman, MD (1962 - 2021)
Dr. Grossman was a trailblazer in her field and among the first female dermatologists to embrace energy-based devices.

Marta Rendon, MD (1957–2021)
Born in Medellin, Columbia, Dr. Rendon enjoyed an illustrious and fulfilling career in dermatology with many important achievements.

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