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Professional Bicycling: Hazardous to the Skin
MADRID – With bicycle racing season now shifting into high gear in Europe and the U.S., both the athletes and the devoted fans lining the course are at increased risk for UV damage and skin cancer.
A survey of an international group of 64 elite professional cyclists conducted during last August’s 10-stage Volta a Portugal–that country’s most important cycling event–found only 60% regularly applied sunscreen before riding, and just two-thirds of those who did made an effort to apply it to all exposed skin, Dr. Osvaldo Correia reported at the 13th World Congress on Cancers of the Skin, sponsored by the Skin Cancer Foundation.
Moreover, only 8% of the professional riders reapplied sunscreen during their long days in the saddle, added Dr. Correia, a dermatologist at the University of Porto (Portugal).
The survey respondents indicated they trained or raced for an average of 3-5 hours daily most of the year, almost always during the UV-intense hours of 11 am to 5 pm. More than half of the riders had followed such a schedule for 10-19 years.
Thirty-six percent of the riders reported having had a significant sunburn during the first 8 months of 2009. The most common site was the arms, followed by the face–especially the nose–and then the legs.
The rate of adherence to standard sun protection measures was considerably low, given that all the top professional cycling teams are closely supported by a medical staff.
In conducting his cyclist interviews at the Volta a Portugal, Dr. Correia noticed many bad sunburns among the fans. Major bicycling races are huge social events in which a party atmosphere prevails. Many cycling enthusiasts camp out overnight to ensure they get a good viewing spot, and stay there for many hours in the sun drinking, socializing, and awaiting the arrival of the peleton of riders.
Dr. Correia suggested that race officials encourage fans to protect themselves by using large hats, adequate clothing, sunglasses, and water-resistant sunscreen with an SPF of 30 or more.
He disclosed having no financial conflicts in connection with this study.
Image above copyright: Hshen Lim/iStockphoto.com
MADRID – With bicycle racing season now shifting into high gear in Europe and the U.S., both the athletes and the devoted fans lining the course are at increased risk for UV damage and skin cancer.
A survey of an international group of 64 elite professional cyclists conducted during last August’s 10-stage Volta a Portugal–that country’s most important cycling event–found only 60% regularly applied sunscreen before riding, and just two-thirds of those who did made an effort to apply it to all exposed skin, Dr. Osvaldo Correia reported at the 13th World Congress on Cancers of the Skin, sponsored by the Skin Cancer Foundation.
Moreover, only 8% of the professional riders reapplied sunscreen during their long days in the saddle, added Dr. Correia, a dermatologist at the University of Porto (Portugal).
The survey respondents indicated they trained or raced for an average of 3-5 hours daily most of the year, almost always during the UV-intense hours of 11 am to 5 pm. More than half of the riders had followed such a schedule for 10-19 years.
Thirty-six percent of the riders reported having had a significant sunburn during the first 8 months of 2009. The most common site was the arms, followed by the face–especially the nose–and then the legs.
The rate of adherence to standard sun protection measures was considerably low, given that all the top professional cycling teams are closely supported by a medical staff.
In conducting his cyclist interviews at the Volta a Portugal, Dr. Correia noticed many bad sunburns among the fans. Major bicycling races are huge social events in which a party atmosphere prevails. Many cycling enthusiasts camp out overnight to ensure they get a good viewing spot, and stay there for many hours in the sun drinking, socializing, and awaiting the arrival of the peleton of riders.
Dr. Correia suggested that race officials encourage fans to protect themselves by using large hats, adequate clothing, sunglasses, and water-resistant sunscreen with an SPF of 30 or more.
He disclosed having no financial conflicts in connection with this study.
Image above copyright: Hshen Lim/iStockphoto.com
MADRID – With bicycle racing season now shifting into high gear in Europe and the U.S., both the athletes and the devoted fans lining the course are at increased risk for UV damage and skin cancer.
A survey of an international group of 64 elite professional cyclists conducted during last August’s 10-stage Volta a Portugal–that country’s most important cycling event–found only 60% regularly applied sunscreen before riding, and just two-thirds of those who did made an effort to apply it to all exposed skin, Dr. Osvaldo Correia reported at the 13th World Congress on Cancers of the Skin, sponsored by the Skin Cancer Foundation.
Moreover, only 8% of the professional riders reapplied sunscreen during their long days in the saddle, added Dr. Correia, a dermatologist at the University of Porto (Portugal).
The survey respondents indicated they trained or raced for an average of 3-5 hours daily most of the year, almost always during the UV-intense hours of 11 am to 5 pm. More than half of the riders had followed such a schedule for 10-19 years.
Thirty-six percent of the riders reported having had a significant sunburn during the first 8 months of 2009. The most common site was the arms, followed by the face–especially the nose–and then the legs.
The rate of adherence to standard sun protection measures was considerably low, given that all the top professional cycling teams are closely supported by a medical staff.
