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

CONFERENCE COVERAGE 18

Patients with haematologicmalignancies more likely to seek inpatient oncodermatology consultation Patients with hematologic malignancies are more likely than those with other cancers to seek an inpatient oncodermatology consultation, finds a retrospective chart review. G regory Phillips, MD, of Memorial Sloan Kettering Cancer Center, New York, explained that dermatologic genitourinary (12.1%) cancer patients than in other patients (6.3% nongastrointestinal, 7.4% nongenitourinary) patients.

typical sun exposure, use of sun-protective clothing and sunscreen, and vitaminD intake. Physician assessment included Fitzpatrick Skin Type determination and measurement of skin pigmentation via spectrophotometry. Blood was drawn to assess levels of serum 25-hydroxyvitamin D2 and D3. All 124 subjects completed the study. The majority (87.9%) were Fitzpatrick Skin Type III–VI. AWilcoxon two- sample test was per- formed to examine the median difference in vitamin D concentration (ng/mL) between patients with Fitzpatrick Skin Type I–III (lightly pigmented) vs Fitzpatrick Skin Type IV–VI (darkly pigmented) and showed sig- nificant evidence of a difference between groups (Z = 3.17, (P < 0.01). Spearman correlation tests showed a neg- ative correlation between serum vitamin D concentration and spectrophotometer measurement of skin pigmentation and a positive correlation between serum vitamin D concentration and average self-reported vitamin D food intake. cancer diagnosis. A total of 484 initial inpatient dermatology consultations revealed 666 distinct der- matologic diagnoses. Infections (n=149, 22.4%); inflammatory conditions (n=133, 20.0%); and drug reactions (n=99, 14.9%) were the most common dermatologic diagnoses. The most common underlying malignancy found was hematological (n=245, 50/6%), followed by gastrointestinal (n=38, 7.9%); and genitourinary (n=36, 7.4%). Patients with breast cancer incurred a greater burden of infectious diseases (37.3%) and a lesser burden of inflamma- tory conditions (13.7%) than patients with other cancers (21.1% infection, 20.5% inflammatory). A higher frequency of skin drug reactions was observed in gastrointestinal (12.1%) and

conditions commonly arise in patients undergoing treatment for cancer but have not been systematically characterised, par- ticularly in the inpatient setting. Dr Phillips and colleagues sought to describe the spectrum of skin diseases encountered and the frequency of under- lying malignancies requiring inpatient dermatology consultations at their centre. The charts of initial dermatology hospital consultations over 2015 were reviewed. Patients were identified through a query of inpatient consultation notes and a consult log. Relevant data were abstracted from each patient’s electronic medical record including demographics, reason for refer- ral, dermatologic diagnosis, and primary

Dr. Phillips concluded that inpatient derma- tology consultations were most frequently requested for patients with hematologic malignancies. Infectious and inflammatory skin conditions were the most common reasons for inpatient referral for dermato- logic evaluation in oncology patients. The results may help identify underlying malignancies that may present increased risk of developing dermatologic conditions requiring expertise of dermatologists for diagnosis and management. The findings reinforce the importance of inpatient onco- dermatology collaboration in optimising care of hospitalised cancer patients and survivors.

PracticeUpdate Editorial Team

Darker skin pigmentation linked with lower serumvitamin D concentrations Darker skin pigmentation has been associated with lower serum vitamin D concentrations, reports a single-centre, cross-sectional study. B ridget Kaufman, MD, of the Mount Sinai School of Medicine, New York, explained that vitamin D is a fat-solu-

Insufficient evidence of a difference in serum 25-hydroxyvitamin D levels between ethnic groups was available, low vs high sun exposure, and low vs high use of sun protection. Dr Kaufman concluded that darker skin pig- mentation is associated with lower serum 25-hydroxyvitamin D concentration. Serum vitamin D level also appears to be related to intake of vitamin D-rich foods and mul- tivitamins containing vitamin D, but not self-reported level of sun exposure or use of sun protection. Given that the study sampled primarily individuals with Fitzpatrick Skin Type III– VI, further research is needed in individuals with Fitzpatrick Skin Type I–VI to evaluate the association between skin pigmentation and vitamin D status. “The research,” Dr. Kaufman asserted, “car- ries important implications in the prevention and treatment of vitamin D deficiency in the US. Research such as ours may help guide clinicians and public health officials in man- aging vitamin D deficiency.”

ble vitamin that maintains skeletal health. Deficiency of vitamin D has been impli- cated in the development of numerous conditions, including diabetes, autoim- mune diseases, and cancer. While some studies have found no associ- ation between 25-hydroxyvitamin D levels and skin phototype, others have demon- strated lower levels in dark-skinned vs fair-skinned individuals. This difference is thought to be due to decreased ultravio- let B absorption in individuals with higher melanin content. Dr Kaufman and colleagues aimed to fur- ther elucidate the correlation between vitamin D status and skin pigmentation in subjects living in New York City. From 2015 to 2016, 124 subjects with Fitzpatrick Skin Type I–VI were recruited. Participants completed a questionnaire on

PracticeUpdate Editorial Team

PRACTICEUPDATE DERMATOLOGY