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Medscape
4 days ago
- General
- Medscape
Systemic Psoriasis Therapy Linked to Less Dementia
SAN DIEGO — While psoriasis is linked to higher rates of dementia, a new study suggested that older patients with psoriasis on systemic treatments may have a much lower risk than those not treated systemically. In fact, the research hints — but doesn't prove — that the medications could lower the dementia risk even below that of the general population. The study, which retrospectively evaluated US medical records of people aged 65-95 years from 2004 to 2024, found that patients with psoriasis on systemic therapies (n = 14,679) had a lower risk of developing dementia than those not on systemic treatment (n = 39,601) and lower than a matched general population group (5.77 million). The adjusted odds ratios (aORs) for the treated psoriasis group vs the untreated group were 0.49 (0.39-0.61) for Alzheimer's disease, 0.65 (0.51-0.83) for vascular dementia, and 0.60 (0.53-0.68) for nonvascular dementia. For the treated group vs the matched general population, the aORs were 0.69 (0.54-0.86), 0.85 (0.65-1.10), and 0.85 (0.75-0.97), respectively. The findings, presented at the Society for Investigative Dermatology (SID) 2025 Annual Meeting, are too preliminary to affect clinical practice. But the study does add to 'a growing body of evidence linking chronic inflammation to neurodegeneration,' study lead author Madison Olexson, a dermatology research fellow at Eastern Virginia Medical School, Norfolk, Virginia, told Medscape Medical News . 'It reinforces [how] treating systemic diseases like psoriasis may not only improve cutaneous symptoms but may have extra-cutaneous benefits as well,' she said. Sparse Data on Systemic Treatments and Psoriasis Several international reports have linked psoriasis with dementia, including a 2019 study that found an elevated risk associated with the skin disease and vascular dementia (hazard ratio [HR], 1.73; 95% CI, 1.21-2.47) and a 2023 study that identified an increased risk for dementia (HR, 1.24; 95% CI, 1.14-1.35). Also, a 2019 study linked dementia to a higher risk for psoriasis (OR, 1.46). Other autoimmune disorders such as rheumatoid arthritis and inflammatory bowel disease have also been linked to higher incidence and risk for cognitive impairment and dementia, Olexson said. 'This is believed to be linked to systemic inflammation and the sustained activity of proinflammatory cytokines such as [tumor necrosis factor] TNF alpha and [interleukin 17] IL-17, which can affect the brain and potentially lead to neurodegeneration. However, the exact mechanisms remain unclear.' She added that 'it's still a mystery whether psoriasis alone drives the development of dementia or if the increased likelihood is due to shared comorbidities or overlapping inflammatory pathways. Furthermore, we don't yet fully understand whether treatments provide direct cognitive protection or how long treatment needs to continue for maximal benefit.' Biologics and Non-Biologics Both Linked to Benefit The researchers launched the new study 'to address the limited and inconsistent data on whether psoriasis associates with dementia outcomes and systemic treatments for psoriasis could influence the likelihood of developing dementia,' Olexson said. The study retrospectively tracked patients via the TriNetX research network database. Before propensity score matching, the mean age was 66.6 ± 8.9 years for non-treated patients and 67.8 ± 9.0 years for the general population. Respectively, the groups were 42.8% and 51.7% women and 65.9% and 72.6% White. Data for the treated psoriasis group were not provided, but Olexson said their characteristics were similar. The study included both biologic medications, which target specific immune pathways, and non-biologic systemic treatments. Patients were treated for a median of 4 years (for both). The biologics were adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, ustekinumab, guselkumab, tildrakizumab, risankizumab, secukinumab, ixekizumab, and brodalumab. The non-biologic treatments were methotrexate, apremilast, acitretin, and ultraviolet phototherapy. Both drug classes were linked to lower risks for dementia at roughly the same rates, but it was not clear if specific medications may have greater effects. Less Inflammation May Protect Against Dementia The adjusted incidence rates of Alzheimer's disease were 1.9% vs 1.2% in the non-psoriasis group vs the treated psoriasis group. For vascular dementia, the rates were 1.2% vs 0.74%, respectively. For nonvascular dementia, they were 5.4% vs 3.7%, respectively. For untreated patients with psoriasis vs treated patients with psoriasis, the adjusted incident rates were 1.7% and 0.84% for Alzheimer's disease, 1.1% and 0.72% for vascular dementia, and 5.1% and 3.1% for nonvascular dementia, respectively, which Olexson reported were statistically significant differences. 'Systemic therapies likely reduce neuroinflammation by suppressing inflammatory cytokines like TNF alpha and IL-17, both of which have been implicated in neurodegenerative processes,' Olexson said. 'These cytokines can disrupt the blood-brain barrier, promote amyloid beta accumulation, and impair neuronal function. By modulating this inflammatory cascade, systemic treatments may protect against or slow the onset of dementia.' Findings Are 'Intriguing' but Not Definitive Asked to comment on the results, Steven R. Feldman, MD, PhD, professor of dermatology, Wake Forest University, Winston-Salem, North Carolina, who was not involved in the study, noted that while the findings are 'intriguing,' they come with caveats because of the observational study design. 'If patients with dementia aren't bothered by their psoriasis or aren't given biologics for that or some other reason, getting a biologic might be associated with less dementia,' he said in an interview. 'It may be that having or not having dementia determines to some degree who gets a biologic, not that taking a biologic determines who gets dementia.' Olexson agreed that the observational design has limitations. While cohorts were matched by demographics, body mass index, and several comorbidities, she said other factors such as disease severity, socioeconomic status, and access to care could play a role in the findings. What's next? Moving forward, Olexson said, 'We have plans to conduct prospective studies related to psoriasis and cognitive health at our institution.'
