The risk of developing melanoma was more closely related to sun exposure in early life than in adulthood in young Caucasian women, according to a long-term study published in Cancer Epidemiology, Biomarkers & Prevention.
Sun exposures in both early life and adulthood were predictive of non-melanoma skin cancers, whereas melanoma risk was predominantly associated with sun exposure in early life in a cohort of young women, explains Abrar A. Qureshi, MD, MPH, professor and chair of the department of dermatology at Warren Alpert Medical School of Brown University and Rhode Island Hospital in Providence.
The study, which was funded by the National Institutes of Health, and the Brigham and Women’s Hospital, followed 108,916 Caucasian registered nurses for about 20 years as part of the Nurses’ Health Study II and found that those who had at least 5 blistering sunburns when they were 15 to 20 years old had a 68% increased risk for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, and an 80% increased risk for melanoma. Those who were exposed to the highest amounts of cumulative ultraviolet (UV) radiation in adulthood had no increased risk for melanoma, but had a 2.35-fold and 2.53-fold increased risk for developing BCC and SCC, respectively, of the skin.
“Pattern of sun exposure was not uniformly associated with the risk for all the 3 main skin cancers we see in the United States, suggesting that there are some differences in the pathophysiology of these skin cancers,” says Dr. Qureshi. “An individual’s risk of developing skin cancer depends on both host and environmental risk factors. Persons with high host-risk traits, such as red hair color, higher number of moles and high sunburn susceptibility, should pay more attention to avoid excessive sun exposure, especially early in life.”
At the time of the study’s registration, the participants were between age 25 and 42 and resided in 14 different states. At registration, the participants responded to a baseline questionnaire about their medical histories and potential risk factors for skin cancers, including number of moles on legs, number of blistering sunburns between age 15 and 20 and family history of melanoma. Updated health information was collected every 2 years for about 20 years. During this time, the participants answered additional questions related to skin cancer risk, including updated family history, tanning bed use, smoking and alcohol consumption habits and body mass index.
The researchers took into account the duration participants spent residing at different locations in the United States during follow-up to calculate the cumulative UV exposure for each individual, and then grouped the participants under 3 categories of UV exposure: low, medium and high baseline annual UV flux.
About 24% of the participants had experienced painful blisters as a child or adolescent, about 10% had more than 5 blistering sunburns between age 15 and 20 and about 24% had used tanning beds. Of the study participants, 6,955 were diagnosed with BCC, 880 were diagnosed with SCC of the skin, and 779 were diagnosed with melanoma. Of those with melanoma, 445 had invasive cancer.
After adjusting for potential confounders, Dr. Qureshi and colleagues found a strong dose-response relationship between cumulative UV flux and risk for BCC and SCC of the skin, but no such association was seen for melanoma. Those who had at least 5 blistering sunburns between age 15 and 20 had increased likelihood for developing any of the 3 types of skin cancers, but the greatest risk was for developing melanoma.The researchers also found that the host-risk profile may alter an individual’s risk for developing sun exposure-associated, non-melanoma skin cancers.
More Atopic Derm Guidelines Published
The American Academy of Dermatology’s (AAD) 2 new guidelines of care for the management of adult and pediatric atopic dermatitis focus on over-the-counter and prescription topical treatment options for milder versions of this skin condition and more potent prescription agents that can provide relief for disease that is more serious and has not responded to other approaches. The evidence-based guidelines, published in Journal of the American Academy of Dermatology, are sections 2 and 3 of a 4-part series on the care and management of atopic dermatitis as developed by dermatologists who are experts in the diagnosis and treatment of this condition.
“These guidelines provide valuable recommendations for both patients and dermatologists for identifying and utilizing the best treatment options depending on the severity of the patients’ disease and its impact on their quality of life,” explains Brett M. Coldiron, MD, FAAD, president of AAD.
Here are the AAD recommended first-line therapies for patients with atopic dermatitis:
• Moisturizers are an essential part of treatment for patients with atopic dermatitis. Patients should choose a moisturizer that is free of additives, fragrances and perfumes, and is in the form (eg, cream, ointment, oils, gels and lotions) that they prefer and will use regularly. Apply as needed for relief. Moisturizers should be applied after bathing.
