Armand Butera is the assistant editor for 

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Armand Butera

A recent investigation into incidences of severe acute radiation dermatitis (ARD) in patients with nasopharyngeal cancer (NPC) treated by proton beam therapy (PBT) suggested that topical corticosteroids, silver sulfadiazine, and non-adhering silicone dressing were effective for treating the dermatological condition.

In recent years, PBT has been heavily adopted in treating patients with NPC. Despite this, a high incidence of severe ARD has been reported in this patient population.

For this observational study, an investigative team led by Ko-Chun Fang, MD, of the Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, considered treatment outcomes and prognostic factors of patients with NPC who developed ARD from this cancer therapy.

Fang and colleagues recruited newly diagnosed patients with NPC who were curatively treated with PBT and received the full treatment course at the proton center of Kaohsiun Chang Gung Memorial Hospital.

Among these patients, 57 were enrolled for data analysis. The median age of this patient group at the time of diagnosis was 48 years, and a majority (73.7%) of these patients were male. Nineteen (33.3%) patients had a smoking habit, and 52 (91.2%) were treated with in combination with chemotherapy.

Weekly ARD was recorded for each patient at their treatment visits, and were based on criteria presented in the Common Terminology Criteria for Adverse Events version 4. Investigators recorded ARD across 9 time points using a 4-grade scale, with grade 4 representing “life-threatening consequences” related to skin necrosis or ulceration of full thickness dermis, among other events.

In the first 3 weeks of therapy, no patients presented with notable ARD. By weeks 6 through 8, peak incidence of grade 2 (42.1%) and 3 (12.3%) ARD had occurred. No grade 4 ARD was observed.

Regarding treatment strategies, 24 (42.1%) patients received TCS alone, 33 (57.9%) received TCS and silver sulfadiazine, and 25 (43.8%) received non-adhering silicone dressing to cover severe skin wound areas.

A majority of grade 2 and 3 ARD had disappeared by week 11 of the study, with nearly all (93%) patients presenting with grade 1 or lower. Despite this, investigators noted a degree of chronic scar formation in 3 of the 7 patients with grade 3 ARD in follow-ups. All of these cases had a smoking habit, and 1 had diabetes.

With their study, Fang and investigators defined ARD as “a major concern for patients with NPC treated with PBT, especially those with a smoking habit or advanced nodal status”, recommending the use of TCS and topical therapies to reduce the severity of PBT-related ARD cases.

“Acute radiation dermatitis among patients with nasopharyngeal carcinoma treated with proton beam therapy: Prognostic factors and treatment outcomes,”

 was published online in the International Wound Journal.

Articles

Proton beam therapy has been heavily adopted for treating patients with nasopharyngeal cancer, and a high incidence of severe ARD has been reported in this patient population.

Topical Corticosteroids Recommended for the Treatment of PBT-Induced ARD

Parental atopic dermatitis (AD) and asthma were associated with an increased risk of objectively diagnosed AD in children, according to new data from a contemporary cohort study.

Previous research has suggested an association between pediatric and parental AD, yet differing odds ratios for AD have been recorded throughout the years.

For this study, an investigative team led by Cathal O’Connor, MD, of Pediatrics and Child Health at Cork University, Ireland, assessed the influence of maternal and paternal atopic disease on AD outcomes in children featured in a large observational birth cohort.

O’Connor and colleagues conducted a secondary analysis of the Cork Babies After Scope: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endoints (BASELINE) Birth Cohort study, which featured a myriad of environmental factors experienced during pregnancy that were believed to effect childhood health and development.

From August 2009 to October 2011, the BASELINE study recruited first-born term babies in Cork Ireland, all of whom received skin barrier assessments at birth and at 2, 6, 12, and 24 months.

In addition to this assessment, parents were tasked with completing questionnaires that gauged parental atopy through questions like “DO or DID you ever suffer from eczema (atopic dermatitis)?”, as well as pediatric atopy with a question regarding whether or not their child had an “itchy rash on the face or in the folds of the arms or legs”.

Data and AD status were available for 1505 children at 6, 12, and 24 months through the BASELINE study.

Investigators observed that AD prevalence was highest at 6 months (18.6%), but tapered off at 12 months (15.2%) and 24 months (16.5%). In both the univariable and multivariable analysis, which featured 1296 children, parental atopic disease was associate with AD in childhood.

Regarding the multivariable analysis, the odds of AD in the first 2 years were higher for infants of parents with a history of atopic disease. Regarding maternal AD, adjusted odds ratios following a multivariable analysis were 1.57 (1.09–2.25) at 6 months and 1.66 (1.12–2.46) at 12 months.

O’Connor and colleagues noted a trend toward early intervention for the prevention of pediatric AD, adding that enhanced early identification had become “increasingly important” in recent years.

“This study from a longitudinal birth cohort adds to the knowledge base relating to parental atopy and risk of AD, showing that both maternal and paternal histories of AD and asthma are associated with increased risk of AD in offspring in early life,” they concluded.

“Parental atopy and risk of atopic dermatitis in the first 2 years of life in the BASELINE birth cohort study,”

Though the association between pediatric and parental AD has been detailed in previous literature, differing odds ratios for AD have been recorded throughout the years.