In conducting his cyclist interviews at the Volta a Portugal, Dr. Correia noticed many bad sunburns among the fans. Major bicycling races are huge social events in which a party atmosphere prevails. Many cycling enthusiasts camp out overnight to ensure they get a good viewing spot, and stay there for many hours in the sun drinking, socializing, and awaiting the arrival of the peleton of riders.
Dr. Correia suggested that race officials encourage fans to protect themselves by using large hats, adequate clothing, sunglasses, and water-resistant sunscreen with an SPF of 30 or more.
He disclosed having no financial conflicts in connection with this study.
Image above copyright: Hshen Lim/iStockphoto.com
Point/Counterpoint: Interferon & Adjuvant Therapies for Melanoma
DR. KIRKWOOD: Interferon benefits make placebo-controls untenable for first-line adjuvant trials...
There are many new alternative therapies that we all hope will alter the outcome of melanoma, including anti-CTLA-4 therapies, vaccines, and new targeted small molecule therapies. But I submit that to date, only interferon has made a significant reproducible impact, and only trials of high-dose interferon have confirmed significant, durable overall and relapse-free survival benefits that are now past 20 years in follow-up.
In the pivotal Eastern Cooperative Oncology Group E1684 trial, use of high-dose interferon reduced mortality and relapse at 5 years by 28% and 38%, respectively (J. Clin. Oncol. 1996;14:7-17). Similar outcomes occurred in the intergroup E1694 trial, in which use of high-dose interferon reduced relapse and mortality at 2 years by 32% and 33%, respectively (J. Clin. Oncol. 2001;19:2370-80).
As for toxicity, E1694 demonstrated that 90% of patients tolerated the medication for 1 year. In addition, the cost per year of life gained is within accepted cost efficacy guidelines for dialysis.
Patients regard toxicity of interferon as far less oppressive than they do the relapse of disease. Indeed, one study found that at least half the patients would be willing to tolerate mild/moderate and severe interferon toxicity for 4% and 10% improvements, respectively, in 5-year, disease-free survival (J. Clin. Oncol. 2001;19:812-23).
Several studies have demonstrated that high-dose interferon is active across the spectrum of disease from microscopic stage IIIA to bulky stage IIIB melanoma, and that it’s equally effective in ulcerated and non-ulcerated forms of disease. Both European (Hellenic Cooperative Oncology Group) and American intergroup studies have shown that high-dose interferon induces autoimmunity in 20-26% of cases. We and other investigators are now looking for the genetic predictors of benefit with interferon, such as major histocompatibility complex profiles and cytokine profiles.
For the time being, high-dose interferon is the standard adjuvant therapy for melanoma. It is unreasonable to force patients into placebo-controlled, first-line studies to gain access to new agents in 2010.
Dr. John M. Kirkwood directs the Melanoma and Skin Cancer Program at the University of Pittsburgh Cancer Institute and is professor and vice chairman for clinical research in the departments of medicine and dermatology at the University of Pittsburgh School of Medicine. He disclosed that he has received an honorarium for his FDA Oncologic Drug Advisory Committee testimony on behalf of Schering.
DR. McMASTERS: Interferon has high toxicity, and survival gains are not consistent across trials...
What about high-dose interferon? E1684 (J. Clin. Oncol. 1996;14:7-17) found a 5-year overall survival rate of 37%, which was significantly higher than 26% in the observation group. However, with longer follow-up, the overall survival advantage of high-dose interferon disappears.
Another intergroup trial, E1690, showed marginal improvement in disease-free survival and no improvement in overall survival (J. Clin. Oncol. 2000;18:2444-58). Patients in the observation group who received salvage therapy with interferon had improved survival compared with those who did not receive interferon. This was a post-hoc analysis of 37 patients out of 642 , however, and subject to selection bias. The proper way to explore the crossover effect would be to exclude crossed-over patients from survival analysis, and see whether overall survival becomes significant. To demonstrate that patients who recurred in the observation arm subsequently treated with interferon did better than those who did not receive interferon does not invalidate a large randomized, controlled trial. E1694 demonstrated improvement in overall survival for interferon, compared with the GMK vaccine—a vaccine since shown in a large randomized trial from the European Organisation for the Research and Treatment of Cancer (EORTC) to have a significant detrimental effect on survival. Therefore, one cannot conclude from E1694 that interferon is beneficial.
The Sunbelt Melanoma Trial, though underpowered to detect small differences in survival, failed to demonstrate a difference in disease-free survival or an advantage in overall survival among patients with a single tumor-positive sentinel lymph node treated with high-dose interferon (J. Clin. Oncol. 2008; May 20 suppl.; abstr. 9003). The recent Dermatologic Cooperative Oncology Group trial of modified high-dose interferon vs. low-dose interferon also failed to show any benefit in relapse-free survival and in overall survival (J. Clin. Oncol. 2009;27:3496-502).