• Bathing: It is generally suggested that patients bathe up to once a day, for 5 to 10 minutes in warm water, followed by moisturizing. Patients should use non-soap cleaners that have a neutral to low pH, are hypoallergenic and fragrance-free.
• Bleach baths are recommended when there are visible signs of infection. A patient’s dermatologist can provide guidance and instructions on when bleach baths may be effective.
• Wet wrap therapy is recommended to reduce patients’ atopic dermatitis flares. Wet wraps help increase the penetration of moisturizers and prescription topical medications, decrease water loss, as well as provide a physical barrier against scratching. To apply a wet wrap, patients moisturize their skin, and then wrap the skin in a layer of wet bandages. A layer of dry bandages is then applied over the wet bandages. Dermatologist should instruct patients on the application time.
• Topical corticosteroids (TCS) can be used to treat active inflammation and itch, and to prevent future disease flares. TCS are available over-the-counter and in increasing prescription strengths, as well as in several forms (eg, ointments, creams, foams, gels and lotions). The dermatologist will determine the appropriate TCS selection for each patient. Patients should follow the product’s and the dermatologist’s directions for frequency and amount when applying.
• Topical calcineurin inhibitors (TCIs) may be prescribed for patients with atopic dermatitis who have not found relief through first-line treatments, such as moisturizing, bathing, wet wrap therapy or TCS, or for when the use of TCS is not advisable. TCIs can be used to treat active inflammation and itch, and to prevent future disease flares. TCIs include tacrolimus or pimecrolimus. Patients, including those under 2 years of age, can use this treatment off-label under the guidance of their dermatologist.
“While the FDA has placed a black box warning on TCI stating that there is a lack of long-term safety data about the potential risk of cancer, such as skin cancer and lymphoma, patients should know that studies have not demonstrated an increased cancer risk from TCI use,” explains Lawrence F. Eichenfield, MD, FAAD, one of the authors of the guidelines. “Patients and parents of patients can talk with their dermatologist about concerns with the use of this medication.”
For patients with severe atopic dermatitis who have been unable to control their symptoms using first-line therapies, the Academy’s guidelines recommend the following treatments:
• Phototherapy: Ultraviolet (UV) light may be prescribed to treat patients with acute atopic dermatitis or as a maintenance therapy. Ultraviolet B (UVB), ultraviolet A (UVA), or a combination of UVB and UVA may be used during therapy. Phototherapy should be provided under the guidance and supervision of a dermatologist or other physician knowledgeable in phototherapy techniques. Phototherapy can be used alone or in combination with TCS and moisturizers. Patients are encouraged to talk with their dermatologist about the risks of UV exposure (including the possible risk of skin cancer), and the ability to maintain the treatment regimen, before beginning treatment.
• Systemic immunomodulators may be prescribed for patients who do not achieve adequate control of their disease through topical therapies or phototherapy or for those who have been unable to control their symptoms despite adherence to recommended treatment plans. These therapies may also be used when a patient’s atopic dermatitis negatively affects their medical, physical and emotional well-being, especially if it impacts work, school performance or interpersonal relationships.
Scientific data demonstrates that cyclosporine, methotrexate, mycophenolate and azathioprine can be effective treatments for unresponsive atopic dermatitis. Once disease is better controlled, use of systemic immunomodulators is slowly decreased and control of atopic dermatitis can be maintained through moisturizers, topical therapies and/or phototherapy.
Part 1 of the guidelines was published in the February 2014 issue of the Journal of the American Academy of Dermatology and focused on the diagnosis and assessment of individuals affected by atopic dermatitis. Part 4 in the series, still in development, will discuss the prevention of disease flares and the use of adjunctive therapies.
New Antibacterial Approved to Treat Skin Infections in Adults
Dalbavancin (Dalvance, Durata Therapeutics), a new antibacterial drug used to treat adults with skin infections received an expedited FDA approval. It is the first drug designated as a Qualified Infectious Disease Product (QIDP) to receive FDA approval. The intravenous drug is intended to treat acute bacterial skin and skin structure infections (ABSSSI) caused by certain susceptible bacteria like Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant strains) and Streptococcus pyogenes.
