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News - March 2020

News - March 2020

Skin Cancer Risk Higher for Certain Sexual and Gender Minority Populations
Gender-nonconforming individuals and gay and bisexual men have a higher prevalence of skin cancer compared with heterosexual and cisgender men and women, according to the findings of two cross-sectional studies published in JAMA Dermatology.1,2

Physician examining a patient“Although the differences in prevalence estimates are small in absolute magnitude, these data provide additional concrete examples of disproportionate skin cancer burden within [sexual and gender minority] subpopulations,” said the authors of an editorial, also published in JAMA Dermatology.3

Using data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2014 to 2018, Singer et al1,2 calculated the adjusted odds ratio (AOR) of reported history of skin cancer. The first study included 7516 gay men, 5088 bisexual men, 351,468 heterosexual men, 5392 lesbian women, 9445 bisexual women, and 466,355 heterosexual women. The second study included 368,197 cisgender men, 492,345 cisgender women, 1214 transgender men, 1675 transgender women, and 766 gender nonconforming individuals.

In the first study, Singer et al1 found the AOR for the prevalence of skin cancer was significantly higher among both gay (1.26; 95% CI, 1.05-1.51) and bisexual men (1.48; 95% CI, 1.02-2.16) compared with heterosexual men. The AOR of skin cancer among bisexual women was statistically significantly lower compared with heterosexual women (0.78; 95% CI, 0.61-0.99), but it was not lower among gay or lesbian women (0.97; 95% CI, 0.73-1.27).

In the second study, Singer et al2 found that the age-adjusted lifetime prevalence of skin cancer was 7.1% among gender-nonconforming individuals, 6.6% among cisgender men, 6.4% among cisgender women, 6% among transgender men,  and 5.8% among transgender women. Compared with cisgender men, the AORs of skin cancer history were significantly lower among cisgender women (0.85%; 95% CI, 0.82-0.88), but the AORs were not significantly different among transgender men or transgender women and were higher among gender-nonconforming individuals (2.11; 95% CI, 1.01-4.39).

Both studies highlighted subpopulations that may need more intensive sun protective counseling. Gay and bisexual men had an increased self-reported lifetime prevalence of skin cancer as did gender-nonconforming individuals.

While additional studies are needed to confirm these findings, the researchers noted the need for patient education and community outreach initiatives to reduce skin cancer risk behaviors in sexual and gender minority communities.

“Continued implementation of the [BRFSS]’s sexual orientation and gender identity module is imperative to improve understanding of the health and well-being of sexual minority populations,” they added.

“It is time for dermatologists to lend their expertise to help prioritize the dermatology-related health of [sexual and gender minority] persons,” the authors of the accompanying editorial wrote.3 

References
1. Singer S, Tkachenko E, Hartman RI, Mostaghimi A. Association between sexual orientation and lifetime prevalence of skin cancer in the United States [published online February 12, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4196
2. Singer S, Tkachenko E, Hartman RI, Mostaghimi A. Gender identity and lifetime prevalence of skin cancer in the United States [published online February 12, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4197
3. Yeung H, Braun H, Goodman M. Sexual and gender minority populations and skin cancer—new data and renewed priorities [published online February 12, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4174


Reapplication May Not Be Necessary for Water Resistant Sunscreen
A recent study in Photodermatology, Photoimmunology & Photomedicine showed that an 80-minute, water-resistant sunscreen does not necessarily need to be reapplied every 2 hours.

“In 2007, the FDA added requirements for sunscreens to be labeled ‘re-apply at least every 2 hours’ based on very limited data,” the researchers said.

Sunscreen by the waterThey assessed the persistence of protection of an 80-minute, water-resistant SPF 50 sunscreen formulation with and without replication over 6 hours. Participants applied the sunscreen to their foreheads and backs and were randomly assigned to either a nonactive group or an active group. In the active group, participants exercised in a heated environment. The efficacy of the sunscreen over time was measured using hybrid diffuse reflectance spectroscopy (HDRS) and UV photography.

