September 25
IN THIS ISSUE / September 25, 2019
- Which biologics cause weight gain in psoriasis patients?
- DW Insights and Inquiries: I never wanted chaperones — until now
- Two sides to every story
- Academy's contribution to skin cancer prevention shows nationwide progress
- Physician burnout is real, but AADA's DERM360 resources can help
- Quinacrine dihydrochloride recalled by Darmerica
- Nominations sought for 2020 Academy election
Which biologics cause weight gain in psoriasis patients?
In a review and analysis that will be published in JAAD, investigators evaluated changes in body weight and body mass index (BMI) in 862 psoriasis patients after receiving various biologics. Compared with conventional systemic treatments, treatment with tumor necrosis factor-inhibitors (anti-TNF) was associated with significant increase in body weight and BMI (mean difference being 1.40 kg and 0.39 kg/m2). No significant increases in body weight and BMI were found among patients who received IL-12/23 and IL-17 biologics.
The study authors conclude the potential effect of anti-TNF on metabolic change may play a role in care of overweight and obese psoriatic patients.
Read a commentary by Warren Heymann, MD, about treatment adherence for psoriasis patients taking biologics in DW Insights and Inquiries.
Related content:
- What is keeping biosimilars out of reach and when will they be available? – Dermatology World (November 2018)
- AAD/NPF psoriasis clinical guidelines
- Taking aim at psoriasis – Dermatology World (November 2017)
- AAD product: Psoriasis and Psoriatic Arthritis patient pamphlet
DW Insights and Inquiries: I never wanted chaperones — until now
My oldest brother George had just gotten his driver’s license — under no circumstances would my mother allow him to drive his date, Ruth, to the movies. George protested vehemently, but ultimately relented, with my mother sitting in the backseat. This was my first exposure to the concept of a chaperone. More than half a century later, I still do not know if my mother was trying to protect my brother, Ruth, the car, or some combination thereof. (Being the youngest of three sons had its advantages — my mother never pulled that trick on me!)
Proteins perform and/or mediate virtually all biological processes in all living organisms. In humans, there are approximately 50,000 different proteins that are synthesized on ribosomes as linear polypeptides. To realize their biological functions, newly synthesized polypeptides must fold into their correct three-dimensional configurations. Misfolded proteins may be pathogenic. Molecular chaperones are a class of proteins (such as heat-shock proteins) that facilitate the proper folding of proteins by binding to and stabilizing unfolded or partially folded proteins. This results in the proper trafficking, sequestration, and turnover of proteins ensuring protein homeostasis (proteostasis). There are approximately 150 genes for molecular chaperones in the human genome. Keep reading!
I was recently perusing a dermatology social media site when I came across a familiar story: A colleague found a suspicious spot on a new patient and removed the lesion, which turned out to be an invasive melanoma. Although this treatment potentially saved the patient’s life, she left a negative review on the dermatologist’s website, stating the long wait time and high out-of-pocket cost had rubbed her the wrong way. No good deed goes unpunished! Read more from DW Young Physician Advisor Jenna O’Neill, MD.
Academy's contribution to skin cancer prevention shows nationwide progress
Last week, the Centers for Disease Control and Prevention (CDC) marked the five-year anniversary of the release of the Surgeon General’s Call to Action to Prevent Skin Cancer with the release of its fifth annual Skin Cancer Prevention Progress Report. The report provides an overview of its efforts to reduce the incidence of skin cancer and educate the public about skin cancer prevention. Among many highlights generated in the report, developments include the decline of indoor tanning among U.S. high school students and findings that reveal high school girls are half as likely to indoor tan when a state law prohibits use. The AADA has actively advocated for tighter restrictions on indoor tanning, which has resulted in 21 states and the District of Columbia now having laws in place to protect minors under the age of 18 from the dangers of indoor tanning.
Listed in the report’s highlights, the American Journal of Public Health published an essay on shade as an environmental design tool for skin cancer prevention. The essay provides a review of the literature on shade design, use, and policy, and highlights the value of integrating shade planning into community design, planning, and architecture. Notably, many organizations across the country have installed shade structures and free sunscreen dispensers at public parks, playgrounds, pools, and sports fields, making it easier for people to be sun-safe while outdoors. The AAD has bestowed grants for nearly 400 shade structures across the country that provide shade to more than 800,000 individuals daily.
In addition, the AAD also has worked closely with U.S. Representative David Joyce (R-Ohio) and leaders of the Congressional Skin Cancer Caucus on H. Res. 323, which urges state and local lawmakers to lift bans on sunscreen in schools. These advocacy efforts have resulted in laws in 23 states that improve access to sunscreen for children, including 22 states with laws that address children’s ability to carry and self-apply sunscreen at school.
Additional highlights from the Skin Cancer Prevention Progress Report include:
- Sunscreen use is low among children compared to other preventive behaviors, such as brushing teeth, wearing a seat belt, helmet use, etc.