Under the Generating Antibiotic Incentives Now title of the FDA Safety and Innovation Act, dalbavancin was granted QIDP designation because it is an antibacterial or antifungal human drug intended to treat serious or life-threatening infections. As part of its QIDP designation, dalbavancin was given priority review. The QIDP designation also qualifies it for an additional 5 years of marketing exclusivity to be added to certain exclusivity periods already provided by the Food, Drug and Cosmetic Act.
Dalbavancin’s safety and efficacy were evaluated in 2 clinical trials with a total of 1,289 adults with ABSSSI. Participants were randomly assigned to receive dalbavancin or vancomycin, another antibacterial drug.
Results showed dalbavancin was as effective as vancomycin for the treatment of ABSSSI. The most common side effects identified in the trials were nausea, headache and diarrhea. In the trials, more participants in the dalbavancin group had elevations in 1 of their liver enzyme tests.
More States Ban Indoor Tanning For Minors Under 18
Louisiana is the ninth state to pass a law that bans minors under the age of 18 years old from using indoor tanning devices. Legislation prohibiting the use of indoor tanning beds by minors under 18 passed the Louisiana legislature unanimously and was signed into law by Governor Bobby Jindal.
Minnesota Governor Mark Dayton also signed a bill into law that bans minors from indoor tanning. Louisiana and Minnesota join Vermont, California, Illinois, Oregon, Nevada, Texas and Washington by passing legislation that prohibits minors under the age of 18 from indoor tanning. Both laws will go into effect on August 1, 2014.
For more news and trends, visit www. the-dermatologist.com/ derm-news-wire.
Blistering Sunburns Before Age 20 May Increase Melanoma Risk
The risk of developing melanoma was more closely related to sun exposure in early life than in adulthood in young Caucasian women, according to a long-term study published in Cancer Epidemiology, Biomarkers & Prevention.
Sun exposures in both early life and adulthood were predictive of non-melanoma skin cancers, whereas melanoma risk was predominantly associated with sun exposure in early life in a cohort of young women, explains Abrar A. Qureshi, MD, MPH, professor and chair of the department of dermatology at Warren Alpert Medical School of Brown University and Rhode Island Hospital in Providence.
The study, which was funded by the National Institutes of Health, and the Brigham and Women’s Hospital, followed 108,916 Caucasian registered nurses for about 20 years as part of the Nurses’ Health Study II and found that those who had at least 5 blistering sunburns when they were 15 to 20 years old had a 68% increased risk for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, and an 80% increased risk for melanoma. Those who were exposed to the highest amounts of cumulative ultraviolet (UV) radiation in adulthood had no increased risk for melanoma, but had a 2.35-fold and 2.53-fold increased risk for developing BCC and SCC, respectively, of the skin.
“Pattern of sun exposure was not uniformly associated with the risk for all the 3 main skin cancers we see in the United States, suggesting that there are some differences in the pathophysiology of these skin cancers,” says Dr. Qureshi. “An individual’s risk of developing skin cancer depends on both host and environmental risk factors. Persons with high host-risk traits, such as red hair color, higher number of moles and high sunburn susceptibility, should pay more attention to avoid excessive sun exposure, especially early in life.”
At the time of the study’s registration, the participants were between age 25 and 42 and resided in 14 different states. At registration, the participants responded to a baseline questionnaire about their medical histories and potential risk factors for skin cancers, including number of moles on legs, number of blistering sunburns between age 15 and 20 and family history of melanoma. Updated health information was collected every 2 years for about 20 years. During this time, the participants answered additional questions related to skin cancer risk, including updated family history, tanning bed use, smoking and alcohol consumption habits and body mass index.
The researchers took into account the duration participants spent residing at different locations in the United States during follow-up to calculate the cumulative UV exposure for each individual, and then grouped the participants under 3 categories of UV exposure: low, medium and high baseline annual UV flux.
About 24% of the participants had experienced painful blisters as a child or adolescent, about 10% had more than 5 blistering sunburns between age 15 and 20 and about 24% had used tanning beds. Of the study participants, 6,955 were diagnosed with BCC, 880 were diagnosed with SCC of the skin, and 779 were diagnosed with melanoma. Of those with melanoma, 445 had invasive cancer.
After adjusting for potential confounders, Dr. Qureshi and colleagues found a strong dose-response relationship between cumulative UV flux and risk for BCC and SCC of the skin, but no such association was seen for melanoma. Those who had at least 5 blistering sunburns between age 15 and 20 had increased likelihood for developing any of the 3 types of skin cancers, but the greatest risk was for developing melanoma.The researchers also found that the host-risk profile may alter an individual’s risk for developing sun exposure-associated, non-melanoma skin cancers.
