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2017 AADANNUALMEETING
Dr Jeffrey Scott’s take-aways
Dr Scott, of the University Hospitals Cleveland Medical
Center at Case Western Reserve University and an editorial
contributor to
PracticeUpdate Dermatology
, offers his key
“take-aways” from the 2017 AAD Annual Meeting.
F008
– Controversies in vitamin D
The wavelengths of ultraviolet radiation (UVR) that both produce vitamin D and skin
cancer cannot be fully separated, thus obtaining vitamin D through exposure to the sun
is inherently risky. Moreover, whereas the UVR dose-response curves for DNA damage,
carcinogenesis, and sunburn are linear (ie, more UVR results in more of the measured
endpoint), the UVR dose-response curve for vitamin D production is not linear, and peaks
at very low levels of UVR exposure. In fact, the rate of production of vitamin D in the skin
is maximized with only one-third of the dose of UVR that is required to produce a slight
sunburn. Finally, studies continue to show that users of sunscreen with a high SPF are
not more likely to be vitamin D-deficient, and it is not likely that use of SPF sunscreen
contributes to less vitamin D production in the skin with sun exposure.
U086
– Treating alopecia areata, vitiligo and atopic dermatitis: JAK
inhibitors, something new for dermatology
The janus kinase inhibitors (JAK inhibitors) are new and efficacious treatment options
for patients with severe and refractory alopecia areata (AA). Patients with >50% of their
body hair affected, and those failing traditional treatment options including intralesional
triamcinolone, topical immunotherapy, prednisone, and other systemic immunosuppres-
sants are best suited for this therapy given the side-effect profile and potential risks.
However, obtaining insurance coverage for JAK inhibitors for AA is quite difficult, as
they are not FDA-approved for AA. Referral to rheumatology for office samples, as well
as letters of appeals containing patient photographs, patient assistance programs, and
documenting the coexistence of rheumatologic disease, if present, are all options for
obtaining insurance coverage for these costly medications.
S067
– Vitiligo
The psychosocial impact of vitiligo is significant and should not be overlooked by derma-
tologists. If a patient is particularly depressed or the disease activity is severely impacting
his or her life, then referral to a psychiatrist or psychologist for a formal multidisciplinary
evaluation can be highly effective. In the dermatology clinic, asking patients how the dis-
ease makes them feel, including in public, demonstrates that that you acknowledge that
they may not be comfortablewith others seeing their skin, that you understand that vitiligo
is a medical rather than cosmetic condition, and that you are interested in their emotional
well-being. These questions serve to strengthen the doctor–patient relationship and will
translate into a better therapeutic alliance with higher compliance rates.
as 80% of Caucasians reported sunscreen
use (P < 0.001).
Second, people of colour demonstrated
significant behavioural differences in seek-
ing medical attention vs Caucasians. For
example, if a suspicious mole developed,
70% of Caucasians stated they were “very
likely” to see a physician vs only 42.1% of
other, 49.5% of African-Americans, 26.3% of
Latinos, 29.4% of Asians, and 10% of Asian
Indians (P < 0.001).
Patient satisfaction differed in terms of the
amount of time the physician spent dis-
cussing skin cancer risk. A total of 67.1%
of Caucasians reported being satisfied vs
47.4% of other, 43.2% of African-Americans,
31.6% of Latinos, 30.3% of Asians, and 30%
of Asian Indians (P < 0.001).
The purpose of the modified Fitzpatrick
scale is to separate the ability to burn vs
tan, provide more variability within races,
and include more categories for darker
skin. Zero to seven points were given for
each of four categories (a maximum total of
28): ability to burn, ability to tan, skin dark-
ness, and maximal darkness of tanned skin.
Scores were similar among other (sample
mean 13.79), Asian (sample mean 13.56),
and Latino (sample mean 13.63) skin as a
group. Asian Indian (sample mean 20) and
African-American (sample mean 20.26)
skin as a group, but differed for Cauca-
sian (sample mean 8) skin in addition to
the modified Fitzpatrick scale.
Mr Kailas concluded that education is
needed regarding sunscreen use and the
importance of seeking medical attention for
suspicious nevi. Physicians need to spend
more time discussing skin cancer risk. The
modified Fitzpatrick scale showed promise
for future use.
The gaps in awareness can be addressed
via:
•
A national sunscreen campaign focusing
on people of colour and their need to
wear sunscreen, including distributing
free sunscreen to low-income areas as
well as educational pamphlets.
•
Educating people of colour to see a
physician if a suspicious mole or nevus
develops. This can be accomplished by
referring this population to resources
that teach them how to examine their
skin, such as online instruction in skin
self-examination.
•
Encouragement of physicians and res-
idents to spend time discussing skin
cancer risk among all new patients,
regardless race or ethnicity.
PracticeUpdate Editorial Team
© 2017 American Academy of Dermatology Association.
2017 AAD ANNUAL MEETING
17
VOL. 1 • NO. 1 • 2017