AAD Annual Meeting 2012

Five years ago NBA Hall of Famer Bill Walton returned home to San Diego from a road trip when “my spine collapsed,” he told attendees at the annual meeting of the American Academy of Dermatology, San Diego.

Years of debilitating back problems had finally caught up with him. He had spent more than 4 decades on the road as a basketball player then as a television broadcaster, navigating his 6-foot, 11-inch frame through “horrendous hotels I couldn’t stand up in, sitting in chairs built for children” and being cramped in the cabins during “mind-numbing airplane flights, [logging] 800,000-plus miles a year.”

Doug Brunk/IMNG Medical Media

He spent 2 years mainly lying in a horizontal position on the floor, he said, “in excruciating, unrelenting pain. If I had had a gun, I would have used it. I was standing on a bridge knowing full well that it was better to jump than to go back to what was left.”

But then he was saved, he said, “by doctors like you, by innovating companies like the ones changing the world of dermatology.” More than 3 year ago Mr. Walton underwent an 8-hour experimental surgery on his spine – his 36^th orthopedic operation.

“They straightened everything up, bolted it back together,” he said, noting that the foundations of the procedure involved placement of two titanium rods and an Erector-Set-like cage. This was followed by a week in a medically induced coma, 73 postoperative days on morphine, “and the long hard climb back to trying to figure out how to play the game of life and how to get on that mountain one more time.”

During his recovery, Mr. Walton, now 59, said that he was reminded of how lucky he’d been in life, of the support of his parents, friends, and “heroes and role models who stood for principle, who lived their lives with passion and purpose. And they believed in more than material accumulation.”

To borrow a phrase from the Grateful Dead gem “Touch of Grey,” well-known Deadhead Mr. Walton appears to be “feelin’ fine” these days. His views on sports are as colorful as ever. He described basketball as “the perfect game of all, unlike football, which is basically a halfway house between the Army and prison. And baseball, which is a bunch of guys out of shape scratching themselves, standing around, taking steroids, and waiting for the game of life to come to them.”

Welcome back, Bill.

--Doug Brunk

Five years ago NBA Hall of Famer Bill Walton returned home to San Diego from a road trip when “my spine collapsed,” he told attendees at the annual meeting of the American Academy of Dermatology, San Diego.

Years of debilitating back problems had finally caught up with him. He had spent more than 4 decades on the road as a basketball player then as a television broadcaster, navigating his 6-foot, 11-inch frame through “horrendous hotels I couldn’t stand up in, sitting in chairs built for children” and being cramped in the cabins during “mind-numbing airplane flights, [logging] 800,000-plus miles a year.”

Doug Brunk/IMNG Medical Media

He spent 2 years mainly lying in a horizontal position on the floor, he said, “in excruciating, unrelenting pain. If I had had a gun, I would have used it. I was standing on a bridge knowing full well that it was better to jump than to go back to what was left.”

But then he was saved, he said, “by doctors like you, by innovating companies like the ones changing the world of dermatology.” More than 3 year ago Mr. Walton underwent an 8-hour experimental surgery on his spine – his 36^th orthopedic operation.

“They straightened everything up, bolted it back together,” he said, noting that the foundations of the procedure involved placement of two titanium rods and an Erector-Set-like cage. This was followed by a week in a medically induced coma, 73 postoperative days on morphine, “and the long hard climb back to trying to figure out how to play the game of life and how to get on that mountain one more time.”

During his recovery, Mr. Walton, now 59, said that he was reminded of how lucky he’d been in life, of the support of his parents, friends, and “heroes and role models who stood for principle, who lived their lives with passion and purpose. And they believed in more than material accumulation.”

To borrow a phrase from the Grateful Dead gem “Touch of Grey,” well-known Deadhead Mr. Walton appears to be “feelin’ fine” these days. His views on sports are as colorful as ever. He described basketball as “the perfect game of all, unlike football, which is basically a halfway house between the Army and prison. And baseball, which is a bunch of guys out of shape scratching themselves, standing around, taking steroids, and waiting for the game of life to come to them.”