Parental Atopy Associated with Increased Risk of Pediatric AD

A new cross-sectional study found that roughly two-thirds of patients in Japan with general pustular psoriasis (GPP) were treated with biologics in order to manage their disease, which investigators attributed to the 8 biologic therapies currently approved for GPP in the country.

Investigators also noted that the public financial aid for medical costs that patients could receive in Japan for GPP-which is considered a designated intractable disease by the Japanese government- played a significant role in the access to biologics therapy for psoriatic disease.

With the broadening of treatment options for GPP in Japan, Koremasa Hayama, PhD, of the Department of Dermatology at Nihon University, sought to better define the current real-world status of GPP treatment in the country.

Hayama and colleagues collaborated with 641 hospitals and facilities across Japan, administering questionnaires that sought to determine the scale of each facility by the number of hospital beds, as well as the number of GPP patients diagnosed based on appropriate criteria established in Japanese guidelines who visited these facilities in the past year.

The questionnaires also gauged disease severity at the last visit of 2021 and the therapeutic regimens that were considered for each patient. Once completed, questionnaires were sent to Nihon University School of Medicine.

A total of 349 facilities submitted completed questionnaires. Among them, over half (57.6%) saw at least 1 patients with GPP in 2021.

A total of 874 patients with GPP visited these facilities, with the patient population being comprised of 433 females, 406 males, and 36 patients whose gender was not defined.

Notably, a majority of patients (78.2%) had mild GPP, while 10.8% had moderate disease, and 6.8% had severe disease.

Topical corticosteroids were used for nearly half (48.9%) of all patients, and commonly used oral medicines included etretinate (19.1%), cyclosporine (10.2%), corticosteroids (5.9%), apremilast (5.3%), and methotrexate (3.1%).

As previously mentioned, a majority of patients (67.5%) were treated with biological agents, with 158 patients (18.1%) being treated with TNF inhibitors, 291 (33.3%) with interleukin (IL)-inhibitors, and 135 (15.4%) with IL-23 inhibitors.

Only 39 (4.7%) patients received ultraviolet therapy while 25 patients (2.9%) experienced granulocyte/monocyte adsorption apheresis.

Investigators noted that TNF inhibitors were most prevalent in smaller Japanese cohort studies from 2016-2019 and 2010-2020, in addition to a recent study on an insurance database from 2010-2019. Despite this, patients were more often prescribed IL-inhibitors.

“This is consistent with the increasing use of IL-17 inhibitors for GPP reported by the analysis of Japanese national inpatient database from 2010 to 2019,” the team wrote. “Expanding drug availability over time may lead to the change in treatment trend.”

“Current trend in the treatment of generalized pustular psoriasis in Japan: Results from a questionnaire-based epidemiological study,”

 was published online in The Journal of Dermatology.

 There are 8 biologic therapies currently approved for GPP in Japan, with IL-inhibitors being the predominant therapeutic option.

Majority of Japanese Patients with GPP Treated with Biologics

Systemic sclerosis (SSc) was responsible for a rise in overall mortality in Spain over the course of nearly 4 decades, according to data from a new database analysis. Notably, a progressive drop in SSc-related deaths was recorded in male patients.

Previous research has suggested that the prevalence of SSC in Spain is approximately 27.7 individuals per 100,000. Despite this prevalence, few studies have assessed the overall mortality rates of SSc in Spain and have often been limited by sample sizes to the RESCLE registry, which was established in 2006 by the Spanish Internal Medicine Society.

With this study, Juan-Carlos Hernández-Rodríguez, PhD, of Virgen del Rocio University Hospital in Seville, and a team of investigators sought changes in mortality trends in the Spain related to SSc between 1980 and 2019.

Hernández-Rodríguez and colleagues collected data on the annual number of deaths due to SSc from this time period from the Spanish National Statistics Institute, drawing from death certificates specifically coded for the condition.

Mid-year population data were also collected through the institute, and cases of systemic sclerosis induced by drug and/or chemicals were not included in the analysis.

From there, age-standardized mortality rates (ASMR) were calculated for individual sex and age groups as well as the overall population, and age-period-cohort (APC) and a potential years of life lost (PYLL) analysis were used to further elucidate the burden of SSc.

Between 1980 and 2019, a total of 2914 deaths were attributable to SSc, with rates increasing in a 4-year period in the Eighties. The ASMR from 1980-1984 was 1.87 per 1,00,000 inhabitants, eventually reaching 2.47 cases from 2015-2019. Female ASMR in particular rose from 2.10 to 3.52 cases during this time, while male ASMR dropped from 1.50 to 1.13.

Investigators noted that the current study was similar to previous SSc mortality studies in that the age effect was associated with higher mortality rates as age progressed, with SSc cases that onset in patients over 60 years being associated with worse survival rates.

The team also attributed the rise of SSc cases in the 1980s to a “greater awareness of physicians and an accurate diagnosis” beginning in the 1950s, an hypothesized that the trend fall recorded in the 1990s in younger cohorts indicated a stabilization of SSc-relared mortality rates in Spain, “although an upcoming monitoring is required to confirm these findings”.

“Systemic sclerosis mortality trends in Spain from 1980 to 2019: age-period-cohort and Jointpoint analysis,”

 was published online in Clinical and Experimental Dermatology.

Between 1980 and 2019 in Spain, a total of 2914 deaths were attributable to SSc, with rates increasing in a 4-year period in the 1980s.