More Atopic Derm Guidelines Published
The American Academy of Dermatology’s (AAD) 2 new guidelines of care for the management of adult and pediatric atopic dermatitis focus on over-the-counter and prescription topical treatment options for milder versions of this skin condition and more potent prescription agents that can provide relief for disease that is more serious and has not responded to other approaches. The evidence-based guidelines, published in Journal of the American Academy of Dermatology, are sections 2 and 3 of a 4-part series on the care and management of atopic dermatitis as developed by dermatologists who are experts in the diagnosis and treatment of this condition.
“These guidelines provide valuable recommendations for both patients and dermatologists for identifying and utilizing the best treatment options depending on the severity of the patients’ disease and its impact on their quality of life,” explains Brett M. Coldiron, MD, FAAD, president of AAD.
Here are the AAD recommended first-line therapies for patients with atopic dermatitis:
• Moisturizers are an essential part of treatment for patients with atopic dermatitis. Patients should choose a moisturizer that is free of additives, fragrances and perfumes, and is in the form (eg, cream, ointment, oils, gels and lotions) that they prefer and will use regularly. Apply as needed for relief. Moisturizers should be applied after bathing.
• Bathing: It is generally suggested that patients bathe up to once a day, for 5 to 10 minutes in warm water, followed by moisturizing. Patients should use non-soap cleaners that have a neutral to low pH, are hypoallergenic and fragrance-free.
• Bleach baths are recommended when there are visible signs of infection. A patient’s dermatologist can provide guidance and instructions on when bleach baths may be effective.
• Wet wrap therapy is recommended to reduce patients’ atopic dermatitis flares. Wet wraps help increase the penetration of moisturizers and prescription topical medications, decrease water loss, as well as provide a physical barrier against scratching. To apply a wet wrap, patients moisturize their skin, and then wrap the skin in a layer of wet bandages. A layer of dry bandages is then applied over the wet bandages. Dermatologist should instruct patients on the application time.
• Topical corticosteroids (TCS) can be used to treat active inflammation and itch, and to prevent future disease flares. TCS are available over-the-counter and in increasing prescription strengths, as well as in several forms (eg, ointments, creams, foams, gels and lotions). The dermatologist will determine the appropriate TCS selection for each patient. Patients should follow the product’s and the dermatologist’s directions for frequency and amount when applying.
• Topical calcineurin inhibitors (TCIs) may be prescribed for patients with atopic dermatitis who have not found relief through first-line treatments, such as moisturizing, bathing, wet wrap therapy or TCS, or for when the use of TCS is not advisable. TCIs can be used to treat active inflammation and itch, and to prevent future disease flares. TCIs include tacrolimus or pimecrolimus. Patients, including those under 2 years of age, can use this treatment off-label under the guidance of their dermatologist.
“While the FDA has placed a black box warning on TCI stating that there is a lack of long-term safety data about the potential risk of cancer, such as skin cancer and lymphoma, patients should know that studies have not demonstrated an increased cancer risk from TCI use,” explains Lawrence F. Eichenfield, MD, FAAD, one of the authors of the guidelines. “Patients and parents of patients can talk with their dermatologist about concerns with the use of this medication.”
For patients with severe atopic dermatitis who have been unable to control their symptoms using first-line therapies, the Academy’s guidelines recommend the following treatments:
• Phototherapy: Ultraviolet (UV) light may be prescribed to treat patients with acute atopic dermatitis or as a maintenance therapy. Ultraviolet B (UVB), ultraviolet A (UVA), or a combination of UVB and UVA may be used during therapy. Phototherapy should be provided under the guidance and supervision of a dermatologist or other physician knowledgeable in phototherapy techniques. Phototherapy can be used alone or in combination with TCS and moisturizers. Patients are encouraged to talk with their dermatologist about the risks of UV exposure (including the possible risk of skin cancer), and the ability to maintain the treatment regimen, before beginning treatment.
