PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

2017 AAD ANNUAL MEETING 17

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.

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.

© 2017 American Academy of Dermatology Association.

PracticeUpdate Editorial Team

VOL. 1 • NO. 1 • 2017