This month’s news from across the specialty

June 1, 2024

In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.  

An interventional study of aging in mice points to a new paradigm for rejuvenation (Nature. 2024. (628): 162-70). This study sought to rejuvenate mice by restoring the balance of stem cells in aged mice through decreasing the myeloid stem cells that increase with aging. The optimal intervention needs to decrease the myeloid stem cells while not harming other cells and organs. Twelve candidate surface antigens, identified through expression screening, were winnowed down to four antibody targets that demonstrated high enrichment in the aged myeloid stem cells with little off-target binding. The intervention paired antibodies against each of these specific cell surface markers with a combination of antibodies that conditioned the immune response to increase cell destruction. Three of the antibody-targeted cell surface markers decreased the counts of myeloid stem cells. Happily, the stem cells associated with the younger immune function rebounded to rebuild cell populations.

Treated aged mice demonstrate durable signs of restoration of younger immune function. There are increased amounts of naïve T and B cells for months after a single treatment. Further, the treated aged mice respond to attenuated virus with a brisk immune response that is comparable to young mice. Importantly, the study demonstrated that the targeted genes have human homologues with similar expression patterns.

The potential for future treatments to restore a younger immune function might be transformative for skin conditions. There is the potential for restoration of cutaneous tumor surveillance to help control aggressive skin cancer. This might deliver a more holistic immunotherapy with greater efficacy and fewer side effects than current checkpoint inhibitors.

The newest American College of Rheumatology Guidelines for the Prevention and Treatment of glucocorticoid-induced osteoporosis (GIOP) have become a staple reference in my clinic (doi: 10.1002/art.42646). Guidelines are not a steadfast rule, however, and individual circumstances need to be considered. Key points: Initial fracture risk assessment including evaluation of osteoporosis risk factors should be done in patients on chronic glucocorticoids ≥2.5mg/day for >3 months. Bone mineral density (BMD) testing should be done as soon as possible in almost all patients except for children <18 years of age without any back pain or fracture history. In adults ≥40 years of age, FRAX (Fracture Risk Assessment Tool) should be used to risk stratify patients. Conditionally recommended for all patients on glucocorticoids are calcium and vitamin D supplementation, as well as lifestyle modifications such as exercising and limiting alcohol intake.

Patients at high to very high risk of GIOP include those with BMD testing showing osteoporosis, those with prior osteoporotic fracture, or those on high dose glucocorticoids ≥30mg/day for >30 days or with cumulative dose ≥5 grams/year. Bisphosphonates are strongly recommended over no treatment in these high- to very high-risk patients, but there is growing data to favor other options such as parathyroid hormone/parathyroid hormone related protein (PTH/PTHrP) to help gain even greater bone density. Patients with moderate risk of GIOP include those with osteopenia, or those who have lost significant bone over the prior 1-2 years; these patients have conditional recommendations to start bisphosphonate, denosumab, or PTH/PTHrP therapy. Patients at low risk of GIOP do not require further treatment.

As dermatologists, we have long held the responsibility of educating patients about the risks of trying to achieve ever-elusive “perfection,” but we now have a higher hill to climb in the age of social media. According to a Current Dermatology Reports paper, “The various collaborative features of Facebook, Twitter, Instagram, TikTok, YouTube, Snapchat, and other emerging platforms have proven appealing to organizations and users seeking dermatology-related content and medical advice. However, the potential for propagation of inaccurate or even dangerous information is high."

“Influencers” range from teens selling products for commission, to board-certified dermatologists debunking skin care myths, but one trend seems near universal — the use of clever lighting, angles, filters, and photo editing software to enhance images and videos posted by the creators. Recalibrating expectations in both our medical and aesthetic practices is nothing new, as we have seen altered media of celebrities for years upheld as cosmetic ideals. With today’s technology, however, we can apply these editing techniques to our own images. This has distorted the way we view ourselves, as well as our expectations of the new standard of beauty. No lines, no pores, high cheekbones, full lips — these attributes are now universally adopted as the gold standard, with patients bringing in edited photos of themselves and others as their aesthetic goals. As we live in an increasingly technologically advanced world with so many sources of information, our specialty is uniquely suited to remind our patients (and ourselves!) that we must be careful not to fall into the illusory trap of the “perfect” yet artificial image.

Allergic contact dermatitis to nail cosmetics is a well-recognized problem. Tosylamide has historically been the primary allergen in traditional nail polishes, but the North American Contact Dermatitis Group (NACDG) has recently reported that acrylates have replaced tosylamide as the most common nail care product associated allergen. This study surveyed skin reactions associated with acrylic nail cosmetics with a focus on home nail kits (Dermatitis. 2024. 35(1): 49-54).

The authors postulate that home nail kit usage increased significantly during COVID as professional manicures were not available. This resulted in more individuals, mostly white females, reporting an increase in use of home acrylic kits, and the majority learned how to do it on social media. This survey showed that home kit users developed skin reactions after starting home kit usage earlier and more frequently than non-home users.

Acrylic monomers are strong allergens but once polymerized, the final polymer is nonallergenic if no residual monomer is present. Acrylates are used in many nail products with ultraviolet or light-emitting diode light for polymerization. This study showed many home users learned how to use the products through social media or other websites and most did not read the package insert that reinforces careful avoidance of the monomer. However, even professional nail technicians developed skin reactions after home use, which implies even training may not prevent the risks of home use kits. The authors postulate this may be due to increased usage given the convenience of home use kits and more spillage and exposure to monomer with self-application. The skin reactions, typically on the hands, fingers, and fingernails, resulted in a significant impact on quality of life. The authors suggest that more regulation of these home kits may be needed, as sensitization to acrylates has a potentially larger impact, particularly for future medical procedures. At a minimum, consumers should be made aware of the potential risk of sensitization.

Additional DermWorld Resources