This year, several important and groundbreaking studies were published. Some of these studies could change practice right away, while others need more time and larger trials before any insights from their findings can be applied in clinical practice.
At the 2019 SDPA Conference, Ted Rosen, MD, discussed several studies published early this year and shared his insights on how these may impact clinical practice in the future. Dr Rosen is a professor of dermatology at Baylor College of Medicine and chief of dermatology service at Michael E. DeBakey Veterans Affairs Medical Center in Houston, TX.
The first study Dr Rosen reviewed used data from the Amazon database that crowdsources perceptions of the general population towards dermatologic diseases, specifically assessing aversion to skin diseases. The study found more men were disgusted by skin diseases than women, more nonparents were disgusted compared with parents, and more nonhealthcare workers were disgusted compared with those working in healthcare. Nodulocystic acne was associated with the highest amount of disgust while vitiligo was associated with the least, said Dr Rosen.
In a study that compared dermatologists’ prescriptions of topical corticosteroids with that of pharmacists, the researchers found pharmacists limited the amount of steroids they give to patients regardless of steroid potency, said Dr Rosen. They often tell patients to use a thin layer. Notably, one-third of pharmacists in this study dispensed less medication than prescribed without contacting the provider. Basically, these findings suggest providers communicate with their pharmacists, Dr Rosen recommended.
Dr Rosen reviewed a Medscape Ethics report that asked providers whether they considered it acceptable to have a romantic relationship with a patient (past or present). From 2010 to 2018, the number of providers who considered a romantic relationship with a patient acceptable went up to 27%, he said. However, the percent of providers who thought it was acceptable for current patients only increased from 1% to 2%. This proportion increased when providers were asked if it was acceptable when the person had not been a patient with the provider for 6 months to a year. Interesting, more women than men thought it was okay to have a romantic relationship with someone who was previously a patient.
One important study Dr Rosen highlighted showed an increased risk of squamous cell carcinoma in past or current sites of hidradenitis suppurativa (HS). Dr Rosen encouraged all providers have a high index of suspicion and to biopsy, especially for patients with long standing HS. Patients with squamous cell carcinoma in the anal region had a bad prognosis. The study found 7 out of 12 patients experienced recurrence, and all patients ultimately died due to metastases.
According to Dr Rosen, leukemia cutis is rare but can invade the skin. It is not symptomatic, but it may be a little tender and is obvious cosmetically, he said. In a study that assessed leukemia cutis in patients with AML, those with skin findings had a worse prognosis. The 5-year survival for leukemia cutis was 8.6% compared with 28.3% among those without skin involvement.
Another interesting study Dr Rosen reviewed was based on a case report that showed a patient with cutaneous T-cell lymphoma (CTCL) treated with antibiotics for a staphylococcus infection and experienced improvement in their CTCL. The review included patients with CTCL that was refractory to traditional therapies. All patients were given an aggressive antibiotic regimen and experienced improvements or clearance, with some staying clear throughout the 8 months of follow-up.
“We need a bigger study over a longer period of time to assess this,” said Dr Rosen. However, this regimen is not expensive. “If your back is against a wall and you don’t want to send a patient to an oncologist yet, you might think about antibiotics,” he suggested.
While the treatment of choice for keratocanthoma is surgical excision, sometimes the lesion is located in difficult-to-treat areas, or the patient cannot or does not want to undergo surgery. Dr Rosen discussed a study that showed intralesional methotrexate had achieved resolution in 88% of patients. However, he said he preferred to use intralesional 5-FU and injected small amounts, just enough to blanch the lesion.
A study on suture placement with 50 patients who had a fusiform wound showed no difference in scarring or complications between sutures that were 2 mm apart or 5 mm apart. Dr Rosen noted that this may be more applicable to the face as opposed to the trunk or extremity.
He briefly reviewed a case of a woman with obesity who developed acne mechanica between her thighs due to the friction in that area. He also discussed a study from Israel, which showed an inverse relationship between acne and obesity among 17-year-old patients.
“We tell patients with rosacea to avoid alcohol to prevent rhinophyma,” said Dr Rosen, but not much evidence existed on this association previously. However, a study from Germany showed the likelihood of developing rhinophyma increased with higher intake of alcohol.
A promising study from Canada found potential serum-based soluble markers for distinguishing psoriatic arthritis from osteoarthritis. While this panel requires further research and validation, Dr Rosen noted this panel could make a big difference in practice for distinguishing arthritis in patients.
Other psoriasis studies Dr Rosen reviewed included one that showed facial involvement was associated with worse disease and earlier onset of disease; telemedicine is as effective as in-person office visits for managing psoriasis, which could improve care of patients who live outside major cities; and active periodontitis is common among patients with psoriasis. Dr Rosen recommended talking to patients about whether their gums bleed when brushing their teeth or if they have seen a dentist to treat any inflammation in their mouth. Dr Rosen also briefly mentioned the study that showed patients with atopic dermatitis are more likely to think about suicide or attempt suicide.
Dr Rosen briefly reviewed the Center for Diseases Control and Prevention guidelines for PrEP, which is recommended for individuals at-risk of acquiring HIV. There are 2 PrEP therapies approved for preventing HIV. While awareness of PrEP has increased to about 90%, the use of PrEP is not keeping pace, with only 35% of people using it, said Dr Rosen. He recommended providers talk to patients who have an increased risk for HIV, such as those who have been treated for other sexually transmitted diseases, about using PrEP. While providers in dermatology will not necessarily administer PRP, plenty of physicians are willing to prescribe this medication, such as infectious disease specialists, and providers can refer patients to these physicians for appropriate treatment, said Dr Rosen.