Experts discuss top derm news: Sunscreen, melanoma treatments and more

MAUI, HAWAII — The FDA decision to study sunscreen ingredients and societies teaming up to develop a guideline for pediatric psoriasis were some of the top updates in dermatology last year, according to presenters here at Maui Derm for Dermatologists 2020.

An analysis of actinic keratosis treatments and a review of certain metastatic melanoma treatments were some of the other updates that the speakers discussed.

Sunscreen ingredients under scrutiny

Sheila Fallon-Friedlander, MD, professor of clinical pediatrics and dermatology medicine, University of California, San Diego School of Medicine, told attendees what a potentially safe sunscreen may contain.

“Any sunscreen that we want our patients to use should use ingredients that are safe and effective,” she said. “Guess what happened with sunscreens? There were only two ingredients that reached that designation: zinc oxide and titanium oxide.”

Hence, one of the reasons the FDA began its studies of sunscreen ingredients, she said. Though both studies have found that some sunscreen ingredients exceed safety thresholds, the FDA says sunscreen is still OK to use sunscreen.

“Why is this enhanced scrutiny important?” Fallon-Friedlander said. “Sunscreens are crucial component of skin cancer prevention. I'm recommending more and more use of them. I tell people apply every 2 hours while on the beach, I tell them to put it on all exposed areas. But we don't have a whole lot about how much of the ingredients is getting absorbed into the skin [yet]. We don’t understand all the issues [yet].”

She added that the answer may not necessarily lie in using sunscreen products with zinc oxide and titanium oxide. “Consumer Reports said these sunscreens with these ingredients might not do as well a job as others at sun protection.”

Pediatric psoriasis guideline

Another important update that Friedlander-Fallon pointed out was the American Academy of Dermatology and National Psoriasis Foundation jointly issuing a guideline on the management and treatment of psoriasis and pediatric patients.

“Now a lot of people feel like pediatric psoriasis is just a little version of adult psoriasis,” she said. “But in fact, there are differences. And this [guideline] was a beautiful dissertation.”

According to Fallon-Friedlander, key takeaways from the guideline include distinguishing diaper rash or contact dermatitis from psoriasis and screening obese children older than 9 years with psoriasis for metabolic syndrome, inflammatory bowel syndrome and mental health conditions.

Actinic keratosis treatments

Hensin Tsao, MD, PhD, associate professor of dermatology, Harvard Medical School, began his discussion with a recap of a New England Journal of Medicine article that looked at four treatment approaches for actinic keratosis.

“I liked this trial because it involved real-life choices that we as clinicians often have to make,” he said.

In the analysis, 624 patients with five or more actinic keratosis lesions on their heads that covered one continuous area of 25 cm² to 100 cm² were randomly assigned to receive either 5% fluorouracil cream, 5% imiquimod cream, methyl aminolevulinate photodynamic therapy (MAL-PDT), or 0.015% ingenol mebutate gel.

According to Tsao, patients who received fluorouracil had the greatest reduction of at least 75% in the number of actinic keratosis lesions after 12 months of treatment, followed by imiquimod, MAL-PDT and ingenol mebutate Researchers reported that there were no unexpected toxic effects, but there were reports of patients experiencing burning feelings during treatments.

“The data was very clear [in this trial],” he said.

Metastatic melanoma treatments

Another study Tsao discussed, which also appeared in NEJM, looked at 5-year outcomes with dabrafenib (Tafinlar, Novartis) plus trametinib (Mekinist, Novartis) in 563 patients with metastatic melanoma. Dabrafenib was dosed at 150 mg twice daily and trametinib was dosed at 2 mg once daily.

He indicated that the progression-free survival rates were 21% at 4 years and 19% at 5 years. The overall survival rates were 37% at 4 years and 34% at 5 years.

“Better survival from metastatic melanoma is real,” he said. “However, the side effects can be severe.” – by Janel Miller

Reference: Fallon-Friedlander S, Tsao H. Dermatology in review. Presented at: Maui Derm for Dermatologists; Jan. 25-29, 2020; Maui, Hawaii.

Disclosures: Tsao reports serving as a consultant to Epiphany Dermatology, serving on several editorial boards and receiving funding from four organizations including NIH and the Melanoma Research Alliance. Healio Dermatology could not confirm Fallon-Friedlander’s relevant financial disclosures prior to this story’s posting.