Need-to-know updates featured in articles, news briefs, podcasts, and videos keep everyone in the dermatology community in the vanguard of the effort to put a cure for melanoma within reach.

Melanoma Awareness Month

This online, on-demand virtual symposium brings together renowned experts in dermatology to discuss newer treatments for patients with psoriasis.

Maui Derm Tyk2 Psoriasis Archived Webcast

Patients with this rare and severe skin disorder may soon have a new therapeutic option.

Perspectives on Generalized Pustular Psoriasis

 development, lifestyle behaviors may garner greater predictive value vs genetic predisposition, according to study findings published in the 

Journal of the American Academy of Dermatology

Characterized as an immune-related inflammatory skin disorder, psoriasis has been shown in prior research to be associated with certain genetic susceptibility. Genetic variants have been implicated in the pathogenesis of psoriasis, noted researchers, as well as several modifiable risk factors, including a high body mass index (BMI), smoking, physical activity, and dietary habits.

“Psoriasis can be triggered by both behavioral and genetic factors. Nonetheless, health behaviors and genetic risk factors have often been investigated separately,” they said. “Whether lifestyle is associated with the risk of psoriasis in the presence of different genetic risk levels remains unknown.”

Researchers conducted a prospective cohort study of data derived from the UK Biobank to investigate the gene-behavior interaction in association with incident psoriasis. Data from a total of 345,672 patients (mean [SD] age, 56.53 [8.06] years; 52% female) were included in the analysis.

Genetic risk was categorized into low, intermediate, and high groups, and lifestyle score comprising BMI, smoking, physical activity, and diet, were differentiated as ideal, intermediate, and poor. The study cohort included 2258 patients with incident psoriasis and 343,414 patients with no psoriasis.

“Within each genetic risk group, the risks of incident psoriasis associated with each lifestyle level were investigated and compared with the low genetic risk and ideal lifestyle group,” explained the study authors.

Overall, findings indicated that risk of incident psoriasis significantly increased in the poor vs ideal lifestyle groups (HR, 2.604; 95% CI, 2.042-3.319), and the high vs low genetic risk groups (HR, 1.342; 95% CI, 1.180-1.526).

The joint effect of genetic risk and lifestyle further showed that compared with the low genetic risk and ideal lifestyle group, the poor lifestyle and high genetic risk group was associated with a more than 4-fold increased risk of psoriasis (HR, 4.625; 95% CI, 2.920-7.348). No interaction between genetic risk and lifestyle was observed.

In response to the absence of interactions between genetic risk and lifestyle, researchers performed a population-attributable fraction (PAF) of both variables. In their findings, 32.2% (95% CI, 25.1%-38.6%) of new-onset psoriasis events during follow-up might have been prevented if all individuals would have adhered to ideal lifestyle, according to the PAF, whereas only 13.0% (95% CI, 3.2%-21.8%) of new-onset events would be reduced if all individuals were low genetic risk.

“To our knowledge, this study was the first to report the associations of combined health lifestyle and genetic risk for psoriasis,” concluded the study authors. “The results suggest the importance of a joint assessment of the risk of psoriasis for individuals—the establishment of an integrated ideal lifestyle for the prevention of psoriasis should be advocated.”

Shen M, Xiao Y, Jing D, et al. Associations of combined lifestyle and genetic risks with incident psoriasis: a prospective cohort study among UK Biobank participants of European ancestry. 

. 2022 Apr 12;S0190-9622(22)00604-1. doi:10.1016/j.jaad.2022.04.006

Articles

Lifestyle behaviors, such as body mass index and smoking, were shown to have  a stronger association with psoriasis, regardless of genetic risk. 

Study: Lifestyle Behaviors Linked With Psoriasis Development 

Patients with palmoplantar pustulosis (PPP) exhibited an overlapping comorbidity profile with patients with 

 vulgaris, but not with those who have pompholyx. Findings were reported recently in 

Although the origin of PPP remains unclear, the researchers note that recent studies on its immunological and genetic pathogenesis suggest systemic involvement of the disease. PPP, which is characterized as a chronic relapsing pustular dermatosis affecting the palms and/or soles, has also been previously considered a variant of psoriasis, but several studies have found differences between the 2 conditions.

“Similar to psoriasis, PPP is occasionally accompanied by systemic conditions, including psoriatic arthritis (PsA) and autoimmune diseases,” said the study authors. “However, to our knowledge, the association of comorbidities with PPP has not been evaluated, and adjustment for possible confounders has not been performed.”

They conducted a nationwide population-based cross-sectional analysis to assess the risks of comorbidities among patients with PPP using data from the Korean National Health Insurance (NHI) database and the National Health Screening Program collected from January 1, 2010, to December 31, 2019.

The comorbidity profiles of Korean patients with PPP were then compared with patients with the 2 major differential diagnoses of PPP: psoriasis vulgaris and pompholyx. Participants were evaluated for 4 categories of comorbidities: inflammatory arthritis, cardiometabolic diseases, autoimmune diseases, and dermatological diseases.