The conclusion you can draw from analyzing the studies is that there is no consistent improvement in relapse-free or overall survival with high-dose interferon. I would categorize high-dose interferon as an unreasonable adjuvant therapy.
Dr. Kelly M. McMasters is professor and chairman of the department of surgery at the University of Louisville (Ky.) School of Medicine. He disclosed that he has received grant funding and honoraria from Schering. He is also a board member for Provectus, is a member of its scientific advisory board, and receives consulting fees from the company.
DR. KIRKWOOD: Interferon benefits make placebo-controls untenable for first-line adjuvant trials...
There are many new alternative therapies that we all hope will alter the outcome of melanoma, including anti-CTLA-4 therapies, vaccines, and new targeted small molecule therapies. But I submit that to date, only interferon has made a significant reproducible impact, and only trials of high-dose interferon have confirmed significant, durable overall and relapse-free survival benefits that are now past 20 years in follow-up.
In the pivotal Eastern Cooperative Oncology Group E1684 trial, use of high-dose interferon reduced mortality and relapse at 5 years by 28% and 38%, respectively (J. Clin. Oncol. 1996;14:7-17). Similar outcomes occurred in the intergroup E1694 trial, in which use of high-dose interferon reduced relapse and mortality at 2 years by 32% and 33%, respectively (J. Clin. Oncol. 2001;19:2370-80).
As for toxicity, E1694 demonstrated that 90% of patients tolerated the medication for 1 year. In addition, the cost per year of life gained is within accepted cost efficacy guidelines for dialysis.
Patients regard toxicity of interferon as far less oppressive than they do the relapse of disease. Indeed, one study found that at least half the patients would be willing to tolerate mild/moderate and severe interferon toxicity for 4% and 10% improvements, respectively, in 5-year, disease-free survival (J. Clin. Oncol. 2001;19:812-23).
Several studies have demonstrated that high-dose interferon is active across the spectrum of disease from microscopic stage IIIA to bulky stage IIIB melanoma, and that it’s equally effective in ulcerated and non-ulcerated forms of disease. Both European (Hellenic Cooperative Oncology Group) and American intergroup studies have shown that high-dose interferon induces autoimmunity in 20-26% of cases. We and other investigators are now looking for the genetic predictors of benefit with interferon, such as major histocompatibility complex profiles and cytokine profiles.
For the time being, high-dose interferon is the standard adjuvant therapy for melanoma. It is unreasonable to force patients into placebo-controlled, first-line studies to gain access to new agents in 2010.
Dr. John M. Kirkwood directs the Melanoma and Skin Cancer Program at the University of Pittsburgh Cancer Institute and is professor and vice chairman for clinical research in the departments of medicine and dermatology at the University of Pittsburgh School of Medicine. He disclosed that he has received an honorarium for his FDA Oncologic Drug Advisory Committee testimony on behalf of Schering.
DR. McMASTERS: Interferon has high toxicity, and survival gains are not consistent across trials...
What about high-dose interferon? E1684 (J. Clin. Oncol. 1996;14:7-17) found a 5-year overall survival rate of 37%, which was significantly higher than 26% in the observation group. However, with longer follow-up, the overall survival advantage of high-dose interferon disappears.
Another intergroup trial, E1690, showed marginal improvement in disease-free survival and no improvement in overall survival (J. Clin. Oncol. 2000;18:2444-58). Patients in the observation group who received salvage therapy with interferon had improved survival compared with those who did not receive interferon. This was a post-hoc analysis of 37 patients out of 642 , however, and subject to selection bias. The proper way to explore the crossover effect would be to exclude crossed-over patients from survival analysis, and see whether overall survival becomes significant. To demonstrate that patients who recurred in the observation arm subsequently treated with interferon did better than those who did not receive interferon does not invalidate a large randomized, controlled trial. E1694 demonstrated improvement in overall survival for interferon, compared with the GMK vaccine—a vaccine since shown in a large randomized trial from the European Organisation for the Research and Treatment of Cancer (EORTC) to have a significant detrimental effect on survival. Therefore, one cannot conclude from E1694 that interferon is beneficial.
The Sunbelt Melanoma Trial, though underpowered to detect small differences in survival, failed to demonstrate a difference in disease-free survival or an advantage in overall survival among patients with a single tumor-positive sentinel lymph node treated with high-dose interferon (J. Clin. Oncol. 2008; May 20 suppl.; abstr. 9003). The recent Dermatologic Cooperative Oncology Group trial of modified high-dose interferon vs. low-dose interferon also failed to show any benefit in relapse-free survival and in overall survival (J. Clin. Oncol. 2009;27:3496-502).
The conclusion you can draw from analyzing the studies is that there is no consistent improvement in relapse-free or overall survival with high-dose interferon. I would categorize high-dose interferon as an unreasonable adjuvant therapy.
