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Acné Vulgar , Fármacos Dermatológicos , Isotretinoína , Humanos , Isotretinoína/efectos adversos , Femenino , Acné Vulgar/tratamiento farmacológico , Masculino , Fármacos Dermatológicos/efectos adversos , Trastornos Mentales/epidemiología , Trastornos Mentales/inducido químicamente , Adolescente , Adulto , Adulto JovenRESUMEN
INTRODUCTION: Limited epidemiologic data has suggested direct associations between hair pigment, race, and incidence of alopecia areata (AA). Here, we examine the relationship between natural hair color, race, and the lifetime risk alopecia. METHODS: In this case-control study, we included UK Biobank patients of all races and self-reported hair color with diagnoses of AA, androgenetic alopecia (AGA), or scarring alopecia (SA). Multivariable logistic regression was used to detect differences in lifetime risk. RESULTS: Findings reveal a significantly increased risk of AA among individuals with black hair compared to dark brown hair (OR 1.71 [95% CI 1.22-2.38], p < 0.001). Those with red or blonde hair showed a decreased risk of AA (0.74 [0.56-0.97]; 0.62 [0.41-0.95], p < 0.05). No racial differences in AA prevalence were observed among individuals with black hair. CONCLUSIONS: Darker hair colors may be associated with a higher risk of AA, lighter hair colors with a lower risk, and differences in hair color could contribute to previously noted racial variations in AA incidence, potentially influencing dermatologists' perspectives on the disease's epidemiology.
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BACKGROUND: Melasma and post-inflammatory hyperpigmentation (PIH) are common cosmetic dermatologic conditions that predominantly affect patients with skin phototypes III-VI. Comparing treatment coverage for these pigmentary disorders to treatment coverage for acne vulgaris may demonstrate disparities in insurance coverage for diseases that primarily affect patients of color. OBJECTIVE: Describe differences in Medicaid coverage for topical tretinoin for melasma and PIH vs. acne vulgaris in all 50 states and the District of Columbia. METHODS: This is a cross-sectional study of Medicaid insurance plans in all 50 states and the District of Columbia conducted between February 1 and 28, 2023. Data was collected from online publicly available preferred drug lists, prior authorization criteria, and email/telephone inquiries. Information was collected regarding coverage restrictions, including age restrictions, diagnostic restrictions, preferred drug status, and prior authorization requirements. RESULTS: Complete coverage data for all three clinical indications was retrieved from 30 (58.8%) states; partial coverage data for acne vulgaris was retrieved from 16 (31.4%) states; no coverage data was retrieved from 5 (9.8%) states. Of states reporting coverage data, topical tretinoin is covered in 45 (97.8%) states for acne vulgaris and 10 (33.3%) states for melasma and post-inflammatory hyperpigmentation. There was decreased Medicaid coverage of topical tretinoin for acne vulgaris compared to melasma and PIH (P<0.05). Conclusion: There is differential Medicaid coverage for acne vulgaris compared to pigmentary disorders which disproportionately affect patients of color. Greater advocacy is required to ensure equal treatment for conditions that affect racial minority patients. J Drugs Dermatol. 2024;23(6):e151-e153. doi:10.36849/JDD.8069e  .
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Acné Vulgar , Cobertura del Seguro , Medicaid , Tretinoina , Humanos , Estados Unidos , Acné Vulgar/tratamiento farmacológico , Tretinoina/administración & dosificación , Tretinoina/economía , Medicaid/estadística & datos numéricos , Estudios Transversales , Cobertura del Seguro/estadística & datos numéricos , Hiperpigmentación/tratamiento farmacológico , Disparidades en Atención de Salud/economía , Femenino , Queratolíticos/administración & dosificación , Queratolíticos/economía , Melanosis/tratamiento farmacológico , MasculinoAsunto(s)
Melanosis , Humanos , Melanosis/epidemiología , Melanosis/etnología , Estados Unidos/epidemiología , Estudios de Casos y Controles , Incidencia , Femenino , Factores de Riesgo , Masculino , Adulto , Persona de Mediana Edad , Población Blanca/estadística & datos numéricos , Negro o Afroamericano/estadística & datos numéricos , Adulto Joven , Adolescente , Hispánicos o Latinos/estadística & datos numéricosAsunto(s)
Inhibidores de la Calcineurina , Humanos , Inhibidores de la Calcineurina/economía , Inhibidores de la Calcineurina/administración & dosificación , Inhibidores de la Calcineurina/uso terapéutico , Ahorro de Costo , Estados Unidos , Bases de Datos Factuales , Administración Tópica , Costos de los Medicamentos , Tacrolimus/economía , Tacrolimus/uso terapéutico , Tacrolimus/administración & dosificación , Prescripciones de Medicamentos/estadística & datos numéricos , Prescripciones de Medicamentos/economíaRESUMEN
Despite having significantly higher rates of atopic dermatitis, psoriasis, and pigmentary disorders compared to White patients, studies suggest that Asian Americans are underrepresented in outpatient dermatology clinics. In this study, we utilize the National Health Interview Survey (NHIS) and prioritize disaggregated analyses to evaluate differences between the most populous Asian American subgroups (Chinese, Filipino, Indian, and "Other") in utilization of outpatient dermatologic care. We utilized multivariable logistic regression to compare outpatient dermatologic care use between each Asian American subgroup and Non-Hispanic Whites. Out of 96,559 adults, our study included 5264 self-identified Asian American and 91,295 non-Hispanic White adults. Most Asian participants were female, had health insurance, and had incomes > 2 times above the federal poverty line. We found that, compared to 21.4% for NH whites, lifetime prevalence of total body skin exam was highest among Filipino Americans (12.3%) and lowest among Indian Americans (7%). Additionally, all Asian American subgroups had a significantly lower odd than NH Whites of ever having a total body skin exam, with Indian Americans having the lowest odds. While the benefit of TBSEs in Indian Americans is unclear, it is possible that differing cultural perceptions about dermatologic needs, barriers to care, or immigration status may be contributing to the observed difference. Furthermore, the Indian diaspora encapsulates a range of skin tones, risk factors, and behaviors that may differentially influence dermatologic disease risk, similar to trends identified among Hispanic patients (Trepanowski et al. in J Am Acad Dermatol 88:1206-1209, 2023). Additional research utilizing the seven national databases that have been identified as providing disaggregated Asian racial information (Kamal et al. in J Am Acad Dermatol, 2023) may be useful to further illuminate avenues for intervention.
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Asiático , Dermatología , Aceptación de la Atención de Salud , Adulto , Femenino , Humanos , Masculino , Encuestas Epidemiológicas , Pacientes Ambulatorios , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Dermatologic diseases have a well-documented association with depression and anxiety, which are in turn often comorbid with alcohol use disorder (AUD). Nonethleess, the relationship between dermatologic disease and AUD, and the relative contribution of depression and anxiety, are poorly understood. Here, we utilize the National Insittutes of Health All of Us Research Program to investigate the association between inflammatory and pigmentary dermatologic diseases with AUD. Furthermore, we investigate whether comorbid depression and anxiety mediates this relationship. We employed a matched case-control model with multivariable logistic regression. We also employed a mediation analysis. We found an increased odds of AUD among patients with atopic dermatitis, acne/rosacea, hidradenitis suppurativa, psoriasis, and pigmentary disorders (vitiligo, melasma, and post-inflammatory hyperpigmentation). This was partially mediated by anxiety and depression, especially for diseases with a significant cosmetic component. Overall, these findings highlight the profound psychological and physical health effects that inflammatory and pigmentary disease can have on patients, both independently and in combination with comorbid psychiatric disease.
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Alcoholismo , Hiperpigmentación , Melanosis , Salud Poblacional , Humanos , Estudios de Casos y Controles , Hiperpigmentación/epidemiología , Melanosis/epidemiologíaRESUMEN
BACKGROUND: Oral tetracyclines (TCNs) are commonly prescribed for acne, but they have been shown to increase the risk of hyperpigmentation, particularly in the setting of sun exposure. OBJECTIVE: We evaluated seasonal trends in TCN-associated hyperpigmentation incidence in addition to Google search trends for hyperpigmentation-related terms. METHODS: We performed a retrospective review of acne patients seen at Massachusetts General Brigham and Women’s Hospital between 1992 and 2022. We calculated the incidence of new hyperpigmentation diagnoses for each drug cohort. We also analyzed search volume of hyperpigmentation-related terms extracted from Google Trends. RESULTS: Seasonal differences in new hyperpigmentation diagnoses were identified among acne patients prescribed doxycycline (P=0.016), with peak incidence in April. In the control group of patients who had never received a TCN, diagnoses peaked in May. There were no significant seasonal differences among patients prescribed minocycline (P=0.885). There was greater search volume for hyperpigmentation-related terms in spring and summer compared to fall and winter (P<0.001). Limitations of this study include its retrospective nature and reliance on prescription and diagnosis coding data. CONCLUSIONS: Our findings support the seasonal periodicity of acne-related hyperpigmentation, underscoring the importance of photoprotection counseling for patients with acne. Additionally, doxycycline may be associated with an earlier onset of hyperpigmentation, suggesting a potential benefit of considering minocycline or other alternatives to doxycycline. J Drugs Dermatol. 2023;22(11):e9-e11 doi:10.36849/JDD.7409e.
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Acné Vulgar , Hiperpigmentación , Humanos , Femenino , Estaciones del Año , Doxiciclina/efectos adversos , Minociclina , Estudios Retrospectivos , Tetraciclina , Antibacterianos/efectos adversos , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/epidemiología , Hiperpigmentación/inducido químicamente , Hiperpigmentación/diagnóstico , Hiperpigmentación/epidemiologíaRESUMEN
The early phase of the COVID-19 pandemic prompted a repurposing of antiviral and immunomodulatory drugs as investigational therapeutics, including hydroxychloroquine and chloroquine. While antimalarials have been well-refuted as a treatment for COVID-19, data on these drugs' role in preventing SARS-CoV-2 infection as pre-exposure prophylaxis is more limited. We investigated the efficacy of antimalarial drugs as pre-exposure SARS-CoV-2 prophylaxis in a US tertiary-care center. We identified all adult patients exposed to antimalarials with active prescriptions from July 1, 2019 to February 29, 2020 and exact-matched antimalarial-treated study patients with controls on age, sex, race, and Charleston Comorbidity Index. We used multivariable logistic regression to calculate the odds ratio (OR) of COVID-19 diagnosis by antimalarial exposure, adjusting for demographics, comorbidities, local infection rates, and specific conditions identified in early studies as risk factors for COVID-19. There were 3,074 patients with antimalarial prescriptions and 58,955 matched controls. Hydroxychloroquine represented 98.8% of antimalarial prescriptions. There were 51 (1.7%) infections among antimalarial-exposed and 973 (1.6%) among controls. No protective effect for SARS-CoV-2 infection was demonstrated among antimalarial-exposed patients in the multivariate model (OR=1.06, 95% CI 0.80-1.40, P=0.70). These findings corroborate prior work demonstrating that hydroxychloroquine and related antimalarials do not have a role in protection against SARS-CoV-2.Klebanov N, Pahalyants V, Said JT, et al. Antimalarials are not effective as pre-exposure prophylaxis for COVID-19: a retrospective matched control study. J Drugs Dermatol. 2023;22(8):840-843. doi:10.36849/JDD.6593.
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Antimaláricos , COVID-19 , Profilaxis Pre-Exposición , Adulto , Humanos , Antimaláricos/uso terapéutico , COVID-19/prevención & control , Hidroxicloroquina/uso terapéutico , SARS-CoV-2 , Estudios Retrospectivos , Pandemias/prevención & control , Prueba de COVID-19 , Antivirales/uso terapéuticoRESUMEN
BACKGROUND: Emerging evidence suggests that cutaneous immune-related adverse events (cirAEs) are associated with a survival benefit in the setting of advanced melanoma treated with immune checkpoint inhibitor (ICI) therapy. Previous studies have not examined the role of melanoma subtypes on cirAE development and downstream therapeutic outcomes. OBJECTIVE: Examine the impact of melanoma subtypes on cirAE onset and survival among ICI recipients. METHODS: Retrospective multi-institutional cohort study. Multivariate time-series regressions were utilized to assess relationships between melanoma subtype, cirAE development, and survival. RESULTS: Among 747 ICI recipients, 236 (31.6%) patients developed a cirAE. Patients with acral melanoma were less likely to develop a cirAE (hazard ratio [HR] = 0.41, P = .016) compared to patients with nonacral cutaneous melanoma. Across all melanoma subtypes, cirAEs were associated with reduced mortality (HR = 0.76, P = .042). Patients with acral (HR = 2.04, P = .005), mucosal (HR = 2.30, P < .001), and uveal (HR = 4.09, P < .001) primaries exhibited the worst survival. LIMITATIONS: Retrospective cohort study. CONCLUSION: This is the first study to demonstrate differences in cirAE development among melanoma subtypes. The presence of cirAEs was associated with better survival. Further, the lower incidence of cirAEs may be a marker of immunotherapy response, which is reflected in the association between acral melanoma and mortality.
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Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/tratamiento farmacológico , Melanoma/epidemiología , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/epidemiología , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Estudios Retrospectivos , Estudios de Cohortes , Incidencia , Melanoma Cutáneo MalignoRESUMEN
Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.
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Acné Vulgar , Hiperpigmentación , Humanos , Estudios Retrospectivos , Etnicidad , Antibacterianos/efectos adversos , Acné Vulgar/tratamiento farmacológico , Tetraciclina/efectos adversos , Hiperpigmentación/inducido químicamente , Hiperpigmentación/epidemiología , Hiperpigmentación/tratamiento farmacológico , MinociclinaRESUMEN
This cross-sectional study assesses the validity of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code for melasma appended to a clinic visit to identify adult patients meeting diagnostic criteria for melasma.
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Clasificación Internacional de Enfermedades , Melanosis , Humanos , Bases de Datos Factuales , Melanosis/diagnósticoRESUMEN
BACKGROUND: Immune checkpoint inhibitors (ICIs) have improved survival and are increasingly used for non-small cell lung cancer. However, use may be limited by immune-related adverse events such as checkpoint-inhibitor pneumonitis (CIP). Literature estimates for CIP incidence are inconsistent. Real-world adherence to guidelines, clinical course, and healthcare utilization in the treatment of CIP has not been described in large cohorts. METHODS: A combined claims and electronic health record database (TriNetX) was used to identify 13,113 patients with lung cancer treated with programmed cell death receptor/ligand 1 (PD-1/PD-L1) inhibitors, and a propensity score-matched control cohort treated with chemotherapy or targeted therapies. The attributable risk of CIP was calculated in the first 12 months after therapy by comparing the incidence of diagnosis codes for pneumonitis/pneumonia between cohorts. Cases of CIP, identified by the most specific code for drug-induced respiratory conditions, were further analyzed for medication usage, rates of diagnostic bronchoscopy, ICI discontinuation rates, and usage of hospital services compared with patients receiving PD-1/PD-L1 inhibitors who did not develop CIP. RESULTS: The attributable risk of pneumonitis to PD-1/PD-L1 inhibitors was 2.49% (95% CI, 1.50% to 3.47%). Median time to onset in the CIP subcohort was 3.9 months (IQR, 2.1-7.3 months). Steroid and antibiotic use increased dramatically after a pneumonitis diagnosis, and 70.2% of patients permanently discontinued ICI therapy. Compared with controls, patients with CIP had more than a threefold increased risk of needing critical care (relative risk 3.59, 95% CI, 2.31 to 5.57) and an increased risk of mortality (HR 2.34, 95% CI, 1.47 to 3.71). CONCLUSIONS: In a large claims-based analysis, PD-1/PD-L1 inhibitors increase the risk of pneumonitis in patients with lung cancer by 2.49%. Cases of CIP are associated with high healthcare utilization, discontinuation of ICIs, and mortality.