One of the most popular sessions at the Annual Meeting is “Hot Topics” because attendees help choose the subjects they want addressed. Friday, an expert faculty presented updates on the selected topics, including the announcement of the 2016 Contact Allergen of the Year, the use of digital dermatoscopes to document lesions, the latest research in sunscreens, and the importance of using biologics to treat psoriasis.
Cobalt named Allergen of the Year
With little fanfare, David E. Cohen, MD, MPH, announced cobalt as the 2016 Allergen of the Year, drawing a round of applause.
Commonly found in industrial products, including tools, engines, and magnets, the rate of reactivity is high at more than 7 percent, and irritant reactions on patch tests are common.
“We often see little peppered red signals under the cobalt pattern patch test. I wouldn’t over-read this unless there is a nice confluence of redness and some induration,” said Dr. Cohen, the Charles and Dorothea Harris Professor and vice chair for Clinical Affairs at New York University School of Medicine.
One recent study found that more than one-third of commonly used products — belt buckles, bracelets, earrings, necklaces, rings, and watches — were spot positive for cobalt. Darker colored metals have a higher rate of risk for having cobalt, he said.
A 2012 patch test study showed about two-thirds of patients reacted to at least one metal.
“If you want a patch test to determine metal hypersensitivity, it’s probably the best test we have right now. It’s certainly so much easier to do it before someone has surgery, than afterward,” said Dr. Cohen, director of the allergic, occupational, and environmental dermatology at New York University. “There is no standard of care for this, and I do not advocate pretesting everyone.”
Just as dermatologists have increased their use of dermatoscopes in the last five years, Allan C. Halpern, MD, said he predicts the next five years will show equal growth in the use of digital dermatoscopes.
“The reality is that digital dermoscopy has become commonplace because you can document lesions and follow them over time,” said Dr. Halpern, chief of dermatology service at Memorial Sloan Kettering Cancer Center, New York.
He pointed to the number of companies marketing dermatoscopes, which consumers can purchase at a reasonable price and attach to their smartphones.
“This will allow consumers to send their own dermoscopic image for a teledermatology diagnosis,” Dr. Halpern said.
“Not surprisingly, we all know there’s this proliferation of apps with hundreds out there claiming to educate people about melanoma based on pictures they take of their own moles. Right now, this is a wild, wild west,” he said. “The Federal Trade Commission fined two companies for false advertising, but that’s in part because there haven’t been great resources for developing really good apps and perhaps, more importantly, for validating and testing whether or not those apps work. I think that will change in the near future.”
Sunscreens and photoprotection
Prevention is a key in battling skin cancers, with a greater emphasis on the use of sunscreens and non-topical agents, said Henry W. Lim, MD, chairman and C.S. Livingood Chair of the department of dermatology at Henry Ford Hospital, Detroit.
Further along in development are sunscreens, with four UVB filters, one UVA filter, and three UVB-UVA filters seeking FDA approval, Dr. Lim said.
Globally, the most widely used UVB filter is octinoxate, but it is not widely used because it destabilizes avobenzone, the only longwave UVA filter approved by the FDA.
The most common filter in the U.S. is oxybenzone, a benzophenone 3. Benzophenones were named the 2014 Allergen of the Year by the American Contact Dermatitis Society, and oxybenzone has been replaced by other UVA filters in Europe, mostly because of its negative effect on coral reefs.
Other problems with sunscreens that Dr. Lim discussed were:
- Photodamage in the dark: Dark CPD formation was linked in vitro to melanocytes, which may be carcinogenic while also being protective.
- Visible Light: Visible Light may play a role in conditions that are aggravated by sun exposure, and currently available UV filters are not sufficient to protect the skin.
- Antioxidants and sunscreens: Studies show that antioxidants used in combination with sunscreens work better than sunscreens alone in suppressing UV-induced pigmentation.
- Non-topical agents: Oral nicotinamide and niacin are the same as vitamin B3, which is being studied for prevention of UV-induced depletion of ATP.
Psoriasis has been a hot topic in dermatology for several years because of advances in the development of biologic treatments. Dermatologists need to embrace the use of biologics, said Kenneth B. Gordon, MD, professor of dermatology at Northwestern University Feinberg School of Medicine.
“Everyone who is a dermatologist should think about treating psoriasis systemically or stop calling yourself a dermatologist,” he said of biologics, but warned, “no medication works for everyone.
“My favorite biologic? I run away from that question as fast as I can,” he said. “Every patient in front of you is distinct and different.”
The most commonly used biologics for psoriasis are apremilast and seckinumab.
Apremilast was approved by the FDA in 2014 and is popular because of its safety record, even though its PASI 75 clearance rates are lower than some other treatments, Dr. Gordon said.
Secukinumab has been in use for about one year and has PASI clearance rates of about 77 percent. About one-fourth of patients achieve complete clearance, he said. In addition, it has a “clean record” with regard to side effects.
One concern is that it may irritate patients with inflammatory bowel disease or Crohn’s disease, Dr. Gordon said.