Dr. Kelly M. McMasters is professor and chairman of the department of surgery at the University of Louisville (Ky.) School of Medicine. He disclosed that he has received grant funding and honoraria from Schering. He is also a board member for Provectus, is a member of its scientific advisory board, and receives consulting fees from the company.
DR. KIRKWOOD: Interferon benefits make placebo-controls untenable for first-line adjuvant trials...
There are many new alternative therapies that we all hope will alter the outcome of melanoma, including anti-CTLA-4 therapies, vaccines, and new targeted small molecule therapies. But I submit that to date, only interferon has made a significant reproducible impact, and only trials of high-dose interferon have confirmed significant, durable overall and relapse-free survival benefits that are now past 20 years in follow-up.
In the pivotal Eastern Cooperative Oncology Group E1684 trial, use of high-dose interferon reduced mortality and relapse at 5 years by 28% and 38%, respectively (J. Clin. Oncol. 1996;14:7-17). Similar outcomes occurred in the intergroup E1694 trial, in which use of high-dose interferon reduced relapse and mortality at 2 years by 32% and 33%, respectively (J. Clin. Oncol. 2001;19:2370-80).
As for toxicity, E1694 demonstrated that 90% of patients tolerated the medication for 1 year. In addition, the cost per year of life gained is within accepted cost efficacy guidelines for dialysis.
Patients regard toxicity of interferon as far less oppressive than they do the relapse of disease. Indeed, one study found that at least half the patients would be willing to tolerate mild/moderate and severe interferon toxicity for 4% and 10% improvements, respectively, in 5-year, disease-free survival (J. Clin. Oncol. 2001;19:812-23).
Several studies have demonstrated that high-dose interferon is active across the spectrum of disease from microscopic stage IIIA to bulky stage IIIB melanoma, and that it’s equally effective in ulcerated and non-ulcerated forms of disease. Both European (Hellenic Cooperative Oncology Group) and American intergroup studies have shown that high-dose interferon induces autoimmunity in 20-26% of cases. We and other investigators are now looking for the genetic predictors of benefit with interferon, such as major histocompatibility complex profiles and cytokine profiles.
For the time being, high-dose interferon is the standard adjuvant therapy for melanoma. It is unreasonable to force patients into placebo-controlled, first-line studies to gain access to new agents in 2010.
Dr. John M. Kirkwood directs the Melanoma and Skin Cancer Program at the University of Pittsburgh Cancer Institute and is professor and vice chairman for clinical research in the departments of medicine and dermatology at the University of Pittsburgh School of Medicine. He disclosed that he has received an honorarium for his FDA Oncologic Drug Advisory Committee testimony on behalf of Schering.
DR. McMASTERS: Interferon has high toxicity, and survival gains are not consistent across trials...
What about high-dose interferon? E1684 (J. Clin. Oncol. 1996;14:7-17) found a 5-year overall survival rate of 37%, which was significantly higher than 26% in the observation group. However, with longer follow-up, the overall survival advantage of high-dose interferon disappears.
Another intergroup trial, E1690, showed marginal improvement in disease-free survival and no improvement in overall survival (J. Clin. Oncol. 2000;18:2444-58). Patients in the observation group who received salvage therapy with interferon had improved survival compared with those who did not receive interferon. This was a post-hoc analysis of 37 patients out of 642 , however, and subject to selection bias. The proper way to explore the crossover effect would be to exclude crossed-over patients from survival analysis, and see whether overall survival becomes significant. To demonstrate that patients who recurred in the observation arm subsequently treated with interferon did better than those who did not receive interferon does not invalidate a large randomized, controlled trial. E1694 demonstrated improvement in overall survival for interferon, compared with the GMK vaccine—a vaccine since shown in a large randomized trial from the European Organisation for the Research and Treatment of Cancer (EORTC) to have a significant detrimental effect on survival. Therefore, one cannot conclude from E1694 that interferon is beneficial.
The Sunbelt Melanoma Trial, though underpowered to detect small differences in survival, failed to demonstrate a difference in disease-free survival or an advantage in overall survival among patients with a single tumor-positive sentinel lymph node treated with high-dose interferon (J. Clin. Oncol. 2008; May 20 suppl.; abstr. 9003). The recent Dermatologic Cooperative Oncology Group trial of modified high-dose interferon vs. low-dose interferon also failed to show any benefit in relapse-free survival and in overall survival (J. Clin. Oncol. 2009;27:3496-502).
The conclusion you can draw from analyzing the studies is that there is no consistent improvement in relapse-free or overall survival with high-dose interferon. I would categorize high-dose interferon as an unreasonable adjuvant therapy.
Dr. Kelly M. McMasters is professor and chairman of the department of surgery at the University of Louisville (Ky.) School of Medicine. He disclosed that he has received grant funding and honoraria from Schering. He is also a board member for Provectus, is a member of its scientific advisory board, and receives consulting fees from the company.