• Systemic immunomodulators may be prescribed for patients who do not achieve adequate control of their disease through topical therapies or phototherapy or for those who have been unable to control their symptoms despite adherence to recommended treatment plans. These therapies may also be used when a patient’s atopic dermatitis negatively affects their medical, physical and emotional well-being, especially if it impacts work, school performance or interpersonal relationships.
Scientific data demonstrates that cyclosporine, methotrexate, mycophenolate and azathioprine can be effective treatments for unresponsive atopic dermatitis. Once disease is better controlled, use of systemic immunomodulators is slowly decreased and control of atopic dermatitis can be maintained through moisturizers, topical therapies and/or phototherapy.
Part 1 of the guidelines was published in the February 2014 issue of the Journal of the American Academy of Dermatology and focused on the diagnosis and assessment of individuals affected by atopic dermatitis. Part 4 in the series, still in development, will discuss the prevention of disease flares and the use of adjunctive therapies.
New Antibacterial Approved to Treat Skin Infections in Adults
Dalbavancin (Dalvance, Durata Therapeutics), a new antibacterial drug used to treat adults with skin infections received an expedited FDA approval. It is the first drug designated as a Qualified Infectious Disease Product (QIDP) to receive FDA approval. The intravenous drug is intended to treat acute bacterial skin and skin structure infections (ABSSSI) caused by certain susceptible bacteria like Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant strains) and Streptococcus pyogenes.
Under the Generating Antibiotic Incentives Now title of the FDA Safety and Innovation Act, dalbavancin was granted QIDP designation because it is an antibacterial or antifungal human drug intended to treat serious or life-threatening infections. As part of its QIDP designation, dalbavancin was given priority review. The QIDP designation also qualifies it for an additional 5 years of marketing exclusivity to be added to certain exclusivity periods already provided by the Food, Drug and Cosmetic Act.
Dalbavancin’s safety and efficacy were evaluated in 2 clinical trials with a total of 1,289 adults with ABSSSI. Participants were randomly assigned to receive dalbavancin or vancomycin, another antibacterial drug.
Results showed dalbavancin was as effective as vancomycin for the treatment of ABSSSI. The most common side effects identified in the trials were nausea, headache and diarrhea. In the trials, more participants in the dalbavancin group had elevations in 1 of their liver enzyme tests.
More States Ban Indoor Tanning For Minors Under 18
Louisiana is the ninth state to pass a law that bans minors under the age of 18 years old from using indoor tanning devices. Legislation prohibiting the use of indoor tanning beds by minors under 18 passed the Louisiana legislature unanimously and was signed into law by Governor Bobby Jindal.
Minnesota Governor Mark Dayton also signed a bill into law that bans minors from indoor tanning. Louisiana and Minnesota join Vermont, California, Illinois, Oregon, Nevada, Texas and Washington by passing legislation that prohibits minors under the age of 18 from indoor tanning. Both laws will go into effect on August 1, 2014.
For more news and trends, visit www. the-dermatologist.com/ derm-news-wire.
The risk of developing melanoma was more closely related to sun exposure in early life than in adulthood in young Caucasian women, according to a long-term study published in Cancer Epidemiology, Biomarkers & Prevention.
Sun exposures in both early life and adulthood were predictive of non-melanoma skin cancers, whereas melanoma risk was predominantly associated with sun exposure in early life in a cohort of young women, explains Abrar A. Qureshi, MD, MPH, professor and chair of the department of dermatology at Warren Alpert Medical School of Brown University and Rhode Island Hospital in Providence.
The study, which was funded by the National Institutes of Health, and the Brigham and Women’s Hospital, followed 108,916 Caucasian registered nurses for about 20 years as part of the Nurses’ Health Study II and found that those who had at least 5 blistering sunburns when they were 15 to 20 years old had a 68% increased risk for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, and an 80% increased risk for melanoma. Those who were exposed to the highest amounts of cumulative ultraviolet (UV) radiation in adulthood had no increased risk for melanoma, but had a 2.35-fold and 2.53-fold increased risk for developing BCC and SCC, respectively, of the skin.
“Pattern of sun exposure was not uniformly associated with the risk for all the 3 main skin cancers we see in the United States, suggesting that there are some differences in the pathophysiology of these skin cancers,” says Dr. Qureshi. “An individual’s risk of developing skin cancer depends on both host and environmental risk factors. Persons with high host-risk traits, such as red hair color, higher number of moles and high sunburn susceptibility, should pay more attention to avoid excessive sun exposure, especially early in life.”