Medscape
16-05-2025
- Health
- Medscape
Atopic Dermatitis Linked to Higher Odds of NMSC
SAN DIEGO — Patients with atopic dermatitis (AD) are at a significantly higher risk for nonmelanoma skin cancer (NMSC), although the overall risk remains low, a new retrospective database study found. Compared with patients without AD, the odds of NMSC in patients with AD were 1.53 times higher in an adjusted analysis (odds ratio [OR], 1.53; 95% CI, 1.17-2.01; P < .05), according to a study of 2021 national survey data presented here at the annual meeting of the Society for Investigative Dermatology. 'The strength of that association surprised us, as well as the consistent findings across various demographic groups. It adds weight to the theory that AD isn't just a quality-of-life disease but may have more serious systemic consequences,' said study lead author Lara Shqair, medical student at the Icahn School of Medicine at Mount Sinai, New York City, in an interview with Medscape Medical News . Other studies have examined possible relationships between AD and NMSC. A 2024 study using US claims data linked any AD and moderate to severe AD to higher rates of NMSC (relative risk, 1.32; 95% CI, 1.30-1.35 and 1.36; 95% CI, 1.12-1.65, respectively). And a 2023 study found that among various malignancies in patients with moderate to severe AD, incidence rates were highest for NMSC (moderate AD: 4.6; 95% CI, 3.9-5.5; severe AD: 5.9; 95% CI, 3.8-9.2). However, 'what was missing was a large, nationally representative study that could give us a clearer picture of this relationship in the general United States population,' said Shqair, who presented the results at the meeting. That's where the new research comes in. Shqair and colleagues evaluated the association between AD and NMSC via 29,116 participants — 7.4% with self-reported AD and 2.7% with NMSC — in the 2021 National Health Interview Survey. Overall, an estimated 3.6 million cases of basal cell carcinoma and 1.8 million cases of squamous cell carcinoma — the two most common types of NMSC — are diagnosed in the United States each year. In an unweighted analysis, 2.0% of the non-AD population and 2.8% of the AD population had NMSC ( P < .05). After researchers weighted the data for age, sex, race, insurance type, education level, and NMSC prevalence, they determined that patients with AD had a higher risk for NMSC. Why might AD and NMSC be related? One possibility is that chronic skin inflammation promotes cancer through local immune dysregulation, Shqair said. Another possibility is that systemic immunosuppressive treatments could increase their risk, 'and there's also the role of barrier dysfunction and transcutaneous sensitization, potentially allowing more exposure to carcinogens,' she added. In the big picture, she said, excess risk is likely due to 'a combination of biological, treatment-related, and behavioral factors.' The researchers also found that women (63% of the AD cases) and patients with private insurance (64%) were more likely to have AD. In their adjusted analysis, AD was linked to higher levels of education (some college education, OR, 0.47; 95% CI, 1.18-1.83; P < .05, and holding a professional degree (OR, 2.41; 95% CI, 1.85-3.13; P < .05) vs high school degree or lower. 'People with more education may be more proactive about their health and more likely to seek dermatologic care,' Shqair said. Other factors may be at play 'such as differences in health literacy, insurance coverage, trust in the medical system, and the ability to take time off work or afford specialized care.' The study's overall message is that 'dermatologists should be aware that patients with AD, especially those with severe or long-standing disease, might be at elevated risk for NMSC,' she said. The new study complements previous analyses and is consistent with their findings, said Christopher G. Bunick, MD, PhD, associate professor of dermatology at Yale University, New Haven, Connecticut, who was not involved in the research. The apparent extra risk 'indicates patients with AD may require careful education on sun protection and may need to undergo routine skin screenings on a consistent basis,' Bunick told Medscape Medical News . 'I recommend a combination of education around risk of NMSC and the need for sun protection and the strict avoidance of tanning beds.'