Welcome back, Bill.

--Doug Brunk

Five years ago NBA Hall of Famer Bill Walton returned home to San Diego from a road trip when “my spine collapsed,” he told attendees at the annual meeting of the American Academy of Dermatology, San Diego.

Years of debilitating back problems had finally caught up with him. He had spent more than 4 decades on the road as a basketball player then as a television broadcaster, navigating his 6-foot, 11-inch frame through “horrendous hotels I couldn’t stand up in, sitting in chairs built for children” and being cramped in the cabins during “mind-numbing airplane flights, [logging] 800,000-plus miles a year.”

Doug Brunk/IMNG Medical Media

He spent 2 years mainly lying in a horizontal position on the floor, he said, “in excruciating, unrelenting pain. If I had had a gun, I would have used it. I was standing on a bridge knowing full well that it was better to jump than to go back to what was left.”

But then he was saved, he said, “by doctors like you, by innovating companies like the ones changing the world of dermatology.” More than 3 year ago Mr. Walton underwent an 8-hour experimental surgery on his spine – his 36^th orthopedic operation.

“They straightened everything up, bolted it back together,” he said, noting that the foundations of the procedure involved placement of two titanium rods and an Erector-Set-like cage. This was followed by a week in a medically induced coma, 73 postoperative days on morphine, “and the long hard climb back to trying to figure out how to play the game of life and how to get on that mountain one more time.”

During his recovery, Mr. Walton, now 59, said that he was reminded of how lucky he’d been in life, of the support of his parents, friends, and “heroes and role models who stood for principle, who lived their lives with passion and purpose. And they believed in more than material accumulation.”

To borrow a phrase from the Grateful Dead gem “Touch of Grey,” well-known Deadhead Mr. Walton appears to be “feelin’ fine” these days. His views on sports are as colorful as ever. He described basketball as “the perfect game of all, unlike football, which is basically a halfway house between the Army and prison. And baseball, which is a bunch of guys out of shape scratching themselves, standing around, taking steroids, and waiting for the game of life to come to them.”

Welcome back, Bill.

--Doug Brunk

SAN DIEGO – The median survival for patients with tumor stage mycosis fungoides who received oral bexarotene therapy was 3.3 years, compared with a median of 7.7 years for patients who did not receive the drug, results from a long-term, single-center study demonstrated.

The finding "was not intuitive, because approximately 54% of patients who took bexarotene responded to the drug, but it had a negative impact on survival," Dr. John A. Zic said in an interview following a poster session at the annual meeting of the American Academy of Dermatology, where the study was presented.

Doug Brunk/IMNG Medical Media

Mycosis fungoides accounts for the majority of cutaneous T-cell lymphoma cases, yet no randomized controlled trials exist to compare existing therapies head to head. "Therefore, it is important to gather long-term clinical data for retrospective analysis when these patient cohorts exist to analyze how different therapies contribute to patient outcome," Dr. Zic and his associates wrote in their poster abstract.

For the current study, the researchers reviewed data from 39 patients with tumor stage mycosis fungoides who were followed at the Vanderbilt University Cutaneous Lymphoma Clinic in Nashville, Tenn., between July of 1995 and July of 2010. They set out to determine if patients who received therapy with oral bexarotene for the treatment of tumor stage mycosis fungoides had improved outcome, compared with those who did not take the drug. Bexarotene is a synthetic retinoid approved by the Food and Drug Administration in 1999 for the treatment of refractory, advanced-stage cutaneous T-cell lymphoma, including mycosis fungoides.

Of the 39 patients 27 (69%) were male. More than half of patients (67%) received oral bexarotene while 33% did not. Patients in the bexarotene group were older than those who did not receive the drug (a mean of 61 vs. 56 years, respectively), and a higher proportion had late clinical stage disease at diagnosis (19 patients vs. 10 patinets). They were also more likely to have large cell transformation, "which is a negative prognostic indicator," said Dr. Zic, associate professor of dermatology at Vanderbilt University.

