Dermatology Times October 2024 Print Recap

The October issue of Dermatology Times includes a collection of thought-provoking articles and topics ranging from intralesional 5-fluorouracil injection for older patients with squamous cell carcinomas to comparing medical and cosmetic hyperpigmentation. Be sure to read the highlights from the issue below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the free print issue and supplement each month.

Neoadjuvant Intralesional 5-Fluorouracil Injection: Improved SCC Treatment in Older Patients

One of the most common types of cancer, squamous cell carcinoma (SCC), accounts for approximately 20% of all nonmelanoma skin cancers. There is a potential for metastasis if it is left untreated. Although Mohs surgery and surgical excision are the gold standard treatments for SCC, there are other modalities of treatment for when surgery is not the best option. The patient may have significant health comorbidities or an extensive history of skin cancer surgeries that makes them less likely to want to undergo surgery. If a tumor is large, the surgery may cause significant morbidity, including tedious reconstruction. Considering this, we can offer other options of therapy as dermatologists and cutaneous oncologists. Nonsurgical options can be alternative treatments or neoadjuvant to surgery to help decrease the tumor burden before surgery. One of these alternative therapies gaining popularity is intralesional 5-FU chemotherapy. Intralesional 5-FU is a localized, effective therapeutic for patients who elect to delay therapy or are not ideal candidates for surgery or radiation.

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New Treatment Targets for Atopic Dermatitis

A recent paper published in the Journal of the European Academy of Dermatology and Venereology presents the Aiming High in Eczema/Atopic Dermatitis (AHEAD) recommendations, developed by broad expert consensus to set new treatment targets for atopic dermatitis (AD) across all ages and severities. Informed by a global patient study and insights from 87 leading dermatologists in 44 countries, including the United States, the AHEAD recommendations emphasize a patient-centered approach. Patients identify their most burdensome AD symptoms, and clinicians select corresponding patient- and clinician-reported severity and objective measures. Treatment targets are then chosen from a range of "moderate" or "optimal" options, with the ultimate goal of achieving the optimal targets or ‘minimal disease activity’ such as EASI-90 and itch-NRS 0/1. While the focus is on reaching optimal targets, moderate targets represent only partial improvements and are not ideal, but they are considered acceptable when patients have limited access to advanced therapies, serving as a fallback when optimal outcomes are not immediately attainable.

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The Changing Face of Aesthetics

Perceptions of medical aesthetics have changed significantly over the years, and these perceptions continue to evolve in the field as we know it today. Once considered an industry shrouded in secrecy, people now see medical aesthetics as an important part of self-care and an opportunity to destigmatize the choice to enhance one’s natural features.

Throughout my over 22 years in the industry, I’ve watched its growth from an exclusive, hushed market of older women seeking plastic surgery to one that welcomes new communities and includes a growing preference for noninvasive treatments and tweakments. More people are turning to aesthetic practitioners hoping to enhance their appearance, and the numbers continue to increase. The global medical aesthetics industry is projected to have a 6% compound annual growth rate through 2027, despite macroeconomic trends.

Continue reading from Terri L. Phillips, MD, FAAP

Hyperpigmentation: Is It Medical or Cosmetic?

The most common cosmetic complaint I receive in my 50% medical and 50% cosmetic practice is hyperpigmentation. Hyperpigmentation can be a primary finding but is more often a secondary finding. Approximately 60% to 70% of my patients who present with hyperpigmentation have an underlying medical disease that has not been diagnosed. Many inflammatory skin diseases, including psoriasis, hidradenitis suppurativa, and atopic dermatitis in patients with darker skin types, can present with secondary hyperpigmentation.

Why is this a problem? Many patients are treated for their secondary findings
with agents such as hydroquinone, which also can cause hyperpigmentation, either from irritant contact dermatitis or, rarely, ochronosis. If hydroquinone is compounded with tretinoin, you get a double whammy in a patient with atopic dermatitis who presents with hyperpigmentation from their atopic dermatitis.

Continue reading from Karan Lal, DO, MS, FAAD

Click here to view all articles in the October issue