NIH IDs Three New Syndromes with Skin Manifestations
MIAMI -- Three newly identified syndromes on the clinical research agenda at the National Institutes of Health should be on dermatologists' radar screens, said Dr. Heidi H. Kong.
One of those important "new" syndromes is combined immunodeficiency syndrome associated with mutations in the dedicator of cytokinesis 8 protein (DOCK8). Cutaneous infections and aggressive skin cancers are hallmarks of the syndrome, and both require careful monitoring to help patients control the manifestations of this novel variant of combined immunodeficiency, said Dr. Kong at the annual meeting of the American Academy of Dermatology.
The NIH research described 11 patients (from eight families) who had recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE that are common in some variants of combined immunodeficiency (N. Engl. J. Med. 2010;361:2046-55).
Longitudinal data showed that among the cutaneous manifestations of the disease were recurrent Staphylococcus aureus skin infections with otitis externa, recurrent and severe herpes simplex virus, herpes zoster infections, severe molluscum contagiosum, and human papillomavirus infections. Other findings included severe atopic dermatitis--sometimes including rashes present since birth--with anaphylaxis; extremely aggressive squamous cell carcinomas; and in one patient, T-cell lymphoma/leukemia. This severe cutaneous phenotype of combined immunodeficiency was linked with the DOCK8 mutations.
"Unfortunately, I don't have a lot of treatment recommendations to give for this," said Dr. Kong, a dermatologist and an assistant clinical investigator at the NIH's Center for Cancer Research. "The most important thing we can do for these patients is to monitor for their cutaneous infections and to tend to their skin cancers."
The NIH is currently considering bone marrow transplantation for treating this inherited immunodeficiency, she said.
Other new syndromes that Dr. Kong described were:
Dominant Monocytopenia-Mycobacterial Infection
NIH investigators recently identified and described a subset of patients with nontuberculosis mycobacterial infections who also have monocytopenia, she said.
Dominant monocytopenia-mycobacterial infections are a distinct clinical syndrome involving increased susceptibility to mycobacterial, viral, and fungal infections, as well as malignancy. This can be transmitted in an autosomal dominant pattern, and also occurs sporadically (Blood 2010;115:1519-29).
In 18 patients studied, common infections included HPV and histoplasmosis. Ten patients developed one or more malignancies, including nine myelodysplasia/leukemia, one vulvar carcinoma and metastatic melanoma, one cervical carcinoma, one Bowen's disease of the vulva, and one multiple Epstein-Barr virus leiomyosarcoma.
Patients also commonly develop multiple inflammatory nodules, which usually resolve spontaneously, said Dr. Kong.
Deficiency to the Interleukin-1 Receptor Antagonist
DIRA is a recently discovered subset of the autoinflammatory syndrome that is characterized by a constellation of serious and potentially fatal symptoms, including bone tissue swelling and bone pain and deformity. Inflammation of the periosteum and a rash involving small pustules or extensive pustulosis covering most of a patient's body also occur.
Symptoms typically begin between birth and 2 weeks of age.
Anakinra, a synthetic form of human IL-1Ra, is an extremely effective and well-tolerated treatment for DIRA, Dr. Kong said. Treatment can result in dramatic improvement in the skin within weeks; however, discontinuation leads to relapse within days. Remember this if you are called on to evaluate a newborn with this syndrome, she advised.
Disclosures: Dr. Kong said that she has no relevant conflicts of interest in regard to her presentation.
MIAMI -- Three newly identified syndromes on the clinical research agenda at the National Institutes of Health should be on dermatologists' radar screens, said Dr. Heidi H. Kong.
One of those important "new" syndromes is combined immunodeficiency syndrome associated with mutations in the dedicator of cytokinesis 8 protein (DOCK8). Cutaneous infections and aggressive skin cancers are hallmarks of the syndrome, and both require careful monitoring to help patients control the manifestations of this novel variant of combined immunodeficiency, said Dr. Kong at the annual meeting of the American Academy of Dermatology.
The NIH research described 11 patients (from eight families) who had recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE that are common in some variants of combined immunodeficiency (N. Engl. J. Med. 2010;361:2046-55).
Longitudinal data showed that among the cutaneous manifestations of the disease were recurrent Staphylococcus aureus skin infections with otitis externa, recurrent and severe herpes simplex virus, herpes zoster infections, severe molluscum contagiosum, and human papillomavirus infections. Other findings included severe atopic dermatitis--sometimes including rashes present since birth--with anaphylaxis; extremely aggressive squamous cell carcinomas; and in one patient, T-cell lymphoma/leukemia. This severe cutaneous phenotype of combined immunodeficiency was linked with the DOCK8 mutations.
"Unfortunately, I don't have a lot of treatment recommendations to give for this," said Dr. Kong, a dermatologist and an assistant clinical investigator at the NIH's Center for Cancer Research. "The most important thing we can do for these patients is to monitor for their cutaneous infections and to tend to their skin cancers."
