Personal Care Products Linked to Facial Dermatitis in Men
Personal care products account for about 60% of cases of facial dermatitis in men, according to results of a recent study published in JAMA Dermatology.
“Facial dermatitis in women is well characterized; however, recent shifts in the men’s grooming industry may have important implications for male facial dermatitis,” the researchers said. They conducted a 22-year retrospective, cross-sectional study of North American Contact Dermatitis Group (NACDG) data. The study included 1332 male patients with facial dermatitis who underwent patch testing by a group of dermatology board-certified patch test experts at multiple centers and 13,732 male patients without facial dermatitis.
Main outcomes included characteristics of male patients with facial dermatitis and those without, including demographics and allergens. Secondary outcomes included sources of allergic and irritant contact dermatitis, as well as specific occupations and industries for relevant cases of facial dermatitis.
The researchers found the face (not otherwise specified), eyelids, and lips were the most common facial sites. Men in the facial dermatitis group were younger than those without facial dermatitis, the researchers said, and were less likely to be white or have occupationally related skin disease.
Overall, 60.5% of NACDG allergen sources were personal care products, the researchers said. The most common allergens included methylisothiazolinone, fragrance mix, and balsam of Peru. In addition, men with facial dermatitis were more likely to react to dimethylaminopropylamine and paraphenylenediamine compared with those without facial dermatitis.
“This study provides insight into the risks and exposures of the increasing number of grooming products used by male dermatology patients,” the researchers concluded. “Male patients with facial dermatitis appear to have unique sources of allergens that must be considered as male grooming practices evolve; dermatologists should be aware of these implications to adequately identify and treat patients.”
Reference
Warshaw EM, Schlarbaum JP, Maibach HI, et al. