Washington, DC, March 1-5
More than 9500 dermatology professionals gathered at the Walter E. Washington Convention Center in the nation’s capital last month to discuss late-breaking research, trade clinical pearls, and learn about the latest advances in the field. Each year, the annual meeting of the American Academy of Dermatology brings together the most skilled experts in the field and industry professionals to present the latest in patient care, clinical research, and education about the diagnosis and treatment of a range of skin diseases and conditions.
The 5-day event included daily lectures, panels, live patient workshops, poster presentations, and question-and-answer sessions, all designed to enhance clinical skills and knowledge across a range of dermatologic specialties. Covered topics ranged from cosmetic advances to new medications for skin disorders. The following are some of the highlights.
Study Indicates Acne Drug Not an Independent Risk Factor for Depression
New research presented at the conference indicated that isotretinoin, an acne drug that, according to some patient reports was associated with mood disorders, is not an independent risk factor for depression in adult acne patients.
Acne affects up to 50 million Americans annually, and while isotretinoin is effective at combatting it, some patients have reported side effects that include depression and suicidal ideation.
“There has been mixed evidence and much debate around the impact of isotretinoin on mood change,” said board-certified dermatologist Bethanee Schlosser, MD, PhD, FAAD, an associate professor in the department of dermatology at Northwestern University Feinberg School of Medicine in Chicago, IL. “There’s also a lot of misinformation out there, particularly on social media, so we hope this large-scale study can shed some light on the issue.”
Dr Schlosser and her colleagues evaluated medical records for more than 38,000 patients aged 18 to 65 years who were diagnosed with acne between January 2001 and December 2017. Forty-one of the 1087 patients exposed to isotretinoin developed depression (3.77%), compared to 1775 of the 36,929 who were not exposed to isotretinoin (4.81%).
“These results showed no significant difference in frequency of depression between acne patients treated with isotretinoin and those who receive other types of therapy,” Dr Schlosser said. “Further, we know the mere presence of acne can be associated with mood disorders, including depression, and isotretinoin can provide significant relief for patients whose acne is not responding to other treatments and causing severe psychosocial distress.”
No studies to date have established a causal relationship between isotretinoin and depression, Dr Schlosser said, and her research indicates that the drug’s effect on mood is limited. She said more research in this area is necessary, however, and she encourages those with acne to see a board-certified dermatologist to discuss their treatment options and let their doctors know if they experience symptoms of depression.
Phase 3 Clinical Trials of Treatment for Molluscum Contagiosum Presented
Results from recent clinical trials of a treatment for molluscum contagiosum, a highly contagious viral skin infection that primarily affects pediatric populations, were presented at the conference. The drug, VP-102, is the first developed to treat this skin disease. “There are 6 million patients out there who have it and no approved drugs,” said Patrick Burnett, MD, PhD, an investigator on the study and chief medical officer at Verrica Pharmaceuticals.
The two randomized, double-blind, placebo-controlled phase 3 trials, known as Cantharidin Application in Molluscum Patients (or CAMP-1 and CAMP-2), included a total of 528 patients aged 2 years or older who were given either VP-102 or a placebo. Complete clearance of molluscum lesions was achieved in all but the 3-week endpoint for CAMP-2. In addition to those clinically meaningful results, Dr Burnett also said the drug has a very favorable safety profile as well, with no serious adverse events, and he is confident the company will make a submission to FDA in the second half of 2019. “As a dermatologist, it’s hard to have patients for whom you don’t have any approved therapies,” Dr Burnett said. “Now we’ll be able to tell them exactly what’s going to happen.”
Tattoo Complications May Warrant a Trip to the Dermatologist
An estimated one-third of US adults between the ages of 18 and 65 years have at least one tattoo, and research indicates that 10% of them experience a complication. Research presented at the conference addressed some common tattoo complications including infections, allergic reactions, and worsening of an existing skin condition such as psoriasis or eczema. Sarcoidosis, an autoimmune disease that can affect the skin and other organs, sometimes first appears with bumps at the site of a tattoo, according to Marie Leger, MD, PhD, FAAD, a board-certified dermatologist in New York, NY, who presented on the topic.
Infections are more common within the first couple of days or weeks of getting a tattoo, Dr Leger said, and they can cause redness and pain around the site of the tattoo (not just on the actual ink), drainage, crusting, and pus. “If you experience these symptoms after getting a tattoo, see a doctor right away, because infections can be quite serious,” Dr Leger said.
Allergies and sarcoidosis may pop up later—months to years after getting a tattoo, Dr Leger said. Signs of these conditions may include itching, bumps, scaling, periodic swelling, or the tattoo becoming raised, she said, adding that anyone experiencing these symptoms should make an appointment with a board-certified dermatologist.
Tattoo infections can come from contaminated ink, unsterile application, or improper care after the tattoo is applied. Dr Leger recommended that those with chronic skin conditions or a history of skin cancer talk to a dermatologist before getting a tattoo. People with psoriasis should be aware that they may develop a patch of the condition on their tattoo, she said, and those with moles should avoid tattooing over them. “There’s no strong data that shows tattoos increase your risk of skin cancer,” she said, “but they can make detection harder.”
Does HS Increase Cardiovascular Disease Risk?
Hidradenitis suppurativa (HS) could be a potential independent risk factor for various cardiovascular diseases, according to the findings of a recent study that was presented at the 2019 American Academy of Dermatology Annual Meeting in Washington, DC.
“Chronic inflammation underlies the pathophysiology in both the development of atherosclerotic disease and HS. Therefore, the increased inflammatory burned in HS potentially places these patients at a higher risk of developing poor cardiovascular outcomes,” the researchers stated.
To determine whether HS was associated with cardiovascular diseases, the researchers identified 4914 patients with HS, 4641 patients with psoriasis, and 23,266 healthy controls at Duke University Medical Center. They calculated and compared the odds of stroke, coronary artery disease (CAD), peripheral artery disease (PAD), and heart failure among all 3 cohorts, and adjusted for gender, race, age, hypertension, hyperlipidemia, and diabetes, as well as body mass index and smoking status.
After adjusting for demographic risk factors, the researchers found a significantly increased odds for CAD, PAD, and stroke among individuals with HS compared with controls. While the odds for heart failure was higher among individuals with HS, it was not significant compared with controls.
Multivariate analysis showed increased odds for stroke, CAD, and PAD among individuals with HS compared with those with psoriasis. However, these findings were not statistically significant.
“Our current results show that the association between HS and cardiovascular diseases persists, despite adjusting for [cardiovascular risk factors],” the researchers concluded. “Our results should be informative to providers caring for patients with HS. Cardiovascular disease is the leading cause of death in the US. Providers should be vigilant about mitigating risk factors and educating HS patients about the risks associated with cardiovascular comorbidity.”