He went on to report that 54% of patients in the bexarotene group achieved durable response, which was defined as a greater than 50% clearing for at least 1 month. However, the median overall survival for patients in the bexarotene group was 3.3 years, compared with 7.7 years for patients who did not receive the drug.

The researchers also found that patients who were diagnosed with mycosis fungoides before the year 2000 "seemed to have a longer survival than patients who were diagnosed after 2000," Dr. Zic said. "You would think that with the introduction of newer therapies we might be able to impact survival in the past decade versus survival two decades ago. We didn’t find that, and we’re not sure why. However, the more recently enrolled patients appear to be sicker; they have higher stages of disease and more [large cell] transformation. That might explain the difference."

Dr. Zic acknowledged that a chief limitation of the study was its retrospective design. "There could be certain biases introduced such as selection bias and referral bias that might help to explain some of the differences that were seen," he said.

Further analyses of the patients are planned.

Dr. Zic said that he had no relevant financial disclosures.

SAN DIEGO – The median survival for patients with tumor stage mycosis fungoides who received oral bexarotene therapy was 3.3 years, compared with a median of 7.7 years for patients who did not receive the drug, results from a long-term, single-center study demonstrated.

The finding "was not intuitive, because approximately 54% of patients who took bexarotene responded to the drug, but it had a negative impact on survival," Dr. John A. Zic said in an interview following a poster session at the annual meeting of the American Academy of Dermatology, where the study was presented.

Doug Brunk/IMNG Medical Media

Mycosis fungoides accounts for the majority of cutaneous T-cell lymphoma cases, yet no randomized controlled trials exist to compare existing therapies head to head. "Therefore, it is important to gather long-term clinical data for retrospective analysis when these patient cohorts exist to analyze how different therapies contribute to patient outcome," Dr. Zic and his associates wrote in their poster abstract.

For the current study, the researchers reviewed data from 39 patients with tumor stage mycosis fungoides who were followed at the Vanderbilt University Cutaneous Lymphoma Clinic in Nashville, Tenn., between July of 1995 and July of 2010. They set out to determine if patients who received therapy with oral bexarotene for the treatment of tumor stage mycosis fungoides had improved outcome, compared with those who did not take the drug. Bexarotene is a synthetic retinoid approved by the Food and Drug Administration in 1999 for the treatment of refractory, advanced-stage cutaneous T-cell lymphoma, including mycosis fungoides.

Of the 39 patients 27 (69%) were male. More than half of patients (67%) received oral bexarotene while 33% did not. Patients in the bexarotene group were older than those who did not receive the drug (a mean of 61 vs. 56 years, respectively), and a higher proportion had late clinical stage disease at diagnosis (19 patients vs. 10 patinets). They were also more likely to have large cell transformation, "which is a negative prognostic indicator," said Dr. Zic, associate professor of dermatology at Vanderbilt University.

He went on to report that 54% of patients in the bexarotene group achieved durable response, which was defined as a greater than 50% clearing for at least 1 month. However, the median overall survival for patients in the bexarotene group was 3.3 years, compared with 7.7 years for patients who did not receive the drug.

The researchers also found that patients who were diagnosed with mycosis fungoides before the year 2000 "seemed to have a longer survival than patients who were diagnosed after 2000," Dr. Zic said. "You would think that with the introduction of newer therapies we might be able to impact survival in the past decade versus survival two decades ago. We didn’t find that, and we’re not sure why. However, the more recently enrolled patients appear to be sicker; they have higher stages of disease and more [large cell] transformation. That might explain the difference."

Dr. Zic acknowledged that a chief limitation of the study was its retrospective design. "There could be certain biases introduced such as selection bias and referral bias that might help to explain some of the differences that were seen," he said.

Further analyses of the patients are planned.

Dr. Zic said that he had no relevant financial disclosures.

SAN DIEGO – The median survival for patients with tumor stage mycosis fungoides who received oral bexarotene therapy was 3.3 years, compared with a median of 7.7 years for patients who did not receive the drug, results from a long-term, single-center study demonstrated.