The NIH is currently considering bone marrow transplantation for treating this inherited immunodeficiency, she said.
Other new syndromes that Dr. Kong described were:
Dominant Monocytopenia-Mycobacterial Infection
NIH investigators recently identified and described a subset of patients with nontuberculosis mycobacterial infections who also have monocytopenia, she said.
Dominant monocytopenia-mycobacterial infections are a distinct clinical syndrome involving increased susceptibility to mycobacterial, viral, and fungal infections, as well as malignancy. This can be transmitted in an autosomal dominant pattern, and also occurs sporadically (Blood 2010;115:1519-29).
In 18 patients studied, common infections included HPV and histoplasmosis. Ten patients developed one or more malignancies, including nine myelodysplasia/leukemia, one vulvar carcinoma and metastatic melanoma, one cervical carcinoma, one Bowen's disease of the vulva, and one multiple Epstein-Barr virus leiomyosarcoma.
Patients also commonly develop multiple inflammatory nodules, which usually resolve spontaneously, said Dr. Kong.
Deficiency to the Interleukin-1 Receptor Antagonist
DIRA is a recently discovered subset of the autoinflammatory syndrome that is characterized by a constellation of serious and potentially fatal symptoms, including bone tissue swelling and bone pain and deformity. Inflammation of the periosteum and a rash involving small pustules or extensive pustulosis covering most of a patient's body also occur.
Symptoms typically begin between birth and 2 weeks of age.
Anakinra, a synthetic form of human IL-1Ra, is an extremely effective and well-tolerated treatment for DIRA, Dr. Kong said. Treatment can result in dramatic improvement in the skin within weeks; however, discontinuation leads to relapse within days. Remember this if you are called on to evaluate a newborn with this syndrome, she advised.
Disclosures: Dr. Kong said that she has no relevant conflicts of interest in regard to her presentation.
MIAMI -- Three newly identified syndromes on the clinical research agenda at the National Institutes of Health should be on dermatologists' radar screens, said Dr. Heidi H. Kong.
One of those important "new" syndromes is combined immunodeficiency syndrome associated with mutations in the dedicator of cytokinesis 8 protein (DOCK8). Cutaneous infections and aggressive skin cancers are hallmarks of the syndrome, and both require careful monitoring to help patients control the manifestations of this novel variant of combined immunodeficiency, said Dr. Kong at the annual meeting of the American Academy of Dermatology.
The NIH research described 11 patients (from eight families) who had recurrent sinopulmonary and cutaneous viral infections with elevated serum levels of IgE that are common in some variants of combined immunodeficiency (N. Engl. J. Med. 2010;361:2046-55).
Longitudinal data showed that among the cutaneous manifestations of the disease were recurrent Staphylococcus aureus skin infections with otitis externa, recurrent and severe herpes simplex virus, herpes zoster infections, severe molluscum contagiosum, and human papillomavirus infections. Other findings included severe atopic dermatitis--sometimes including rashes present since birth--with anaphylaxis; extremely aggressive squamous cell carcinomas; and in one patient, T-cell lymphoma/leukemia. This severe cutaneous phenotype of combined immunodeficiency was linked with the DOCK8 mutations.
"Unfortunately, I don't have a lot of treatment recommendations to give for this," said Dr. Kong, a dermatologist and an assistant clinical investigator at the NIH's Center for Cancer Research. "The most important thing we can do for these patients is to monitor for their cutaneous infections and to tend to their skin cancers."
The NIH is currently considering bone marrow transplantation for treating this inherited immunodeficiency, she said.
Other new syndromes that Dr. Kong described were:
Dominant Monocytopenia-Mycobacterial Infection
NIH investigators recently identified and described a subset of patients with nontuberculosis mycobacterial infections who also have monocytopenia, she said.
Dominant monocytopenia-mycobacterial infections are a distinct clinical syndrome involving increased susceptibility to mycobacterial, viral, and fungal infections, as well as malignancy. This can be transmitted in an autosomal dominant pattern, and also occurs sporadically (Blood 2010;115:1519-29).
In 18 patients studied, common infections included HPV and histoplasmosis. Ten patients developed one or more malignancies, including nine myelodysplasia/leukemia, one vulvar carcinoma and metastatic melanoma, one cervical carcinoma, one Bowen's disease of the vulva, and one multiple Epstein-Barr virus leiomyosarcoma.
Patients also commonly develop multiple inflammatory nodules, which usually resolve spontaneously, said Dr. Kong.
Deficiency to the Interleukin-1 Receptor Antagonist
DIRA is a recently discovered subset of the autoinflammatory syndrome that is characterized by a constellation of serious and potentially fatal symptoms, including bone tissue swelling and bone pain and deformity. Inflammation of the periosteum and a rash involving small pustules or extensive pustulosis covering most of a patient's body also occur.
Symptoms typically begin between birth and 2 weeks of age.