At the time of the study’s registration, the participants were between age 25 and 42 and resided in 14 different states. At registration, the participants responded to a baseline questionnaire about their medical histories and potential risk factors for skin cancers, including number of moles on legs, number of blistering sunburns between age 15 and 20 and family history of melanoma. Updated health information was collected every 2 years for about 20 years. During this time, the participants answered additional questions related to skin cancer risk, including updated family history, tanning bed use, smoking and alcohol consumption habits and body mass index.
The researchers took into account the duration participants spent residing at different locations in the United States during follow-up to calculate the cumulative UV exposure for each individual, and then grouped the participants under 3 categories of UV exposure: low, medium and high baseline annual UV flux.
About 24% of the participants had experienced painful blisters as a child or adolescent, about 10% had more than 5 blistering sunburns between age 15 and 20 and about 24% had used tanning beds. Of the study participants, 6,955 were diagnosed with BCC, 880 were diagnosed with SCC of the skin, and 779 were diagnosed with melanoma. Of those with melanoma, 445 had invasive cancer.
After adjusting for potential confounders, Dr. Qureshi and colleagues found a strong dose-response relationship between cumulative UV flux and risk for BCC and SCC of the skin, but no such association was seen for melanoma. Those who had at least 5 blistering sunburns between age 15 and 20 had increased likelihood for developing any of the 3 types of skin cancers, but the greatest risk was for developing melanoma.The researchers also found that the host-risk profile may alter an individual’s risk for developing sun exposure-associated, non-melanoma skin cancers.
More Atopic Derm Guidelines Published
The American Academy of Dermatology’s (AAD) 2 new guidelines of care for the management of adult and pediatric atopic dermatitis focus on over-the-counter and prescription topical treatment options for milder versions of this skin condition and more potent prescription agents that can provide relief for disease that is more serious and has not responded to other approaches. The evidence-based guidelines, published in Journal of the American Academy of Dermatology, are sections 2 and 3 of a 4-part series on the care and management of atopic dermatitis as developed by dermatologists who are experts in the diagnosis and treatment of this condition.
“These guidelines provide valuable recommendations for both patients and dermatologists for identifying and utilizing the best treatment options depending on the severity of the patients’ disease and its impact on their quality of life,” explains Brett M. Coldiron, MD, FAAD, president of AAD.
Here are the AAD recommended first-line therapies for patients with atopic dermatitis:
• Moisturizers are an essential part of treatment for patients with atopic dermatitis. Patients should choose a moisturizer that is free of additives, fragrances and perfumes, and is in the form (eg, cream, ointment, oils, gels and lotions) that they prefer and will use regularly. Apply as needed for relief. Moisturizers should be applied after bathing.
• Bathing: It is generally suggested that patients bathe up to once a day, for 5 to 10 minutes in warm water, followed by moisturizing. Patients should use non-soap cleaners that have a neutral to low pH, are hypoallergenic and fragrance-free.
• Bleach baths are recommended when there are visible signs of infection. A patient’s dermatologist can provide guidance and instructions on when bleach baths may be effective.
• Wet wrap therapy is recommended to reduce patients’ atopic dermatitis flares. Wet wraps help increase the penetration of moisturizers and prescription topical medications, decrease water loss, as well as provide a physical barrier against scratching. To apply a wet wrap, patients moisturize their skin, and then wrap the skin in a layer of wet bandages. A layer of dry bandages is then applied over the wet bandages. Dermatologist should instruct patients on the application time.
• Topical corticosteroids (TCS) can be used to treat active inflammation and itch, and to prevent future disease flares. TCS are available over-the-counter and in increasing prescription strengths, as well as in several forms (eg, ointments, creams, foams, gels and lotions). The dermatologist will determine the appropriate TCS selection for each patient. Patients should follow the product’s and the dermatologist’s directions for frequency and amount when applying.
• Topical calcineurin inhibitors (TCIs) may be prescribed for patients with atopic dermatitis who have not found relief through first-line treatments, such as moisturizing, bathing, wet wrap therapy or TCS, or for when the use of TCS is not advisable. TCIs can be used to treat active inflammation and itch, and to prevent future disease flares. TCIs include tacrolimus or pimecrolimus. Patients, including those under 2 years of age, can use this treatment off-label under the guidance of their dermatologist.
