This month’s news from across the specialty
What’s hot
September 1, 2022
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
What’s Hot? Capsaicin! The popular spice has been shown to decrease inflammation through a mechanism that is independent of the TRPV1 receptors that relay the sensation of burning through nociceptor nerves that weave a stimulating narrative of capsaicin directly targeting multiple metabolic regulators of macrophages to decrease death from sepsis in a murine model. Through covalent binding to pyruvate kinase isozyme M2 (PKM2) and lactate dehydrogenase A (LDHA), capsaicin limits the proliferation of macrophages by inhibiting the Warburg effect. The Warburg effect is the metabolic reprograming of inflammatory and cancer cells that we target with PET scans.
The clinical application of capsaicin to treat sepsis will be limited by the intense irritation from the high doses of capsaicin that are required to produce a survival benefit. Still, this work expands our understanding of the distinct functions of the capsaicin molecule. The anti-inflammatory benefits of capsaicin expand beyond activation of the TRPV1 receptors.
DermWorld Insights & Inquiries
The sobering truth is that our practice of medicine is imperfect. Multiple levels of disparities are brought to our attention in a recent systematic review of Mohs micrographic surgery (MMS) in the treatment of vulvar cutaneous malignancies (J Am Acad Dermatol. 2022. Jul;87(1):159-62). While the literature supporting MMS for male genital tumors is robust, supporting literature regarding vulvar MMS is a rarity.
In this review, 29 articles representing 107 cases covered MMS for a variety of vulvar malignancies. No recurrent tumors were reported for basal cell carcinoma (25 cases), dermatofibrosarcoma protuberans (9 cases), verrucous carcinoma (two cases), basosquamous carcinoma (one case), and nodular infiltrating adenocarcinoma of mammary-like glands (one case). Recurrence rates for squamous cell carcinoma and extramammary Paget disease were 10.53% (4/38 cases) and 13.8% (4/29 cases), respectively.
The authors comment that standard treatments of vulvar malignancies include wide local excision, partial vulvectomy, and total vulvectomy. However, these treatments are associated with significant morbidity. In addition, gender disparity is brought to light as the National Comprehensive Cancer Network guidelines recommend MMS in some cases of penile SCC, but not vulvar SCC.
Disparities in education, training, and access to MMS surely become apparent in this article. Prior studies have demonstrated that some patients prefer their genital skin exams to be done by their primary care physician or gynecologist. It is conceivable then that if a patient’s first exposure to care in the setting of a vulvar malignancy is with gynecology, that MMS may never be offered or discussed as an option. More studies are certainly needed, including those assessing the training and readiness of our own dermatologic surgeons. Equally important are our efforts to collaborate with our primary care physicians and gynecologic surgeons to make sure our patients can make fully informed choices regarding their care.
Patient-clinician partnership is crucial in supporting gender-affirming care for transgender and gender-diverse (TGD) individuals. Dermatologists play an increasingly critical role in supporting gender-affirming care for TGD patients. A recent article by James Pathoulas et al, “Characterizing the role of facial hair in gender identity and expression among transgender men,” published the results of a survey exploring the role of facial hair enhancement in nearly 450 transgender men.
In this study, 86% of survey respondents reported that facial hair was a crucial component of their gender identity and 85.1% reported that facial hair enhancement was critical to successful gender transition. However, the majority of respondents noted that they were dissatisfied with their facial hair density (74.3%) and distribution (67.6%). Additionally, while the majority of respondents were receiving treatment with testosterone, only 44.1% of respondents were using treatment to enhance their facial hair. Critically, despite our expertise in hair, dermatologists were the source of information surrounding facial hair enhancement in only 0.5% of respondents, with social media being the most common source of information around facial hair enhancement in 35.4% of respondents.
This study highlights a gap in care for transmasculine individuals as well as an opportunity for dermatologists to partner with transmasculine patients to address this gap via continued education and discussion around options for facial hair enhancement (i.e., topical or oral minoxidil). Additionally, given topical minoxidil is rarely covered by insurance, this study enhances advocacy efforts to encourage insurers to support this medication, and other forms of facial hair enhancement, as gender-affirming medical care. As experts in skin and hair, we should partner with our TGD patients to be at the forefront of these efforts to improve the care of, and coverage for, facial hair enhancement as a means of comprehensive and competent gender-affirming care.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup at the DermWorld homepage.
Consumers increasingly want skin and personal care products that claim to be natural, clean, hypoallergenic, or organic. However, there are no standardized definitions, regulatory guidelines, or oversight of these marketing terms. Many natural products can cause allergic contact dermatitis.
A recent study reviewed the ingredients of skin care products at two large chains that were labeled and marketed as clean, natural, organic, or hypoallergenic (Dermatitis. 2022. 33(3):215-9). Ingredients were considered to be a potential allergen if they were in the NACDG 2017-2018 screening series or reported in the literature. The authors found that 93.8% of products contained at least one potentially allergenic ingredient. The most common allergen was listed as fragrances/botanicals (82.9%), followed by phenoxyethanol (40.2%), tocopherol (40.2%), benzoic acid and benzoates (29.5%), propylene glycol (25.1%), alkyl glucosides (20.7%), and benzyl alcohol (15.8%).
Dermatologists need to help our patients understand that these products can lead to potential allergen exposure. Clinicians must also remember to query specifically about products labeled this way when considering allergic contact dermatitis as many patients neglect to report usage perceiving them to be safe.