Anakinra, a synthetic form of human IL-1Ra, is an extremely effective and well-tolerated treatment for DIRA, Dr. Kong said. Treatment can result in dramatic improvement in the skin within weeks; however, discontinuation leads to relapse within days. Remember this if you are called on to evaluate a newborn with this syndrome, she advised.
Disclosures: Dr. Kong said that she has no relevant conflicts of interest in regard to her presentation.
SDEF: Previous BCC, SCC Boosts Melanoma Metastasis Risk
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
WAIKOLOA, HAWAII - Melanomas are more likely to be fatal when they occur in patients with a history of nonmelanoma skin cancer.
He cited a recent University of Pennsylvania nested case-control study involving 549 patients who presented with nonmetastatic melanoma and subsequently developed metastatic disease at least 6 months after definitive surgery. Each of the patients was matched to a control subject who had melanoma that did not metastasize.
The study identified two novel risk factors for melanoma metastasis: prior nonmelanoma skin cancer and a history of malignancy other than skin cancer. In a multivariate, logistic, regression analysis adjusted for 34 variables, a past medical history of nonmelanoma skin cancer was independently associated with a 2.89-fold increased risk of metastasis. Prior cancer at a non-cutaneous site conferred a 3.68-fold increased risk.
Previously established risk factors for melanoma metastasis were reaffirmed in this study. For example, tumor ulceration was associated with a 2.85-fold increased risk, male gender had a 1.8-fold risk, a vertical growth phase tumor had a 7.67-fold risk, and the presence of microscopic satellites was associated with a 6.62-fold increased risk of metastasis, noted Dr. Grichnik, professor of dermatology at the University of Miami and director of the melanoma program at the Sylvester Comprehensive Cancer Center.
Early metastases, defined as being diagnosed within 3 years after definitive surgery, developed in 320 melanoma patients. Another 70 patients developed late metastases, arising 8 years or more post-surgery. The strongest predictor of early, as compared to late, metastasis was a history of non-melanoma skin cancer, with a 4.83-fold increased risk. Patients with early metastasis were also significantly more likely to have ulcerated lesions and thicker tumors (Cancer 2010;116:415-23).
Also useful in identifying aggressive melanomas are the American Joint Committee on Cancer Staging criteria, based largely on tumor thickness, nodal involvement, and metastases, Dr. Grichnik said. Other factors worth considering include tumor mitotic rate, the presence or absence of circulating tumor cells, and molecular marker status.
Dr. Grichnik disclosed having financial relationships with DigitalDerm Inc., Spectral Image Inc., and Electro-Optical Sciences.
SDEF and this news organization are owned by Elsevier.
3.75% Imiquimod Cream Approved by FDA
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.
In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.
The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.
“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.
Why CTCL Can Be Such a Challenging Diagnosis
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
Dr. John A. Zic on the controversies in cutaneous T-cell lymphoma, particularly the difficulty in diagnosis. Dr. Zic disclosed that he is an investigator for Therakos, and he serves on the advisory board for Eisai.
"Ban the Tan" Movement Continues
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
Skin & Allergy News continues its multimedia coverage of the "Ban the Tan 2010" movement. On March 25, we talked with AAD President Dr. William James who discussed the testimony he gave before an FDA panel on why he thinks indoor tanning should be banned.
FDA Panel Backs Stricter Regulation of UV Tanning Devices
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
GAITHERSBURG, Md. – A Food and Drug Administration advisory panel has recommended tougher restrictions on indoor tanning devices, including a ban on their use by people under age 18.
At a meeting March 25, most members of the FDA’s General and Plastic Surgery Devices Panel supported such a ban as one measure to address the widespread use and potential skin cancer risks of indoor tanning.
Other panelists recommended different controls to protect this age group from exposure to these devices, including required informed parental consent. The FDA usually follows the recommendations of its advisory panels, which are not binding.
The meeting was held to discuss whether current labeling of tanning beds and lamps adequately addresses their known risks and to discuss increasing concerns about the heightened skin cancer risks associated with the devices.
The advisory panel unanimously recommended moving indoor tanning devices to a higher risk category, subjecting them to more controls and requirements.
Currently, UV lamps and beds used for tanning are regulated by the FDA as Class I devices, the lowest risk category. Band-Aids are also regulated as Class I devices. Panelists were divided between recommending reclassifying tanning devices as Class II devices, which require special controls, or as Class III, the highest risk category. Examples of Class II devices include medical lasers and UV lamps used to treat dermatologic disorders; Class III devices include breast implants and injectable cosmetic fillers.
The American Academy of Dermatology and other medical associations recommend a broad ban on the sale and use of these products for tanning, but at a minimum, the AAD says, they should be banned for use in minors under age 18.
Among those speaking during the public hearing portion of the meeting was AAD President Dr. William James of the University of Pennsylvania, Philadelphia, who said that dermatologists are seeing more young women with advanced skin cancer, including melanoma, who have used indoor tanning devices.