Medscape
16-05-2025
- Health
- Medscape
‘Allergen Free' Sunscreen? Take a Closer Look
SAN DIEGO — More than half of popular sunscreens advertised as 'hypoallergenic,' 'allergen free,' and 'allergy free' contain at least one allergen that could trigger allergic contact dermatitis (ACD), a new study reported. 'We discovered an exorbitant amount of sunscreens with marketing claims that were not accurate,' said University Hospitals, Cleveland, dermatologist Chandler Rundle, MD, co-author of the report, which was presented here at the annual meeting of the Society for Investigative Dermatology. 'While the most reliable claim was 'sensitive skin,'' he told Medscape Medical News , 'more than a quarter of products [with that label] still had a relevant allergen.' Sensitivity to sunscreen is common, but actual allergy to ingredients appears to be quite rare. A 2013 study reported that only 0.9% of 23,908 patch-tested patients had sunscreen coded as an allergen. Still, 'ACD on the face, eyelids, ears, or other sensitive areas can be deeply concerning to patients and negatively impact their mental wellness,' Rundle said. 'ACD can go undiagnosed or undertreated for months and even years.' For the new study, he and his coauthors looked for North American Contact Dermatitis Society Core Allergens in the ingredients of 200 sunscreens. All the products were among the 40 sunscreens listed first — either by popularity or 'relevance' — when searches were performed on the websites of Amazon, CVS, Target, Walgreens, and Walmart. Of the 200 sunscreens, 88.5% had at least one allergen, 35.5% had at least two, 18.5% had at least three, and 2.0% had at least five. The top five most commonly identified allergens were fragrance (53.5%), phenoxyethanol (44.5%), ethylhexylglycerin (29.5%), propylene glycol (18%), and methacrylate (17.0%). Allergens were more commonly found in non-tinted (64.6%) vs tinted (35.3%) products and in chemical (64.5%) and physical (65.9%) vs combination (26.7%) products. Products with lower sun protection factor (SPF) levels (< 30 SPF, 45.5%; SPF 30-60, 62.2%) were less likely to contain allergens than products with the highest levels (> 60 SPF, 76.9%). Also, products labeled as 'gentle' were more likely to contain allergens (66.7%) than those with 'dermatologist recommended' (55.9%), 'hypoallergenic,' 'allergen free, 'allergy tested' (52.9%), and 'sensitive skin' (26.2%) claims on their labels. Study lead author Andrew B. Fay, a student at Loma Linda University School of Medicine, Loma Linda, California, noted that 'companies can legally label products as 'fragrance-free' even if they contain fragrance chemicals as long as those ingredients serve another purpose, like moisturizing or preserving, and are not used 'solely to impart an odor to a product.'' Fay told Medscape Medical News that the US Food and Drug Administration doesn't regulate claims like 'allergen-free,' 'hypoallergenic,' and 'dermatologist recommended.' Other studies have reached similar conclusions about allergens in sunscreens. A 2011 study examined 201 sunscreens and found that a high proportion contained the allergens oxybenzone (68%), fragrance (63%), and vitamin E (53%). The new study reported that 7.5% of products analyzed contained oxybenzone, and vitamin E was not listed. Walter Liszewski, MD, assistant professor of dermatology and preventive medicine at Northwestern University, Chicago, who was not involved in the study, told Medscape Medical News that there are common misconceptions about skin reactions to allergens. Patients may think they are allergic because they develop rashes after exposure, he said. 'The reality is that most rashes people get from sunscreens aren't due to an allergy. Rather, it's because the sunscreens are so irritating. They're just inherently irritating on the skin.' Sunscreens with higher SPFs are especially irritating, said Liszewski, who specializes in ACD. 'Many patients who complain of having sunscreen allergies are just using sunscreens with too high of an SPF.' He advised dermatologists to 'not be afraid to encourage [sensitive] patients to use a lower SPF like SPF 30, SPF 20, or even SPF 15. If a patient can tolerate a low SPF sunscreen, it suggests that their sensitivities to the sunscreen are due to irritancy and not an allergy. But if they continue to develop rash with a lower SPF, then that patient should be referred to a patch test expert to undergo allergy testing.' Mineral-based sunscreens such as those with titanium or zinc are other options for sensitive patients, Liszewski said, although they can leave a white residue on the skin and sometimes sting or burn. Fragrance-free products can also be helpful, he said, although he agreed with Fay that this phrasing is a sticky area on the marketing front. A sunscreen may include a claim that it's fragrance-free, he said, when it contains an ingredient such as lavender oil for a purpose other than odor, such as serving as a moisturizer. While the lavender oil 'is not intentionally being used as a fragrance, [the sunscreen] is going to have a strong lavender scent,' Liszewski said.