A total of 37,399 patients with PPP (mean [SD] age, 48.98 [17.20] years; 51.7% female); 332,279 patients with psoriasis vulgaris (mean [SD] age, 47.29 [18.34] years; 58.7% male); and 365,415 patients with pompholyx (mean [SD] age, 40.92 [17.63] years; 57.4% female) were included in the analyses.

After adjusting for demographic covariates, patients with PPP were found to report significantly greater and lower risks of several comorbidities compared with those with psoriasis vulgaris:

Risks of ankylosing spondylitis (adjusted odds ratio [aOR], 1.37; 95% CI, 1.16-1.62; 

 < .001) and Graves disease (aOR, 1.40; 95% CI, 1.23-1.58; 

 < .001) were significantly higher among patients with PPP vs psoriasis vulgaris

Risks of PsA (aOR, 0.54; 95% CI, 0.47-0.63; 

 < .001), systemic lupus erythematosus (aOR, 0.67; 95% CI, 0.46-0.97; 

 = .04), Sjögren syndrome (aOR, 0.70; 95% CI, 0.50-0.96; 

 = .03), systemic sclerosis (aOR, 0.29; 95% CI, 0.11-0.77; 

 = .01), vitiligo (aOR, 0.53; 95% CI, 0.47-0.60; 

 < .001), and alopecia areata (aOR, 0.88; 95% CI, 0.81-0.95; 

 = .001) were significantly lower among those with PPP vs psoriasis vulgaris

Patients with PPP conversely showed significantly higher risks of the assessed comorbidities vs those with pompholyx after adjusting for demographic covariates: psoriasis vulgaris (aOR, 72.96; 95% CI, 68.19-78.05; 

 < .001), psoriatic arthritis (aOR, 8.06; 95% CI, 6.55-9.92; 

 < .001), ankylosing spondylitis (aOR, 1.91; 95% CI, 1.61-2.27; 

 < .001), type 1 diabetes (aOR, 1.33; 95% CI, 1.16-1.52; 

 < .001), type 2 diabetes (aOR, 1.33; 95% CI, 1.29-1.38; 

 < .001), Graves disease (aOR, 1.25; 95% CI, 1.11-1.42; 

 < .001), Crohn disease (aOR, 1.63; 95% CI, 1.11-2.40; 

 = .01), and vitiligo (aOR, 1.87; 95% CI, 1.65-2.12; 

Subgroup analyses also revealed differences in comorbidities according to sex and age. The researchers concluded that further studies are warranted to explore the pathogenetic mechanisms of these comorbidities and elucidate their associations with PPP.

Kim DH, Lee JY, Cho SI, Jo SJ. Risks of comorbidities in patients with palmoplantar pustulosis vs patients with psoriasis vulgaris or pompholyx in Korea. 

. Published online April 27, 2022. doi:10.1001/jamadermatol.2022.1081

This was origianlly posted by our sister publication AJMC. 

The risks of certain comorbid conditions varied between the 2 groups of patients.

Study: Overlapping Comorbidity Risks Found in Psoriasis and Palmoplantar Pustulosis

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, posted his lasted podcast episode. View the episode below:

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

Videos

In this week’s Pointers with Dr Portela, the 208SkinDoc hosts a podcast called, “Between Two Derms.” This week he covers cases in the clinic, psoriasis at the Met Gala and more. 

Pointers with Dr Portela: Between Two Derms Podcast

Ilya Petrou, MD, is a contributing writer for 

New study findings show that patients with chronic inflammatory skin diseases including psoriasis, atopic dermatitis (AD), alopecia areata (AA), vitiligo, an,hidradenitis suppurativa (HS) do not have an increased risk of venous thromboembolism (VTE) compared to healthy individuals without these dermatologic diseases. This data is important for dermatologists who are assessing treating patients with systemic immunomodulatory agents  known to modulate VTE such as corticosteroids as well as the newly FDA-approved Janus kinase (JAK) inhibitors.

Clincians should be aware that VTE is a common and potentially serious risk  in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), both of which have increased inherent risk for developing VTE in these patient populations. 

However, data on the risk of VTE in patients with chronic inflammatory skin diseases are mixed. Establishing a robust estimate of the background VTE risk in this patient population is critical to the treatment and management plans with new system immunomodulatory medications such as the JAK inhibitors. 

“For a long time, it has been thought that patients with RA and IBD have a higher inflammatory burden than patients with chronic inflammatory skin diseases. As such, patients with dermatologic conditions may not have the same baseline increased risk and therefore may not have the same increased risk for TVE compared to these patients who have this higher inflammatory burden from their IBD and RA disease,” said Maria Schneeweiss, MD. 

She is an instructor in medicine, Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and lead author of the study.

Schneeweiss and fellow colleagues recently conducted a study to assess the risk of VTE in patients with and without chronic inflammatory skin disease, evaluating patients from a US healthcare database (Optum’s deidentified Clinformatics Data Mart Database) from 2004-2019.