“While the FDA has placed a black box warning on TCI stating that there is a lack of long-term safety data about the potential risk of cancer, such as skin cancer and lymphoma, patients should know that studies have not demonstrated an increased cancer risk from TCI use,” explains Lawrence F. Eichenfield, MD, FAAD, one of the authors of the guidelines. “Patients and parents of patients can talk with their dermatologist about concerns with the use of this medication.”
For patients with severe atopic dermatitis who have been unable to control their symptoms using first-line therapies, the Academy’s guidelines recommend the following treatments:
• Phototherapy: Ultraviolet (UV) light may be prescribed to treat patients with acute atopic dermatitis or as a maintenance therapy. Ultraviolet B (UVB), ultraviolet A (UVA), or a combination of UVB and UVA may be used during therapy. Phototherapy should be provided under the guidance and supervision of a dermatologist or other physician knowledgeable in phototherapy techniques. Phototherapy can be used alone or in combination with TCS and moisturizers. Patients are encouraged to talk with their dermatologist about the risks of UV exposure (including the possible risk of skin cancer), and the ability to maintain the treatment regimen, before beginning treatment.
• Systemic immunomodulators may be prescribed for patients who do not achieve adequate control of their disease through topical therapies or phototherapy or for those who have been unable to control their symptoms despite adherence to recommended treatment plans. These therapies may also be used when a patient’s atopic dermatitis negatively affects their medical, physical and emotional well-being, especially if it impacts work, school performance or interpersonal relationships.
Scientific data demonstrates that cyclosporine, methotrexate, mycophenolate and azathioprine can be effective treatments for unresponsive atopic dermatitis. Once disease is better controlled, use of systemic immunomodulators is slowly decreased and control of atopic dermatitis can be maintained through moisturizers, topical therapies and/or phototherapy.
Part 1 of the guidelines was published in the February 2014 issue of the Journal of the American Academy of Dermatology and focused on the diagnosis and assessment of individuals affected by atopic dermatitis. Part 4 in the series, still in development, will discuss the prevention of disease flares and the use of adjunctive therapies.
New Antibacterial Approved to Treat Skin Infections in Adults
Dalbavancin (Dalvance, Durata Therapeutics), a new antibacterial drug used to treat adults with skin infections received an expedited FDA approval. It is the first drug designated as a Qualified Infectious Disease Product (QIDP) to receive FDA approval. The intravenous drug is intended to treat acute bacterial skin and skin structure infections (ABSSSI) caused by certain susceptible bacteria like Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant strains) and Streptococcus pyogenes.
Under the Generating Antibiotic Incentives Now title of the FDA Safety and Innovation Act, dalbavancin was granted QIDP designation because it is an antibacterial or antifungal human drug intended to treat serious or life-threatening infections. As part of its QIDP designation, dalbavancin was given priority review. The QIDP designation also qualifies it for an additional 5 years of marketing exclusivity to be added to certain exclusivity periods already provided by the Food, Drug and Cosmetic Act.
Dalbavancin’s safety and efficacy were evaluated in 2 clinical trials with a total of 1,289 adults with ABSSSI. Participants were randomly assigned to receive dalbavancin or vancomycin, another antibacterial drug.
Results showed dalbavancin was as effective as vancomycin for the treatment of ABSSSI. The most common side effects identified in the trials were nausea, headache and diarrhea. In the trials, more participants in the dalbavancin group had elevations in 1 of their liver enzyme tests.
More States Ban Indoor Tanning For Minors Under 18
Louisiana is the ninth state to pass a law that bans minors under the age of 18 years old from using indoor tanning devices. Legislation prohibiting the use of indoor tanning beds by minors under 18 passed the Louisiana legislature unanimously and was signed into law by Governor Bobby Jindal.
Minnesota Governor Mark Dayton also signed a bill into law that bans minors from indoor tanning. Louisiana and Minnesota join Vermont, California, Illinois, Oregon, Nevada, Texas and Washington by passing legislation that prohibits minors under the age of 18 from indoor tanning. Both laws will go into effect on August 1, 2014.
For more news and trends, visit www. the-dermatologist.com/ derm-news-wire.
Subscribe
