Currents: Year In Focus

AAD and NPF Release First-ever Guidelines for Pediatric Psoriasis Treatment

One-third of psoriasis cases begin in the pediatric years, and onset is most common during adolescence. That’s why the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) are releasing guidelines to help ensure that pediatric psoriasis patients receive the best possible treatment and care.

The joint AAD/NPF “Guidelines of Care for the Management and Treatment of Psoriasis in Pediatric Patients,” published in the Journal of the American Academy of Dermatology, outline best practices for treatment of the disease in this vulnerable population. The guidelines are based on the most up-to-date scientific evidence for managing the disease.

Because psoriasis can increase a person’s risk of developing certain diseases, like diabetes, the new guidelines address some of those comorbidities in young people:

• The link between obesity and psoriasis is greater for children than adults.
• There may be a link between type 1 diabetes and psoriasis, as insulin resistance in children with psoriasis is estimated to be approximately twice that of children without the condition.
• Inflammatory bowel disease is three to four times more common in pediatric psoriasis patients than in kids who don’t have psoriasis.
• Unlike in adult psoriasis patients, there’s not enough evidence to support a relationship between psoriasis and heart disease in young patients, though experts recommend that children with psoriasis undergo appropriate cardiovascular screening, regardless.

Emotional stress can also manifest psychosocially in children with visible skin disease. Alan Menter, MD points out that kids with psoriasis are susceptible to bullying, name-calling and shaming at school and in other social settings.

“We’ve found that pediatric psoriasis patients have higher rates of depression and anxiety than their peers and use psychiatric medications more frequently,” Dr. Menter said. “Those are all addressed in these guidelines in the hopes that more people will recognize the seriousness of this disease in young people.”

Also outlined in the guidelines are physical symptoms of the disease, which can include pain and itchiness along with stinging, burning, and tightening sensations. Itch is highlighted as an under-recognized, serious symptom that plagues pediatric psoriasis patients and aggravates and spreads the psoriasis lesions.

Melanoma Rates Drop Sharply Among Teens, Young Adults

Cases of melanoma among US adolescents and young adults declined markedly from 2006 to 2015—even as the skin cancer’s incidence continued to increase among older adults and the general population during the span, new research in JAMA Dermatology shows.

The finding, based on national cancer-registry data, suggests that public-health efforts advocating sun protection are changing behaviors among Millennials and Post-Millennials, the investigators surmised.

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The researchers gathered de-identified patient data of 988,000 invasive melanoma cases from databases at the Centers for Disease Control and Prevention and the National Cancer Institute. In analyzing data, the investigators calculated annual percentage of change for multiple demographics, including age: pediatric (ages 0-9), adolescent (10-19), young adult (20-29), and adults in 10-year increments from 30 to 80+.

The researchers found that, across all ages, the number of melanoma cases rose steadily during the study span, from 50,272 in 2001 to 83,362 in 2015. The overall increasing incidence rates seen over time was primarily driven by adults 40+ years, the authors wrote.

However, for adolescents and young adults, incidence peaked around 2005 and then fell sharply through 2015: Among males, the incidence rate dropped about 4 percent per year and, among females, about 4.5 percent per year across the two age groups.

The drop-off mirrors reductions in melanoma rates seen among younger populations in Australia starting around 1988, the authors wrote. They attributed that nation’s turnaround to public-health campaigns for sun-protective behaviors, including a “Slip! Slop! Slap!” campaign.

Dr. Roy Geronemus Honored

Roy Geronemus, MD of Laser & Skin Surgery Center of New York received The American Society for Dermatologic Surgery inaugural Vic Narurkar, M.D., Innovations in Aesthetic Dermatology Lectureship Award.

Dr. Geronemus received the award at the 2019 ASDS Annual Meeting in Chicago, where he delivered the lecture “Expanding the Scope of Dermatologic Surgery Through Lasers and Related Technologies.” This lecture honors the legacy of Dr. Vic Narurkar, who Dr. Geronemus said, “is a great educator and exercised excellent clinical judgment and care to his patients,” in a recent interview with Practical Dermatology®.

LEO Science & Tech Hub and Epicore Biosystems Advance AD Collab

LEO Science & Tech Hub, the Boston-based R&D innovation unit of LEO Pharma A/S, is starting the next phase of a research collaboration in atopic dermatitis (AD) with Epicore Biosystems.

The partnership advances the development of Epicore’s wearable Discovery patch and electrochemical sensors to measure prognostic skin health and inflammation biomarkers. The goal is to explore if and how these biochemical markers can apply to and inform treatment decisions and therapeutic targets.

Phase two of the collaboration will involve a proof-of-principle study in AD patients to track inflammatory biomarkers across different skin locations. The study will be conducted in the Department of Dermatology at Northwestern University’s Feinberg School of Medicine to establish baselines. The partnership will also leverage Epicore’s connected electrochemical-sensing solutions toward characterization of skin health and disease-specific biomarkers in real-time and outside confines of a clinic.

“Real-time assessment of inflammatory biomarkers found in sweat and interstitial fluid push the boundaries, leading to objective assessment of interventions for people affected by AD as well as across other chronic diseases,” says Dr. Roozbeh Ghaffari, Epicore Biosystems co-founder and CEO.

“This collaboration between Epicore and LEO Science & Tech Hub represents a unique opportunity to collect data to enable research in translational medicine on the link between cytokines in sweat and disease state of atopic dermatitis patients,” adds Michael Sierra, Vice President, LEO Science & Tech Hub. “Non-invasive technologies have the potential to deepen unique disease understanding, paving the way for precision medicine within dermatology.”

An initial study was completed in June 2019. The team demonstrated the ability to quantify the concentrations of target cytokines in sweat across different skin locations. This serves as a foundation for the phase 2 effort in AD patients.