The chief of the dermatology service at Memorial-Sloan Kettering, New York, Dr. Allan Halpern, testified that 25% of melanomas in young women could be attributed to UV tanning bed use.
Of the more than 1 million people per day in the United States who are exposed to UV radiation from indoor tanning devices, 70% are women, and most are between ages 16 and 29. A total of 24% of female adolescents ages 13-19 have used a tanning bed at least once in the previous year, according to the AAD.
FDA officials at the meeting said they believe there’s evidence of a potential raised risk for skin cancer associated with increased UV exposure acquired with UV tanning lamps.
Standards for indoor tanning devices in Europe are more restrictive than in the United States and include age restrictions and requirements for informed consent in some countries, according to the FDA.
Members of FDA advisory panels have been cleared of potential conflicts of interest related to the products under discussion prior to the meeting.
AAD: Vitamin D Deficiency Plagues Patients With Skin of Color
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Vitamin D deficiency is a particular problem in individuals with skin of color, and screening of these patients should be considered given the growing list of diseases associated with the condition, said Dr. Grimes at the annual meeting of the American Academy of Dermatology.
African Americans have an increased incidence of many of the diseases also linked to vitamin D deficiency, including hypertension, diabetes, obesity, aggressive prostate and breast cancer, lupus, tuberculosis, and non-Hodgkins lymphoma, said Dr. Grimes.
Vitamin D deficiency has been shown to be associated with numerous other conditions, including neurocognitive disorders, such as Alzheimer's disease, and dermatologic disorders, such as atopic dermatitis, psoriasis, malignant melanoma, and other skin cancers.
In a recent study of 194 African American men undergoing risk assessment for prostate cancer, mean 25-hydroxyvitamin D (25[OH]D) serum concentrations were 13.7 ng/ml (BMC Public Health 2009;9:191). A concentration lower than 20 ng/ml is considered deficient; concentrations of 21-50 ng/ml are considered insufficient; and concentrations of greater than 50 ng/ml are considered sufficient.
More than 60% of the men in the study had levels less than 15 ng/ml; even 55% of the men ingesting more than 400 IU of vitamin D daily had levels less than 15 ng/ml, said Dr. Grimes, a clinical professor of dermatology at the University of California, Los Angeles. She noted the finding raises the question of whether there is a genetic, racially-induced polymorphism that predisposes African Americans to vitamin D deficiency.
Other studies from around the world have also demonstrated racial and gender differences in regard to vitamin D levels, with significantly lower levels found in African Americans and women.
In a study of 185 patients, Dr. Grimes and her colleagues found the highest vitamin D levels were seen in whites, and the lowest were in those with skin of color. Women had slightly lower levels than men. Sun exposure appeared to be a factor, with about 40% of patients using sunscreen regularly, and most only getting sun exposure on weekends.
Sun exposure is the best source of vitamin D, accounting for 80% to 90% of vitamin D levels, compared with 10% to 20% for dietary intake, said Dr. Grimes. The use of a sunscreen with an SPF of 15 can decrease vitamin D production by 99%.
The problem of vitamin D deficiency has increased over time, perhaps due in part to improved photoprotective and sun-avoidance behaviors. Data from the Centers for Disease Control's National Health and Nutrition Examination Survey (NHANES) found that 25(OH)D concentrations decreased in all ages, both genders, and all racial and ethnic groups between 1988 and 2001, she said. "In patients with [25(OH)D] less than 20 ng/ml, I invariably put them on 2,000 IU of vitamin D daily and have them come back in 3-4 months to check their levels," Dr. Grimes said.
Vitamin D3, the natural form of vitamin D when exposed to sunlight, is superior to vitamin D2, which can be found in a select group of foods, said Dr. Grimes. Doses of up to 5,000 IU are also acceptable.
Patients should be advised about the best sources of dietary vitamin D, including fish liver, fish liver oil, fatty fish like salmon (wild is better than farm raised), egg yolks, and milk, she noted. Also, in patients with skin of color, it may be important to weigh the low risk of developing skin cancer against the risks of vitamin D deficiency.
"It is imperative that we educate patients … I think we need to have a dialogue regarding sunscreen," Dr. Grimes said. If a patient with pigmented skin is using an SPF 75 sunscreen, the wisdom of that should be questioned, as should the value of advising more outdoor activity and sun exposure.
"I don't have the answers … but as clinicians we have to think about these things as we move forward," she said.
Dr. Grimes reported she had no disclosures related to her presentation.
Skin Cancer History Ups Risk for Melanoma With Metastasis
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.
Melanoma patients who have a prior history of nonmelanoma skin cancers are at a three-fold increased risk of having a metastasis. Dr. James Grichnik spoke at the Hawaii Dermatology Seminar, sponsored by the Skin Disease Education Foundation. SDEF and this news organization are owned by Elsevier.