This month's news from across the specialty
What's hot
February 1, 2022
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Food portion sizes are getting bigger and so are Americans. Obesity is associated with many dermatologic diseases including hidradenitis suppurativa, psoriasis, acanthosis nigricans, and the skin diseases of hyperandrogenism (acne, hair loss, hirsutism) (J Am Acad Dermatol. 2019;81(5):1037-57). America has a well-known, persistent, and growing obesity epidemic. Understanding some of the underlying mechanisms for the epidemic can help dermatologists advise patients with obesity-related dermatoses and participate in public health discussions within our own communities.
In the American Journal of Public Health, Young and Nestle investigated large portion sizes as one of the reasons for America’s obesity problem (Am J Public Health. 2021;111(12):2223-2226). The authors review how portion sizes of single servings of food began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing American body weights. All the highest sales “single serving” French fry, hamburger, candy bar, soda, and beer servings in America are two to five times larger than the original offerings. For example, in the 1950s McDonald’s offered only one size of French fries, but today that size is considered a “small.” The original Coke bottle was 6.5 ounces, but now Coke has six sizes ranging from 7.5 to 24 ounces — all marketed as single servings. The original single serving beer bottle in 1976 was seven ounces; today you can purchase a 40 ounce “single serving” beer bottle.
The authors note how the cost of food in the United States is inexpensive compared with manufacturing and service. Thus, our current economy supports the production of larger portion sizes to generate additional revenue at little cost. As educational interventions to curb eating behaviors have been insufficient and the food industry is unlikely to voluntarily decrease portion offerings, the authors make a plea for national policies to make smaller food portions more available, convenient, and inexpensive.
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Increasingly, we are recognizing that not all skin cancers identified during screening examinations are destined to lead to clinical symptoms during a patient’s lifetime. This is likely to be particularly true for more indolent cancer types, such as basal cell carcinoma (BCC). However, it can be difficult to predict the clinical behavior of skin tumors in individual patients, and sparse data on this topic exists to guide decision making. A recent observational study from the Netherlands examined the behavior of 280 BCCs in 89 patients that underwent “watchful waiting” (JAMA Derm. 2021;157(10):1174-81). Patients had a median age of 83 years and patient-related factors (that is, comorbidities, frailty, limited life expectancy) were the reasons watchful waiting was chosen in most cases. Interestingly, only 47% of tumors increased in size over a median (interquartile range) follow-up of nine months. The estimated one-year increase in tumor diameter was 4.5 mm for high-risk BCCs and 1.1 mm for low-risk BCCs. Surprisingly, tumor growth was not associated with initial tumor size and anatomical location. Based on these findings, the authors suggested that active surveillance could be a reasonable treatment option in appropriately selected, asymptomatic superficial/nodular BCCs occurring in patients with a limited life expectancy.
Is acral lentiginous melanoma subtype independently associated with sentinel lymph node positivity? Acral lentiginous melanoma has unique prognostic characteristics, and it is a rare form of melanoma. Due to its rarity, treatment protocols are often based on those used to treat more common subtypes of cutaneous melanoma. According to a review, published in JAMA Dermatology, of 60,148 melanoma patients — 959 of whom had acral lentiginous melanoma — this subtype is independently associated with sentinel lymph node positivity (doi:10.1001/jamadermatol.2021.4812).
Acral lentiginous melanoma has the highest risk of sentinel lymph node positivity of any subtype and has relatively high positivity rates at clinical stage IB and stage II. The rate of sentinel lymph node positivity for stage IB was 18.39% and stage II was 39.53%. While further studies need to be performed regarding stage IA acral lentiginous melanoma, based on the findings in this article, sentinel lymph node biopsy should be encouraged for all patients with stage IB and stage II acral lentiginous melanoma.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup at the DermWorld homepage.
The British Association of Dermatology (BAD) has developed a comprehensive, updated guideline for the management of chronic urticaria (Br J Dermatol. 2021; Nov. 13. doi: 10.1111/bjd.20892). This guideline was initially produced by the BAD in 2001, and last reviewed in 2010. The objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of urticaria from an appraisal of all relevant literature up to March 2020, focusing on any key developments.
After a detailed evaluation, necessary work-up, and elimination of possible etiologies, the consensus is to initiate treatment for chronic urticaria with a second generation H1-antihistamine. Specific recommendations are made on up-dosing, addition of montelukast, switching between H1-antihistamines, then subsequently on second line considerations like omalizumab, ligelizumab, and cyclosporine. Second-line options for inducible urticaria are phenotype specific, while multiple systemic options such as azathioprine, dapsone, and methotrexate are available for chronic spontaneous urticaria. Progression of therapy should be done every 2-4 weeks. Tests such as total IgE levels and basophil histamine release assay may predict responsiveness to omalizumab and cyclosporine, respectively.
What distinguishes this paper is that it specifically outlines unique treatment algorithms for each form of chronic urticaria. The panel also provides responses to the most relevant and practical clinical questions that arise from clinicians and patients in the management of chronic urticaria in adults, pediatric, and pregnant/breastfeeding patients. Overall, this is an excellent and well-outlined reference guide.
