March 17, 2021
IN THIS ISSUE / March 17, 2021
DermWorld Insights and Inquiries: Hoops and happiness — Having the courage to take a shot
Vitiligo patients share struggles, therapeutic needs with FDA
COVID-19 in melanoma patients
According to a research letter published in JAAD, initial findings from a national registry of 70 melanoma patients infected by COVID-19 show that melanoma staging and active anti-tumor therapy are not associated with worse COVID-19-related outcomes.
[Read the highlights or access the complete melanoma clinical guidelines.]
Just over half of patients had stage IV melanoma and 20% had stage I. About 50% were undergoing active treatment with either anti–PD-1 therapy or BRAF plus MEK inhibitors. Overall, 21% of patients died from COVID-19 and 13% died from melanoma during the time of data collection. The authors stated that there were no significant differences in the clinical severity of the COVID-19 infection according to melanoma therapy.
Severe symptoms developed in 58% of patients treated with immunotherapy, 57% of patients treated with an antitumoral BRAF plus MEK inhibitor, and 53% of patients who were not receiving any active antitumoral therapy. The COVID-19 mortality rate was 22%, 17%, and 27% for patients treated with immunotherapy, targeted drugs, and those without systemic cancer treatment, respectively.
Dermatologists are key providers in multispecialty care of melanoma and serious skin disease. Read more in DermWorld.
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DermWorld Insights and Inquiries: Hoops and happiness: Having the courage to take a shot
For me, sports have always been a source of enjoyment amid a busy work schedule. Several years ago, as we were walking to our cars after a long day of clinic and excitedly discussing the upcoming games we would be watching, my friend (and recently retired) colleague, Gabriel Sciallis, MD, said to me, “Thank goodness we have sports to help us relax and put our minds at ease for a few hours.”
Knowing that I love sports, my former dermatology chair, Clark Otley, MD, would routinely ask me during our annual chair review, “David, have you put up a basketball hoop yet? You won the state free throw championship; what are you waiting for?” (Disclosure: I won the Missouri State Free Throw Championship through the Knights of Columbus in the boys’ age 13 division, in January 1992. These were the glory days of my basketball “career.” Despite my sharpshooting, I rarely got beyond the bench during my varsity high school basketball days due to a lack of size, strength, speed, and vertical leap!) Sadly, even though I would have loved a hoop at home, I always came up with excuses as to why putting one up would not be logistically feasible. Keep reading!
DermWorld Young Physician Focus: Forging ahead
Chemical peels for melasma in patients with skin of color
A study published in Dermatologic Therapy compared the safety and efficacy of lactic acid, glycolic acid, and trichloroacetic acid (TCA) peels in melasma patients with skin of color. The investigators found that glycolic acid and TCA peels were associated with greater reduction in melasma severity, although the lactic acid peels had fewer side effects.
Study participants were randomly assigned 1:1:1 to the following chemical peel conditions: 30% glycolic acid, 92% lactic acid, and 15% TCA. The chemical peels were administered every two weeks for a total of 12 weeks. The distribution of patients by Fitzpatrick skin phototype was 16.7% type III, 48.9% type IV, and 34.4% type V.
Patients in all three groups experienced significant improvements on the Melasma Area Severity Index (MASI). The mean MASI score at eight weeks was lower in the glycolic acid and TCA peel groups. However, by 12 weeks, MASI scores were comparable in all three groups. The incidence of adverse events was greatest in the TCA group. Patients who received lactic peels reported the fewest side effects, although all symptoms resolved with time and no treatments were stopped.
Dermatologists discuss new understandings of the pathogenesis of melasma and emergent treatments in DermWorld.
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Monitoring patients on methotrexate for lab abnormalities
Authors of an article published in the Journal of Drugs in Dermatology suggest that in the absence of any concerning baseline characteristics, dermatologists can wait to repeat labs for methotrexate monitoring until 15 to 30 days after initiating treatment. A retrospective analysis of lab monitoring included 243 dermatology patients during the first 90 days of methotrexate therapy. In total, 309 of the lab values were abnormal with 18% of these resulting in a change in clinical management (a clinically relevant event), such as decreased dose, drug discontinuation, repeat lab testing, or continuation of the same dose when the physician had intended to increase it.
While high AST and low hemoglobin were the most common lab abnormalities, high ALT, low absolute lymphocyte count, and low absolute neutrophil count were the most likely to be associated with a clinically relevant event. Fewer than 1% of labs drawn in the first 14 days of therapy led to discontinuing or decreasing the dose of methotrexate.
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Vitiligo patients share struggles, therapeutic needs with FDA
On March 8, patients with vitiligo and their caretakers shared their stories with the U.S. Food and Drug Administration (FDA) during its Patient-Focused Drug Development Meeting for Vitiligo.
Patients shared the most significant symptoms of their condition, including discomfort, itching, burning, and sun sensitivity in addition to tremendous psychological, social, and emotional effects. They described how bullying, body shaming, medication side effects, and ignorance about their disease resulted in withdrawing from school activities, inability to secure entry level jobs, and intimacy problems.
Patient speakers also discussed their significant dissatisfaction with current treatment approaches and emphasized a need for medications that re-pigment more than 50% of their skin as well as the urgent need for a cure. Among their concerns were the temporary nature of treatments, the significant barriers posed by the inconvenience of light therapy, the impact on daily life from treatment side effects such as blistering and oozing, and the barrier to access posed by high costs of medications such as JAK inhibitors. Read more about what happened at the meeting.
What’s next: The AADA will submit comments to the FDA, capturing the specialty’s perspective, by May 10, 2021.