The finding "was not intuitive, because approximately 54% of patients who took bexarotene responded to the drug, but it had a negative impact on survival," Dr. John A. Zic said in an interview following a poster session at the annual meeting of the American Academy of Dermatology, where the study was presented.

Doug Brunk/IMNG Medical Media

Mycosis fungoides accounts for the majority of cutaneous T-cell lymphoma cases, yet no randomized controlled trials exist to compare existing therapies head to head. "Therefore, it is important to gather long-term clinical data for retrospective analysis when these patient cohorts exist to analyze how different therapies contribute to patient outcome," Dr. Zic and his associates wrote in their poster abstract.

For the current study, the researchers reviewed data from 39 patients with tumor stage mycosis fungoides who were followed at the Vanderbilt University Cutaneous Lymphoma Clinic in Nashville, Tenn., between July of 1995 and July of 2010. They set out to determine if patients who received therapy with oral bexarotene for the treatment of tumor stage mycosis fungoides had improved outcome, compared with those who did not take the drug. Bexarotene is a synthetic retinoid approved by the Food and Drug Administration in 1999 for the treatment of refractory, advanced-stage cutaneous T-cell lymphoma, including mycosis fungoides.

Of the 39 patients 27 (69%) were male. More than half of patients (67%) received oral bexarotene while 33% did not. Patients in the bexarotene group were older than those who did not receive the drug (a mean of 61 vs. 56 years, respectively), and a higher proportion had late clinical stage disease at diagnosis (19 patients vs. 10 patinets). They were also more likely to have large cell transformation, "which is a negative prognostic indicator," said Dr. Zic, associate professor of dermatology at Vanderbilt University.

He went on to report that 54% of patients in the bexarotene group achieved durable response, which was defined as a greater than 50% clearing for at least 1 month. However, the median overall survival for patients in the bexarotene group was 3.3 years, compared with 7.7 years for patients who did not receive the drug.

The researchers also found that patients who were diagnosed with mycosis fungoides before the year 2000 "seemed to have a longer survival than patients who were diagnosed after 2000," Dr. Zic said. "You would think that with the introduction of newer therapies we might be able to impact survival in the past decade versus survival two decades ago. We didn’t find that, and we’re not sure why. However, the more recently enrolled patients appear to be sicker; they have higher stages of disease and more [large cell] transformation. That might explain the difference."

Dr. Zic acknowledged that a chief limitation of the study was its retrospective design. "There could be certain biases introduced such as selection bias and referral bias that might help to explain some of the differences that were seen," he said.

Further analyses of the patients are planned.

Dr. Zic said that he had no relevant financial disclosures.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.

SAN DIEGO – Antibiotics are the greatest contributor to allergic contact dermatitis among topical medications, according to a retrospective study of 100 patients.

"Neomycin and bacitracin are the worst offenders," said Dr. Shanna Spring, who presented the study at the annual meeting of the American Contact Dermatitis Society.

The most common positive patch test was for bacitracin (44 tests), followed by neomycin (29) and tixocortol-21-pivalate (19). Notably, 14% of individuals tested positive for both neomycin and bacitracin.

The researchers conducted a retrospective file review from the Ottawa Patch Test Clinic between January 2000 and September 2010. They randomly selected 100 patient files from the “interesting case database” compiled by the clinic staff.

Patients were eligible for the study if they had at least one positive patch test result to a topical medication; those whose patch test read as an irritant, macular erythema, or equivocal were excluded. Three-quarter of patients (74%) were older than 40 years, 68% were female and 34% were atopic, said Dr. Spring of the University of Ottawa.

The researchers were able to identify present relevant sensitizers in 80 patients. The most common sensitizers were antibiotics (59 patients), followed by steroids (31), anesthetics (6) and antifungals (6).

Most patients (64) had only one positive patch test; 20 had two positive tests. Eight patients had five positive patch tests.

In terms of co-reactions, 14 patients had more than one positive patch test for antibiotics. “This is not unexpected, as we know that aminoglycosides cross react,” said Dr. Spring. Eight patients had co-reactions of antibiotics and anesthetics; five patients had co-reactions to steroids only.

Dr. Spring reported that she has no relevant disclosures.