Romi Bloom

Google Search Trends and Skin Cancer: Evaluating the US Population’s Interest in Skin Cancer and Its Association With Melanoma Outcomes

ues decreased, MI values increased monotonically. We then analyzed how these measurements correlated after raw values were categorized. Although ITA and MI values place individuals into 1 of 6 skin types, these classification systems are currently unrelated, with no consensus about which MI values belong to which FST group.4,5 We found that by placing participants with MI values of 750.0 or greater in FST VI, we observed a very strong correlation between these unrelated classification systems (Spearman ρ = 0.95; P < .001) (Figure, B).

TNF-α: a treatment target or cause of sarcoidosis?

Sarcoidosis is a systemic granulomatous disease that affects numerous organs, commonly manifesting at the lungs and skin. While corticosteroids remain the first line of treatment, tumour necrosis factor alpha (TNF‐α) inhibitors have been investigated as one potential steroid sparing treatment for sarcoidosis. TNF‐α is one of many components involved in the formation of granulomas in sarcoidosis. While there have been larger scale studies of biologic TNF‐α inhibition in systemic sarcoidosis, studies in cutaneous disease are limited. Paradoxically, in some patients treated with biologic TNF‐α inhibitors for other diseases, treatment can induce the development of sarcoidosis. In the light of this complexity, we discuss the role of TNF‐α in granuloma formation, the therapeutic role of TNF‐α inhibition and immunologic abnormalities following treatment with these TNF‐α inhibitors including drug‐specific alterations involving interferon‐γ, lymphotoxin‐α, TNF receptor 2 (TNFR2) and T‐regulatory cells.

A systematic review with pooled analysis of clinical presentation and immunodiagnostic testing in mucous membrane pemphigoid: association of anti-laminin-332 IgG with oropharyngeal involvement and the usefulness of ELISA

Mucous membrane pemphigoid (MMP) is characterized by subepithelial blistering due to IgG autoantibodies targeting various components of the dermal–epidermal basement membrane zone. Immunodiagnostics play an important role in making a precise diagnosis. Measures of test sensitivity and specificity, however, typically come from studies in diseases such as bullous pemphigoid, where the exact antigenic site may not be the same. Additionally, the association of clinical phenotype and autoantibody profiles has been an area of debate.

An increased risk of non-Hodgkin lymphoma and chronic lymphocytic leukemia in US patients with Merkel cell carcinoma versus Australian patients: A clinical clue to a different mechanism of pathogenesis?

The US and Queensland populations both demonstrate an increased risk of secondary malignancies following the diagnosis of Merkel cell carcinoma (MCC). A recent Queensland study failed to demonstrate a significantly increased risk of developing non‐Hodgkin lymphoma (NHL) or chronic lymphocytic leukaemia (CLL) in these patients. In contrast, using the US Surveillance, Epidemiology, and End Results database, we demonstrate there is an increased risk in CLL and NHL following the diagnosis of MCC in the USA. We hypothesise that this difference may be a result of a differing pathogenesis.

Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials

Lamotrigine is an antiepileptic drug used for the treatment of epilepsy, bipolar disorder and numerous off-label uses. The development of rash significantly affects its use. The most concerning of these adverse reactions is Stevens-Johnson syndrome/toxic epidermal necrolysis. We performed a systematic review of randomized controlled trials using lamotrigine as a monotherapy to quantify the incidence of cutaneous reactions, particularly Stevens-Johnson syndrome/toxic epidermal necrolysis. Of a total of 4,364 papers regarding lamotrigine, 122 studies met our inclusion and exclusion criteria. In total, 18,698 patients were included with 1,570 (8.3%) of patients experiencing an adverse dermatologic reaction. The incidence of Stevens-Johnson syndrome/toxic epidermal necrolysis was 0.04%.

Assessing the current market of sunscreen: a cross-sectional study of sunscreen availability in three metropolitan counties in the United States.

Sunscreen use is recommended for the prevention of sunburn and skin cancer. Little is known regarding sunscreen availability in high versus low income communities. We analyzed sunscreen availability in three large metropolitan counties to determine the relationship between availability and community demographics. We included sun care products in all pharmacies and supermarkets open as of July 2013 in representative high and low income zip codes in Cook County, Illinois, Miami-Dade County, Florida, and San Diego County, California. We recorded the percentage of tanning oil, sunscreens with a sun protection factor (SPF) < 15, SPF > 15, physical sunscreens, spray sunscreens, mean price per ounce (PPO), and mean SPF. Of the total products assessed, 11.0% were tanning oils, with physical sunscreens accounting for only 3.4% of the available sunscreens and 46.2% of sunscreens being spray-on. A comparison between higher and lower income zip codes demonstrated a significantly increased percentage of sunscreens with SPF < 15 in high income zip codes. Lower income zip codes had higher percentages of sunscreens with SPF > 15 and higher PPO, even when taking into account SPF. Further studies of sunscreen usage patterns in different populations must take into account sunscreen availability and price, as these significantly differ based on the community demographic.