- Sunburn remains common among U.S. adults and there has been little change in its prevalence in recent years
- National incidence rates of Merkel cell carcinoma are on the rise
- Lack of time is an important barrier to clinical counseling on skin cancer prevention by primary care physicians as well as more urgent health concerns and patient disinterest
There is still work to address skin cancer prevention efforts. The AAD is committed to educating the public about the importance of skin cancer detection and providing solutions to protect them from the sun’s harmful UV rays. In addition, the AADA will continue to advocate for skin cancer prevention initiatives that serve the needs of the public. To get involved in the AAD’s skin cancer prevention and detection efforts, visit www.aad.org/members/volunteer.
Related content:
Physician burnout is real, but AADA's DERM360 resources can help
According to the World Health Organization's International Classification of Diseases, burnout is officially linked to chronic workplace stress. Because physicians, including more than 20,000 Academy members, aren’t immune to the condition, the Academy’s newest content area — DERM360 — offers a holistic approach to help dermatologists address day-to-day practice challenges. Eliot Mostow, MD, MPH, member of the AAD’s Council on Practice Management, gives an overview of DERM360’s resources and tools that help provide relief from physician burnout.
1. What is the Academy doing to help dermatologists reduce burnout?
Unfortunately, physicians aren’t immune to burnout. The Academy has developed practical tools and resources dermatologists can use to overcome burnout and increase physician wellness in the Practice Management Center’s newest content area — DERM360. The hub offers useful tips on dealing with day-to-day practice challenges, a tool for assessing your stress level, and techniques for recharging your motivation. Because burnout is not limited to professional challenges alone, DERM360 takes a holistic approach to help address challenges that span professional as well as personal.
2. Medicine is evolving on what seems to be a daily basis. Years ago, for example, dermatologists didn’t have to navigate electronic health records the way they’re required to today. How does DERM360 help dermatologists overcome practice challenges?
I agree. Sometimes it feels like we experience new trends in medicine every day. DERM360 was created to respond to the shifts in the health care environment and to address the emotional burdens associated with the practice of medicine. From the practical resources to relevant tools featured in DERM360, each link covers current issues in the specialty to ensure that dermatologists have what they need to meet practice needs, care for their patients, and be emotionally empowered. Speaking of EHRs, I recommend checking out “9 tips for using EHRs to your office’s benefit,” a resource designed to help make it more efficient in practice.
3. Can you tell us why dermatologists seeking to better balance work and life priorities should check out DERM360’s “care for yourself” resources?
During the safety presentation on every aircraft, we’re told to apply our own oxygen mask before assisting others. As physicians, we find happiness while caring for others — and that’s okay. But we can do this for much longer and with less frustration if we take some time to take care of ourselves. The tools and resources in DERM360 provide a framework that helps us address issues that can contribute to burnout. From practical tips on finding time to exercise to podcast recommendations, DERM360’s “care for yourself” resources target many different areas that can help dermatologists address stress and find joy in the specialty.
4. You spent some time offering physician-to-physician advice for addressing burnout in the DERM360’s “recharge your motivation” section. What are some other resources in this section that you’ve found helpful?
Stay motivated: 3 podcasts that can change your day: I’ve listened to two of the three podcasts recommended in this resource. Podcasts are a great diversion and sometimes quite thought-provoking offering much-needed balance to our busy work days.
Practicing gratitude to boost your mood: We can often get too caught up in the negative and forget to take a moment to appreciate all that we have. Being thankful helps to you reconnect with your purpose and remind you of the joy of practicing medicine. It will also help you appreciate what you have outside of the job, which is just as important.
5. It’s common for people not to recognize that they’re stressed. The AAD stress assessment survey helps to address this gap. What are the benefits of monitoring stress and taking the stress assessment?
The survey is simply a conversation starter and helps to put things into perspective. The assessment, by itself, does not address stress. What I appreciate most about the assessment is that it offers a customized plan of tools and resources from DERM360 that can help you get back on track and address some of the factors that may be contributing to your stress. After getting your results and your customized plan, open up to friends and family, and, if need-be, professionals.
Related content:
Quinacrine dihydrochloride recalled by Darmerica
Darmerica LLC has voluntarily recalled two lots of quinacrine dihydrochloride bulk API powder — DR4654A and DL4654A — due to a labeling error. The product intended for compounding use labeled as quinacrine API was tested and identified as artemisinin API. Receiving artemisinin instead of quinacrine could lead to worsening of disease and serious adverse reactions, which may require medical or surgical intervention. Darmerica is notifying its distributors and customers by email and telephone and is arranging for return of all recalled products. To date, Darmerica has not received any reports of adverse events related to this recall.
Health care professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA MedWatch Safety Information and Adverse Reporting Program.
Nominations sought for 2020 Academy election
Nominations for Officers, Directors, and Nominating Committee Member Representatives (West Region) are now being accepted through Oct 1. To view reference materials, and submit a nomination and letter of support, visit www.aad.org/aadnominations, or email callfornominations@aad.org.