After 6 hours, the researchers found the sunscreen maintained SPF 50 efficacy among nonactive participants with a single application. In the active group, the sunscreen maintained SPF 50 efficacy for 2 hours and dropped slowly to SPF 30 after 6 hours of sweating. Reapplication of sunscreen gave an additive SPF, with two applications resulting in SPF greater than 100 and three applications resulting in approximately SPF 150, the researchers said.

However, UV photography was found to be insensitive to the differences in protection detected by the HDRS instrument, they added.

“Sunscreen efficacy is maintained over time in the absence of sweating or rub-off,” the researchers concluded. “After 2 hours of sweating, an 80-minute water resistant sunscreen does not need to be re-applied ‘at least every 2 hours’.”

Reference
Ruvolo E, Aeschliman L, Cole C. Evaluation of sunscreen efficacy over time and re-application using hybrid diffuse reflectance spectroscopy [published online February 6, 2020]. Photodermatol Photoimmunol Photomed. doi:10.1111/phpp.12535


Psoriasis Treatment Meta-analysis Identifies Therapies With Highest Response Rates
A meta-analysis highlighted several biologics that were associated with higher short- and long-term response rates. Risankizumab-rzaa (Skyrizi), brodalumab (Siliq), ixekizumab (Taltz), and guselkumab (Tremfya) were found to achieve and maintain Psoriasis Area and Severity Index (PASI) improvements of 75% or higher at weeks 10 to 16 and weeks 44 to 66 compared with other therapies, according to the findings of the study.1

Patient with psoriasis“The clinical benefits of novel treatments for moderate to severe psorias 0is are well established, but wide variations exist in patient response across different therapies,” the researchers said.

“In the absence of head-to-head randomized clinical trials of treatments for moderate to severe plaque psoriasis, this study provides what we believe to be a comprehensive assessment of the comparative short-term and long-term efficacy among several novel treatments,” they added.

In the literature review and meta-analysis, the researchers analyzed data from 60 clinical trials to compare the short- and long-term efficacy of biologics and oral agents. Data was extracted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Main outcomes included PASI 75, PASI 90, and PASI 100 at 10 to 16 weeks and at 44 to 60 weeks from baseline.

The researchers found that risankizumab-rzaa (71.6%; 95% credible interval [CrI], 67.5%-75.4%), had the highest PASI 90 rates at week 10 to 16, followed by brodalumab (70.8%; 95% CrI, 66.8%-74.6%), ixekizumab (70.6%; 95% CrI, 66.8%-74.6%), and guselkumab (67.3%; 62.5%-71.9%).

At weeks 44 to 60, risankizumab-rzaa had the highest PASI 90 rates (79.4%, 95% CI, 75.5%-82.9%), followed by guselkumab (76.5%; 95% CI, 72.1%-80.5%), brodalumab (74.0%; 95% CI, 69.3%-78.1%), and ixekizumab (73.9%; 95% CI, 69.9%-77.5%), the authors noted.

These findings were consistent for short- and long-term PASI 75 and PASI 100 responses as well.

In an accompanying editorial,2 Drs Strober and Kenneth B. Gordon noted that there were several pitfalls for performing drug comparisons using meta-analyses, such as biases in the data used for analysis and the inability to evaluate long-term drug survival. According to Drs Strober and Gordon, “what is left to the reader is determining the clinical relevance of small distinctions between medications that result from these evaluations.”

They added, “the raw rankings of efficacy as determined by the Armstrong et al1 network meta-analyses and other recently published network meta-analyses offer a valuable starting point from which to initiate discussions with patients and improve shared decision making related to choosing the most appropriate psoriasis treatment.”

References
1. Armstrong AW, Puig L, Joshi A, et al. Comparison of biologics and oral treatments for plaque psoriasis: a meta-analysis [published online February 5, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4029
2. Strober B, Gordon KB. Comparative effectiveness studies for psoriasis—the methods matter [published online February 5, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4025

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