Private and public coverage policies for rituximab in the treatment of immunobullous disease in the United States

clinical and histologic features that differ markedly from those of lichen nitidus. Unusual histologic patterns in cases of clinically straightforward pityriasis rubra pilaris have been recognized. Acantholysis has been described in the literature since Kao and Sulica first reported this histologic anomaly in pityriasis rubra pilaris in 1989. Lichenoid dermatitis has only been reported in the literature in isolated case reports. In each of the previously reported cases, the descriptions of the histology have been scant, and in most instances simply state the infiltrate to be ‘‘lichenoid.’’ In several, the possibility of a lichenoid drug eruption was considered, possibly because of admixed eosinophils. Photomicrographs are similarly limited in detail. None of the patients in our series had clinical features of lichen nitidus or lichen planus. Importantly, none had been receiving medication before the onset of symptoms. Histologic features of lichen nitidus in patientswith pityriasis rubra pilaris is exceptional. Nevertheless, the previous reports of lichenoid inflammation, together with the patients described herein should serve as reminders to clinicians of this anomaly and thereby facilitate the diagnosis.

The Clinical Features of Nail Psoriasis

Nail involvement is present in over half of patients with psoriasis and consequently has a prominently negative impact on society. The clinical gamut of nail involvement is diverse and includes changes to the nail matrix, the nail bed, or both. The main nail matrix dystrophy is nail pitting while onycholysis, subungual hyperkeratosis, splinter hemorrhages, and oil-drop discoloration are the major nail bed findings. Lesions of the nail plate are due to the location of disease in the nail matrix as well as the duration of the disease. This chapter will describe the broad array of clinical features of nail psoriasis in order to help clinicians identify the condition, which will enable dermatologists to treat the symptoms and hopefully improve patients’ lives.

Rate of serious infection in patients who are prescribed systemic biologic or nonbiologic agents for psoriasis: A large, single center, retrospective, observational cohort study

Systemic biologic and nonbiologic agents used to treat psoriasis may or may not contribute to serious infection (SI) risk. Safety data, particularly for biologic agents, and associated risk for SI, are scarce. The studys aim was to explore the risk for SI in psoriasis patients exposed to systemic biologic or nonbiologic agents.

Association of Google Search Volume Index Peaks for Skin Cancer With Skin Cancer Awareness Month--Reply.

Association of Google Search Volume Index Peaks for Skin Cancer With Skin Cancer Awareness Month To the Editor I read with great interest the article by Bloom et al1 on the use of Google Trends to assess the US population’s interest in skin cancer. The authors should be commended for presenting this novel methodology as an approach to assessing patient interest in skin cancer, and for examining the putative relationship between the search volume index (SVI) and melanoma outcomes. The authors highlight that interest in skin cancer and melanoma is cyclical and that the “summer months” consistently demonstrate the highest SVI for skin cancer and melanoma searches. Yet Google Trends data show a consistent peak for the search term “skin cancer” in the month of May. Given sun exposure trends, the a priori assumption would be that searches for skin cancer and melanoma, spurred by sun overexposure and burns, would peak in mid July. The early peak in May, before most Americans have increased their sun exposure behaviors, followed by a persistently high level of interest over the summer months, suggests that something other than sun exposure patterns may be driving this phenomenon. Interestingly, a recent Brazilian study on the frequency of web visits to the Brazilian National Cancer Institute website failed to demonstrate a cyclical pattern of interest in skin cancer.2 Since 1985, the American Academy of Dermatology has sponsored May as skin cancer awareness month. The May peak in searches for skin cancer, and the frequent May peak in searches for melanoma, may suggest that such outreach programs are having an impact, at least insofar as SVI correlates with actual screening behaviors, which a recent study has questioned.3 The May peak for melanoma and skin cancer echoes a similar October peak for breast cancer searches, as breast cancer awareness month has become a major cultural trope in the United States and beyond. These findings suggest that the cycle of awareness, led by outreach programs, may lead to a significant and meaningful feedback loop, with the founding of an awareness month leading to increased media coverage, which in turn leads to more searches and public interest, which then again feeds an increased interest in media coverage. While it is difficult to draw valid conclusions from secular trends, these data should be heartening to the dermatology community at large because they suggest that outreach, advocacy, and education efforts, coupled with free skin cancer screenings, may be effectively contributing to an increased awareness of skin cancer.