Chemoprevention of keratinocyte carcinoma with imiquimod, 5-FU, and tretinoin
Authors of a study published in the Journal of Drugs in Dermatology performed a retrospective review of more than 300 patients who employed a combination of imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream in a field therapy regimen over the face/ears or scalp for chemoprevention of keratinocyte carcinomas (KCs). The authors conclude that patients had lower odds of developing KCs in both treated and non-treated areas in the one-year period after treatment than in the one-year period preceding field treatment. The need for cryotherapy sessions for AKs was reduced in the treated areas. Nonsmokers benefitted more from chemoprevention than smokers.
DermWorld Insights and Inquiries: Paraneoplastic Merkel cell carcinoma: Searchin’ for my lost shaker of salt
By pure coincidence, Jimmy Buffett passed away from Merkel cell carcinoma (MCC) as I researched the topic of paraneoplastic MCC. Although I am no parrothead, every time I’d hear Margaritaville, I’d smile and fantasize about a lifestyle that is counter to my reality. I chose the topic of paraneoplastic MCC for this commentary because of an intriguing case report of the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) in an 86-year-old woman with recurrent MCC. I would wager that there are many Google searches about MCC today. I do not know any details about Jimmy Buffett’s case. Regardless, dermatologists should recognize that MCC patients may rarely exhibit paraneoplastic phenomena.Keep reading!
Vitiligo patients may have reduced incidences of skin cancer
Researchers of a study published in the Journal of Investigative Dermatology conducted a population-based study to examine the risk for melanoma and nonmelanoma skin cancer in patients with vitiligo compared with those without vitiligo. According to study results, vitiligo is associated with a lower risk for new onset skin cancer. The overall prevalence of skin cancer in participants with vitiligo was 1.04%, which was similar to the prevalence in the control group (1.15%). However, after 7.7 years, the 10-year cumulative incidence of skin cancer was lower in participants with vitiligo (1.3%) compared with the control group (2.0%).
Patients with vitiligo were observed to have lower rates of individual skin cancer compared with the control group. The incidence of melanoma was 0.1% in vitiligo cases vs. 0.4% in the control group. The incidence rates of squamous cell carcinoma (SCC) were 0.5% in vitiligo cases and 0.7% in the matched control group. Basal cell carcinoma (BCC) rates were 0.7% in vitiligo cases vs. 1.1% in the matched control group. The patients with vitiligo had a 38% lower risk of developing primary composite skin cancer and a consistently lower risk for melanoma, SCC, and BCC.
Dermatology drugs make Medicare’s price negotiation list
The Biden Administration recently unveiled the first 10 prescription drugs that will be subject to price negotiations between manufacturers and Medicare, according to Reuters. President Biden’s Inflation Reduction Act (IRA), signed into law last year, allows Medicare for Americans aged 65 and over to negotiate prices for some of it’s most costly drugs. Two drugs used by dermatologists are included on this list: Enbrel (etanercept) and Stelara (ustekinumab). The new prices will go into effect in 2026.
CMS spent $50.5 billion between June 1, 2022, and May 31, 2023, on the 10 drugs, which is the time period used to determine which drugs were eligible for negotiation. That was about 20% of the total cost of drugs in Medicare Part D.
The 10 medicines accounted for $50.5 billion, or about 20%, of total Part D prescription drug costs from June 1, 2022, to May 31, 2023, according to CMS. The negotiations are expected to save Medicare an estimated $98.5 billion over a decade, according to the Congressional Budget Office.
Clinical factors, hair care practices influencing outcomes in patients with CCCA
Authors of a study published in Dermatology characterized factors affecting clinical outcomes, including medical features, concurrent medical conditions, hair care practices, and treatments used for central centrifugal cicatricial alopecia (CCCA). This retrospective study of 100 patients with CCCA found that 50% of the patients were stable, 36% improved, and 14% worsened at the one-year follow-up after treatment. Treatment of diabetes with metformin, use of hooded dryers, and wearing natural hairstyles were associated with increased odds of CCCA improvement. Scaling and pustules of the scalp were associated with increased odds of worsening of the disease. The presence of thyroid disease was associated with disease stability.
[Academy HAIR grants enable new research on hair loss and skin of color. Read more in this two-part DermWorld article: Part 1 and Part 2.]
On Monday Aug. 28, Pfizer announced it will restart production in quarter four at its facility in Rocky Mount, North Carolina. Currently, Pfizer has a temporary warehouse location to accommodate product storage. As of Aug. 30, the FDA lists lidocaine hydrochloride (Xylocaine) injection and lidocaine hydrochloride (Xylocaine) injection with epinephrine as “currently in shortage.” As of Aug. 17, Fresenius Kabi USA Product Availability Report notes most Xylocaine with epinephrine products as “backordered.” In July, the AADA sent a letter to the FDA requesting a status update on the lidocaine drug shortage. The AADA will continue to keep members informed of additional developments or updates as we receive them.
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