A total of 158,123 patients with dermatologist-recorded psoriasis (n=96,138), AA (n=17,889), AD (n=30,418), vitiligo (n=7,735), or HS (n=5,934), and 9 patients having two of these conditions, were identified and compared to a healthy control cohort of 1,570,387 patients without a chronic inflammatory skin disease. The incidence rate (per 1000 person-years) of outpatient or inpatient VTE for AD, HS, psoriasis, AA, and vitiligo was 1.83, 1.65, 1.57, 0.94, and 0.93, respectively. 

Results showed the incidence rate to be 1.53 in chronic inflammatory skin disease overall, compared to 1.76 in patients without a chronic inflammatory skin disease.

Knowing the background risk and rate of VTE in the specific dermatologic conditions being looked at can indicate early if a VTE signal is seen among patients who are using these new systemic immunomodulatory drugs like the JAK inhibitors. According to Schneeweiss, this allows clinicians to contextualize and discern whether it is due to the medication or the inherent increased risk attributable to the skin disease.

“In RA, we know that studies have been done showing that RA patients have a baseline increased risk of VTE. We did not find that in the dermatologic conditions studied. That will help us to contextualize if we see a signal with the JAK inhibitors, which may prove important to optimal treatment planning,” Schneeweiss said. 

That's especially noteworthy as an increasing number of new systemic immunomodulatory agents for the treatment of dermatologic conditions, including JAK inhibitors for AD, AA, and vitiligo, will likely be marketed in the near future. 

Many patients may also have overlapping dermatologic conditions or also have some other chronic inflammatory diseases, such as IBD and psoriasis.

Although the study revealed no risk inherent to the chronic inflammatory skin diseases, VTE remains a very important potential adverse event to be monitored going forward. There are many different factors to be considered when contemplating ideal therapy and, according to Schneeweiss, the treatment regimen must be specific to the individual patient's case.

“When looking at potential systemic immunomodulatory therapies, including the JAK inhibitors, going forward, I think the treatment and management will be very specific to the patient," said Schneeweiss. "It will be a discussion between the patient and the provider, putting into context other risks that we know may raise the risk of VTE. However, when factoring the chronic inflammatory skin conditions into that equation, the risk for VTE does not appear to be high."

Schneeweiss reported no relevant conflicts of interest.

1. Schneeweiss MC, Kim SC, Wyss R, Jin Y, et al. Incidence of venous thromboembolism in patients with dermatologist-diagnosed chronic inflammatory skin diseases. 

.2021 Jul 1;157(7):805-816. doi: 10.1001/jamadermatol.2021.1570.

Patients with chronic inflammatory skin diseases do not have an increased risk of venous thromboembolism (VTE) compared to a matched healthy control cohort. This knowledge can be useful to clinicians when contemplating systemic immunomodulatory therapies in their dermatologic patients. 

Refocusing on Venous Thromboembolism and Chronic Inflammatory Skin Diseases 

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

Podcasts

In this episode, the topics up for discussion include possible technologies to help atopic dermatitis patient adherence with treatment along with new strategies to improve patient experiences at the practice. 

The Cutaneous Connection: Adherence to Atopic Dermatitis Treatment

POLL: What Type of Content Would You Like to See More Of?

Improvement Needed in Immediate Access to VA Skin Cancer Care in Midwest, East Coast

In a presentation at the current American College of Mohs Surgery meeting, Jennifer G. Powers, MD, highlights the needed improvement for immediate access to skin cancer care for VA patients, noting a 33 day average wait time compared to the VAs optimal goal of 28 days.

Seconds Matter: A Pearl for Improving Communication During Surgery

Presenters highlight the possible solutions to communication between the scrubbed-in surgery team and outside help that could save time.

Examining These Patient Variables May Help Predict Aggressive Basal Cell Carcinomas

A study presented at the current ACMS meeting highlights variables that could predict BCC, including: gender, immune status, and more.

Carefully Consider Post-Op Bleeding Risk when Treating Patients with Chronic Lymphocytic Leukemia

At the current ACMS meeting, Kelsey E. Hirotsu, MD, discussed the bleeding complications seen in patients on ibrutinib for CLL.

Immunotherapy, intralesional treatments, multidisciplinary care teams define rapidly-evolving multimodal approach.

Hope for the Future: Innovative Physicians Changing the Way Health Care Delivered

Marty Makary, MD, MPH, predicts systemwide change in the world of health care.

Periosteal Flap Safety, Effectiveness, and Aesthetic Quality in Posterior Lamella Reconstruction

Single-stage periosteal flap technique to treat full-thickness eyelid defects is safe, effective, and aesthetically acceptable, according to a study presented at the 2022 American College of Mohs Surgery Annual Meeting on May 12, 2022.

Topical Tranexamic Acid Shows Efficacy for Postoperative Bleeding Reduction

Topical tranexamic acid is an effective wound care adjunct in reducing rates of postoperative bleeding of granulating defects in Mohs micrographic surgical settings.

Chart the Changes in NMSC Prevalence and Procedural Treatments

Overall, non-melanoma skin cancer (NMSC) visits (all pooled specialties/areas) have been plateauing. However , metropolitan but not rural areas saw an increase in visits where NMSC was the chief complaint. However, the percentage of NMSC in rural areas that is managed by dermatologists and dermatologic surgeons is also on the rise, according to a presentation given at the 2022 American College of Mohs Surgery Annual Meeting.

How to Ensure Outdoor Workers Use Sun Protection

Sunscreen use is on the rise, but further education is needed.

Staging Accuracy for Squamous Cell Carcinoma

At the ACMS meeting, Chrysalyne D. Schmults, MD, MScE, highlighted molecular diagnostics for squamous cell carcinoma.

Bimekizumab Fails FDA Pre-Approval Inspection

UCB announced the FDA issued a CRL that stated that the FDA cannot approve the BLA in its current form.

Multiple Myeloma May Increase Incidence of Melanoma

A poster presented at the 2022 American College of Mohs Surgery Annual Meeting not only suggested a link between multiple myeloma and a heightened rate of melanoma, but also demonstrated potential for higher overall mortality rates.

Data from one study showed younger women more likely to use sunscreen than older adults.

Access to Mohs Surgeon a Barrier to Referral

A survey asked dermatologists whether they had personal treated head and neck melanoma with excision, and if and when they referred patients with melanoma on the head and neck to a Mohs surgeon.

Majority of patients OK with artificial intelligence helping with diagnosis or treatment options

Many patients worry about privacy and accuracy.

Many older adults can’t afford prescription drug insurance

Lower household income and requiring multiple medications play large roles.

In this episode, the topics up for discussion include possible technologies to help atopic dermatitis patient adherence with treatment along with new strategies to improve patient experiences at the practice.

Refocusing on Venous Thromboembolism and Chronic Inflammatory Skin Diseases

Patients with chronic inflammatory skin diseases do not have an increased risk of venous thromboembolism (VTE) compared to a matched healthy control cohort. This knowledge can be useful to clinicians when contemplating systemic immunomodulatory therapies in their dermatologic patients.

In this week’s Pointers with Dr Portela, the 208SkinDoc hosts a podcast called, “Between Two Derms.” This week he covers cases in the clinic, psoriasis at the Met Gala and more.

Study: Lifestyle Behaviors Linked With Psoriasis Development

Lifestyle behaviors, such as body mass index and smoking, were shown to have a stronger association with psoriasis, regardless of genetic risk.

Protection from the harsh rays of the sun is crucial for everyone—including children. Now that summer has arrived, a refresher course for your patients and their families on sun protection, which can go a long way in preventing skin damage and disorders due to the sun.

Skin Cancer Foundation Raises $625,000 For Skin Cancer Education Programs

The Skin Cancer Foundation at its Annual Champions for Change Gala in New York, New York, raised the money while also honoring 157 dermatologists for volunteering with the Foundations skin cancer screening program on May 12.

In 2023 as many as 11 biosimilars to Humira are headed for the US market.

Avoiding Abbreviations Boosts Patient Understanding of Health Records

Study shows a marked improvement when medical abbreviations and acronyms are spelled out instead.

ICYMI, this week we had stories from the 2022 American College of Mohs Surgery Annual Meeting, bimekizumab's FDA set back, and more.


The Weekly Roundup: May 16-20

A study of patient comprehension showed that when medical abbreviations and acronyms were avoided, patients were significantly more likely to understand the information being provided to them by physicians.

When 10 common medical abbreviations were expanded, researchers found a significant increase in overall comprehension from 62% to 95%. The findings suggest that expanding medical abbreviations and acronyms can improve patient understanding of their health information and may benefit ongoing national efforts to provide patients with electronic access to their own documentation.

Even though study participants had substantial prior exposure to the health care system, comprehension of common abbreviations such as MI or HTN remained below 40%, which is lower than clinicians estimated.

Researchers recommend that clinicians be mindful of assuming patients understand abbreviations. However, not all abbreviations are equal. Those that are well understood, such as hrs or MD, as well as those whose meanings are still poorly understood even when expanded, such as myocardial infarction, did not benefit from expanstion.

The number of patients accessing their medical 

 is expected to increase, but researchers note that medical abbreviations and acronyms often limit patient understanding of health 

. One possible solution is an automated expansion of abbreviations through software, but it is unclear whether the benefit is large enough to justify the cost of implementation.

This was originally posted by Medical Economics. 

 Avoiding Abbreviations Boosts Patient Understanding of Health Records

In recent years, rheumatologists have become more accepting of biosimilars, and their willingness to use these agents will be critical to the success of biosimilar versions of Humira (adalimumab) coming to the U.S. market in 2023. Clinical data supporting safety and efficacy of these biosimilars will be paramount in prescribing decisions, and Humira biosimilars that also have interchangeability designations will have an advantage in that respect, says Marcus Snow, M.D., chair of the American College of Rheumatology’s Committee on Rheumatologic Care and an assistant professor in the Division of Rheumatology at the University of Nebraska College of Medicine.

Humira is widely used in rheumatology to manage inflammatory and autoimmune conditions such as psoriatic arthritis, Crohn disease, polyarticular juvenile idiopathic arthritis and ankylosing spondylitis.

“The switching of a (patient with well-controlled disease) to a different product is concerning,” Snow says. “The FDA designation of interchangeability provides a lot of comfort for rheumatologists because they can look at the data supporting switching between biosimilars and bio-originators and see that there has not been any drop in efficacy or increase in antibody production. Interchangeability data are going to be very, very helpful, and I think this designation will increase the use of (Humira) biosimilars as they become available,” Snow says.

Interchangeable status is awarded to biosimilars that have not shown any difference in patient outcomes in clinical studies of multiple switches between the biosimilar and its reference product. A biosimilar with interchangeable status can be dispensed in place of an originator brand without the need for physician approval, although states have placed some restrictions on this practice. For example, physicians in many states can insist that the originator brand be used for a particular patient rather than a biosimilar.

Just a few developers of Humira biosimilars have applied for interchangeable status, but even without it, all biosimilars are as safe and efficacious as their reference products, according to the FDA. Snow says it’s difficult to bring a rheumatic disorder under control, so it’s important to have that extra level of trust that a biosimilar won’t lead to a setback. “I think that’s the biggest concern rheumatologists have,” Snow says.

Until the need for individual COVID-19 vaccines increased drugmakers’ revenues by tens of billions of dollars, Humira for years was the world’s top-selling drug, generating $20.69 billion in global revenues for AbbVie in 2021 alone.

So far, the FDA has approved seven biosimilars of Humira, and next year as many as 11 of these agents could be available, based on pending applications.

Not all biosimilars of Humira are alike, so physicians and payers will have plenty to think about when choosing between these products for clinical practice or placement on a formulary tier.

These biosimilars vary by concentration, citrate content, needle size, and potential for allergic reactions to latex. Citrate is a buffer that can cause pain upon injection, so citrate-free Humira is preferred by some patients. Similarly, smaller needles can be less painful. Latex is present in some needle coverings and can contaminate needles, affecting patients with allergies. Boehringer Ingelheim has obtained interchangeable status for
Cyltezo, its biosimilar of Humira, and Alvotech is seeking interchangeable status for its own Humira biosimilar, Simlandi, although Simlandi will be a much higher concentration formulation than Cyltezo (100 milligrams vs. 50 milligrams respectively).

Other biosimilar makers, such as Samsung Bioepis, which is based in South Korea, and Organon of Jersey City, New Jersey, have decided that the interchangeable designation is not essential for marketing success. They also avoid jumping through additional FDA hoops. Samsung Bioepis and Organon will market Hadlima and are seeking approval for a 100-milligram formulation, which is considered to have an advantage because it is high concentration and low volume, making it more convenient to administer.

The FDA first approved Humira as a treatment for rheumatoid arthritis in 2002. By contending that Humira’s patent protections extend beyond 2023, AbbVie has been able to compel all biosimilar makers so far to settle on licensing terms, rather than come to market as free agents. The most recent to settle was Alvotech, an Icelandic company that faced patent infringement and trade secret allegations over Humira. Alvotech decided to pay royalties to AbbVie rather than wage a legal battle that might have caused it to miss out on next year’s coming-out party for Humira biosimilars. As of now, Alvotech’s Humira biosimilar, AVT02, is set to enter the fray in July 2023.

However, Amgen may be in the best position among the companies jockeying for biosimilar market share. Its Humira biosimilar, Amjevita, is scheduled to hit the market in January 2023, giving it a six-month head start on the others.

The wave of Humira biosimilars in 2023 could lead to savings for patients and payers and the knock-on effect of improved access due to lower costs. The success of these biosimilar competitors capturing market share from Humira will hinge on pricing, according to Wayne Winegarden, Ph.D., a senior fellow in business and economics and director of the Center for Medical Economics and Innovation at Pacific Research Institute who has written extensively about biosimilar markets. Past experience with biosimilars in other therapeutic categories has shown that it takes a large price difference for biosimilars to wrest market share from the originator, he says. “You want to see the biosimilars coming in at 40% to 50% discounts; if they come in at 10% or something very close to the originator’s price, that would certainly temper people’s excitement or interest in switching. You need to grab people’s attention with a discount,” Winegarden says.

Another important factor is formulary placement by payers. Payers are favorably disposed toward biosimilars, but how much so depends on how much more inexpensive the biosimilars are, Winegarden explains. At the same time, the list price isn’t the same as the net price, and manufacturer rebates and other factors influence formularies and which tiers products are placed on. It is possible that AbbVie will counter biosimilar competition by offering rebates for use of Humira or force payers into bundling deals that penalize them with reduced access to other drugs if they prefer biosimilars over Humira.

“This is where we need policy changes, particularly making sure consumers benefit from rebates,” Winegarden says. There has been much criticism of rebates that allow savings for payers while patients continue to pay the same amount out of pocket, or even more if manufacturers raise their list prices.

Biosimilar competition outside the United States has steadily chipped away at Humira’s revenues. But in the U.S., AbbVie has had the adalimumab market to itself. The company has seen revenues from Humira grow continually, largely by increasing the price. From 2019 to 2020, AbbVie increased the price of Humira by 9.6%, and in early 2021 the company increased it another 7.4%. By the beginning of 2021, the average sales price for a full year’s supply was as much as $84,000.

Anticipating steep revenue declines next year when biosimilar versions of Humira appear on market, AbbVie is attempting to switch patients with inflammatory disorders to two relatively new products, Skyrizi (risankizumab) and Rinvoq (upadacitinib). Skyrizi has been approved as a treatment for plaque psoriasis and psoriatic arthritis, and Rinvoq, for rheumatoid and psoriatic arthritis, ulcerative colitis and atopic dermatitis. These efforts have worked from a sales perspective. Global revenues for Skyrizi have grown from

$355 million in 2019 to $2.9 billion in 2021. Rinvoq had an enormous jump from $47 million in revenues in 2019 to $1.7 billion in 2021.

In an earnings conference call in February, AbbVie CEO Richard Gonzalez explained that the snowballing revenue growth is expected to reach $4.4 billion and $2.7 billion for Skyrizi and Rinvoq in 2022, respectively, and eventually top $15 billion in combined revenue for the two drugs by 2025. AbbVie wants to get Skyrizi and Rinvoq approved for all the indications that currently apply to Humira. But AbbVie is still bracing for “significant erosion” of approximately 45% in Humira revenues from 2022 to 2023, with more declines in 2024 as biosimilars gain traction, according to Gonzalez.

Skyrizi and Rinvoq may be increasing in market share, but they are brand-name drugs that will command high prices by virtue of their newness. Physicians who have determined that their patients will benefit from Humira may bypass Skyrizi and Rinvoq and prescribe Humira or a biosimilar, Winegarden says.

Snow agrees. Humira is an important drug in the rheumatologist’s armamentarium, and although Skyrizi and Rinvoq have their own merits, rheumatologists will continue to use Humira and its biosimilars for managing rheumatic disorders, the Nebraska rheumatologist explains. “In some cases they’re not going to be direct competitors, but in some cases, they will be. They’re different enough that it’s not like they’re a direct replacement.”

This article originally appeared on Managed Healthcare Executive.

Biosimilars for Humira Are on Their Way

The Skin Cancer Foundation raised $625,000 for the organization’s educational campaigns, community programs and research initiatives at its annual Champions for Change Gala at The Plaza in New York City. There were 300 attendees which included Skin Cancer Foundation donors, industry, physicians, celebrity supporters, such as Taye Diggs, and media.

Photos from the Champions for Change Gala hosted by the Skin Cancer Foundation

Wali Collins emceed the event after the cocktail reception in the Grand Ballroom for dinner. The president of the Skin Cancer Foundation, Deborah S. Sarnoff, MD, FAAD, FACP, who is also a board-certified dermatologist and Director of Dermatology at COSMETIQUE Dermatology, Laser & Plastic Surgery, LLP, in New York, New York, was center stage to talk about the organization’s work and the continued effort of members, staff and supporters throughout the pandemic.

“The Skin Cancer Foundation has certainly been through a lot in our 43 years, but nothing compares to the past two years,” Sarnoff said at the event. “The pandemic tested our organization in so many ways, and I could not be prouder of how we came through it. We figured out how to safely get our mobile skin cancer screening program back on the road. We developed new digital awareness campaigns and education materials. We answered questions from terrified skin cancer patients and guided them to appropriate resources. And we accomplished all of this while most of our staff was working from home. Our goal was to continue to serve the people who needed us and come out on the other side in a position of strength. And that’s exactly what we did. Tonight is about celebrating our strength as a community and your generosity.”

Ariel Ostad, MD, a cosmetic dermatologist at private practice in New York, New York, and one of the event’s physician co-chairs with Jesse M. Lewin, MD, dermatologists and system chief of the division of dermatologic and cosmetic surgery and the program director for the Micrographic surgery and dermatologic oncology fellowship program at Mount Sinai also in New York, presented the Champion for Change Award in recognition of this generosity, honoring the dermatologists who have volunteered their time to the Foundation’s 

“Last year, for the first time, I volunteered for a Destination Healthy Skin event here in New York,” said Ostad, who identified two suspected melanomas during his shift. “I’m so happy I got involved in this program, and I really respect the people who do it year after year.”

The award took the form of a plaque listing the names of all 157 volunteers, which will hang in the Destination Healthy Skin RV for all to see as the RV heads out for a four-month tour around the country, according to the press release. Volunteers present at the Gala were asked to stand and be recognized for collectively donating about 1,000 hours of their time to perform nearly 5,000 screenings over 4 years of Destination Healthy Skin events. 

Click here for a complete list of honorees.

Other highlights of the evening included performances by Season 19 winner of NBC’s 

, Carter Rubin. He performed his new single, “Horoscope,” and teamed up with his grandfather Ric Mango (Jay & The Americans) for a surprise duet of “I’ll be there,” originally by the Jackson 5. Auctioneer Harry Santa-Olalla lead a Fund the Mission pledge drive and created a friendly competition, offering a bottle of champagne to the first table to donate. 

The Gala was chaired by Susan Manber, Ophelia and Bill Rudin, and Stephanie and Adam Schweitzer. Ariel Ostad, MD, and Jesse M. Lewin, MD, served as Physician Co-chairs, while the Honorary Chair was Marcia Robbins-Wilf, EdD. The Gala Committee included Jeremy Brauer, MD; Kim Campbell; Jennifer and Joseph A. Dussich; Elizabeth K. Hale, MD; Jacqueline Flam; April Franzino; Adele Haimovic, MD; Julie K. Karen, MD; Celine Mactaggart; Kim Nichols, MD; Maral Skelsey, MD; Mary L. Stevenson, MD; Shelley N. Tanner and Brian Underwood.

Event sponsors included DermTech, L'Oréal Dermatological Beauty, and Regeneron and Sanofi.

The Skin Cancer Foundation raises $625,000 for skin cancer education programs at Annual Champions for Change Gala in New York City. The Skin Cancer Foundation. May 12, 2022. Accessed May 20, 2022. https://www.skincancer.org/press/the-skin-cancer-foundation-raises-625000-for-skin-cancer-education-programs-at-annual-champions-for-change-gala-in-new-york-city/

The Skin Cancer Foundation at its Annual Champions for Change Gala in New York, New York, raised the money while also honoring 157 dermatologists for volunteering with the Foundations skin cancer screening program on May 12. 

As pediatric health care providers, we are fully aware of the havoc that the sun can wreak, especially on unproteced skin. Protective measures such as sunscreen use help reduce the effects of the sun’s UV rays, especially on the delicate skin of children. Specific effects of UV radiation (UVR) include erythema, edema, darkening pigment, suppression of the immune system, and premature aging of the skin. UVR can damage DNA and interfere with normal cell function, leading to skin cancers.


The sun’s UV light is divided into UV-A, UV-B and UV-C. UV-A (320-400 nm) is not absorbed by the ozone layer. UV-A is believed to penetrate deeper into the skin, damage connective tissue, and lead to skin cancers, among other kinds of skin damage. UV-B (290-320 nm) is mostly absorbed by the ozone layer, but some does get through. It does not penetrate the skin as deeply, but the risk of triggering skin cancer is well established. UV-B is also responsible for burns. UV-C (100-290 nm) is absorbed by the ozone layer not thought to pose a skin cancer risk. Multiple factors affect how much UVR gets to the earth surface; unfortunately, ozone-depleting chemicals used in industry and consumer products have thinned the ozone layer.

Although UV-B can help the body synthesize vitamin D, most pediatric health care providers recommend using sun protection and taking a supplement of 400 IU of vitamin D3, if it is not consumed in the diet. The effects of UVR on the eyes have been associated with a number of disorders—some affect only adults, others also affect children—including macular degeneration, pterygium (a noncancerous growth that starts on the conjunctiva and can extend to the sclera and cornea), photokeratitis (temporary sunburn-like change that affects the cornea), keratopathy (disease that affects the cornea), and cortical cataracts.

The sun is the most intense on your skin between 10 am and 2 pm. However, for a patient’s eyes, the time of maximum UV exposure is from 8 to 10 am and from 2 to 4 pm, when the sun is parallel to the eyes. UV-B is absorbed mainly by the cornea, whereas UV-A is absorbed by the cornea, aqueous, and lens.

According to the American Academy of Ophthalmology, sunglasses should block 99% to 100% of both types of rays. A “UV 400 rating signifies the highest level of protection, blocking wavelengths up to 400 nm. Polarized sunglasses block glare but do not provide adequate UV protection. Ideally, sunglasses offer both UV 400 and polarization. Wearing sunglasses with side panels, which address oblique rays, is also recommended.

 Eye damage is from UVR is cumulative, not showing up until you are in your forties. Children are more at risk because they have larger pupils and more transparent ocular media.

Clinical study findings show that people get most of their sun exposure before 18 years of age. As with the eyes, sun damage to skin builds up, and consequences may not be seen for decades. Getting blistering sunburns and working outside in the sun for at least 3 years before age 18 years increases the chances of developing skin cancer later.

The type of exposure to UVR also affects risk of skin cancer. Chronic exposure refers to frequent, extended outdoor exposure; outdoor workers, swimming instructors, and camp counselors, for example, are more likely to develop squamous cell carcinoma. Those who get intermittent recreational exposure—from, say, spending extended time on the beach a few times a year—may be predisposed to basal cell carcinoma and melanoma. Burns may not be seen for 4 hours, worsen for 24 to 36 hours, and usually resolve in 3 to 5 days.

Other contributing factors to UV exposure include time of day, time of year, latitude, altitude, and weather conditions, as well as reflective surfaces such as snow, cement, water, and sand. A common misconception is that cloud cover protects against solar rays, but clouds scatter just 20% of UV light—80% gets through.


The US Food and Drug Administration (FDA) describes sunscreen’s active ingredients as chemicals that absorb, reflect, or scatter radiation in wavelengths ranging from 290 to 400 nm. Sunscreens are further divided into the organic type, which absorb UVR, and the physical type (including zinc oxide and titanium dioxide), which reflect or scatter UVR.

Sun protective factor (SPF) is a measure of how much UVR is required to produce a sunburn on protected skin relative to the amount required to produce a sunburn on unprotected skin. The higher the SPF, the greater the protection.


The FDA also categorizes OTC sunscreens based on their active ingredients. Those deemed generally recognized as safe and effective (GRASE) are products that contain zinc oxide and titanium dioxide. The second category contains non-GRASE ingredients such as p-aminobenzoic acid (PABA) and trolamine salicylate, which have been pulled off the market because of safety concerns. PABA can trigger contact allergy and photosensitivity.

 Trolamine salicylate safety and efficacy have not been established for children, and when used in sunscreen, this compound can trigger salicylate toxicity and serious bleeding.

Other non-GRASE active ingredients include avobenzone, cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, oxybenzone, padimate O, and sulisobenzone. For ingredients of this group to move to the GRASE category, additional safety and effectiveness data are needed.

Also non-GRASE: combinations of sunscreens with insect repellents are non-GRASE. Sunscreen should be applied liberally every 2 to 3 hours, where insect repellant is generally applied much less frequently—maybe 1 to 3 times daily, depending on the repellent’s strength the child’s age. Therefore, the sunscreen/repellent combination is not recommended.

GRASE formulations for sunscreen include oils, lotions, creams, gels, butters, pastes, ointments, and sticks are GRASE. Because of particle size and concern about unintended inhalation risk and flammability concerns, sprays and powders are GRASE subject to proposed testing. Wipes, towelettes, body washes, and shampoos are excluded from the GRASE category because there are no data to show they are safe.


The FDA has proposed that sunscreens under SPF 15 be taken off the market and that the maximum SPF be 60 to 80. The agency further recommends that all sunscreens SPF 15 and above meet broad-spectrum requirements, especially against UVA. Labels must prominently show consumers the SPF value and include an alphabetical list of ingredients. Labels for broad-spectrum SPF 30 and above sunscreens can state that if used properly and with other sun protective measures, the sunscreen reduces risks of skin cancer and early skin aging caused by the sun. Water-resistant sunscreens (there is no waterproof sunscreen available) may be labeled as offering protection for 40 or 80 minutes.

Sunscreen should be applied 15 minutes before going outdoors and reapplied every 2 hours, as well as after drying off once out of the water.

 An ounce (30 g) of sunscreen should cover exposed areas of an average adult or child. Sunscreen should not be used on damaged or broken skin or near the eyes; rinse eyes with water to remove any product. Individuals should stop using a product if a rash occurs and, if it persists, consult with a doctor.


Benzene, a known carcinogen, is not an active ingredient of sunscreens, but small quantities have been detected in them. It is more likely a contaminant or by-product of another raw material that is used in manufacturing sunscreen. In 2021, Valisure, an independent testing lab, petitioned the FDA to recall more than 50 sunscreen products that had more than 3 times the FDA-recommended level of 0.1 ppm.

A colorless chemical, benzene evaporates when exposed to air. It is found naturally in crude oil, gasoline, and cigarette smoke. After multiple exposures and high levels, it can cause cancer, according to the American Cancer Society. Benzene can damage white blood cells and nerve cells and affect the size of ovaries, causing irregular menstrual cycles. Benzene in aerosol sunscreens is most concerning because more is known about inhalation of the chemical; there is less research regarding absorption through the skin. However, because sunscreen is so commonly recommended and used, the FDA worries about chronic exposure.


In May 2018, based on information on seawater analyses in Hanauma Bay, Hawaii banned the sale and use of sunscreens with oxybenzone and octinoxate to protect the marine ecosystems. The sunscreen washes off humans, gets into the water, and affects marine life, especially the coral reef, sea turtles, and monk seals, a problem that grows with increased numbers of swimmers. In addition, in humans, oxybenzyone is easily absorbed from into the bloodstream and may affect hormone production.

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Avoiding Abbreviations Boosts Patient Understanding of Health Records

Biosimilars for Humira Are on Their Way

Skin Cancer Foundation Raises $625,000 For Skin Cancer Education Programs

Sunscreen Protection for Children

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