Medscape
14-05-2025
- Health
- Medscape
Psoriasis: DMARDs, Biologics Linked to Less Alopecia Areata
SAN DIEGO — Disease-modifying antirheumatic drugs (DMARDs) and biologics were linked to as much as a 74.5% reduction in the risk for alopecia areata (AA) in patients with psoriasis, a new retrospective cohort study reported. 'With higher numbers and more data, this could definitely be clinically applicable in patients we know are at higher risk of AA,' said study Co-Author Bethany Rohr, MD, associate professor of dermatology, Case Western Reserve University School of Medicine, Cleveland, in an interview prior to the presentation of her findings at the annual meeting of the Society for Investigative Dermatology. 'We could choose a medication for their psoriasis to give them some protective benefit,' she added. Patients with psoriasis have an increased risk for AA. A 2022 systematic review and meta-analysis estimated that the pooled prevalence rate of AA in patients with psoriasis was 0.5% (95% CI, 0.3-0.7%). The pooled risk for AA in patients with psoriasis was estimated at 2.71 (95% CI, 2.29-3.21). Both AA and psoriasis are autoimmune disorders. Some DMARDs and biologics are used to treat AA off-label, while others have not been evaluated as treatments for the disease, Rohr said. She noted that methotrexate can actually cause alopecia but not AA, and in fact, has been studied as a treatment for AA. 'We wanted to investigate if our drug choice for these patients who require systemic therapies could have some protective benefit,' Rohr said. Via the TriNetX international electronic record database, she and her coauthors tracked 48,724 patients with psoriasis who were on DMARDs (average age, 52.6 years ± 16.3; 56.6% women; 70.4% White individuals; 21.9% with overweight/obesity) vs a propensity-matched cohort who were not taking systemic medications. The patients were followed for 5 years following the start of therapy. The tracked DMARDs were methotrexate, cyclosporine, and apremilast. The primary outcome was AA within 5 years of medication initiation. Researchers also tracked 66,837 patients with psoriasis who were on biologics (average age, 52.9 years ± 16.9; 54.8% women; 71.5% White individuals; 21.5% with overweight/obesity) vs a propensity-matched cohort who were not taking systemic medications. The biologics were tumor necrosis factor inhibitors (adalimumab, etanercept, infliximab, certolizumab pegol, and golimumab), interleukin (IL)-17 inhibitors (brodalumab, ixekizumab, secukinumab, and bimekizumab), and IL-12/23 and IL-23 inhibitors (ustekinumab, guselkumab, risankizumab, and tildrakizumab). They found that 19 patients in the DMARD group developed AA vs 37 in the nonsystemic treatment group (risk ratio [RR], 0.514; 95% CI, 0.295-0.893; P = .019). In the biologics group, 13 developed AA vs 51 in the nonsystemic treatment group (RR, 0.255; 95% CI, 0.139-0.469; P < .001). No statistically significant difference was seen between the DMARD and biologic groups ( P = .322). Other studies have reported similar links between psoriasis and AA. Study lead author Nada Hentati, a medical student at Case Western Reserve, told Medscape Medical News that the researchers had to group many medications together because the sample size was small. 'We lost some of the granularity regarding which medications might be independently protective,' she said. In addition, she said, 'the number of cases was pretty low. Part of that is because we constrained our data to make sure that all the cases we were seeing were within 5 years of starting the drugs.' The reduction in risk 'has the potential to be significant,' Rohr noted in the interview. 'However, it's important to remember this is a pilot study,' she added, and the data has limitations. 'Ideally,' she said, 'it would be nice to have a really large prospective study following individual drugs and patients with similar body surface area and severity of psoriasis to better understand the significance of our data.' Asked to comment on the study findings, Deshan Sebaratnam, MBBS, MMed, associate professor of dermatology at the University of New South Wales, Sydney, Australia, told Medscape Medical News many DMARDs are used to treat AA, and 'there have been small-volume case reports where patients with alopecia areata have improved on biologics.' It's feasible that dampening the immune system may make patients less likely to develop AA, added Sebaratnam, who was not involved with the study. However, for psoriasis, he noted, 'I don't think this is really going to change management. You wouldn't immunosuppress someone to decrease the likelihood of developing AA.'
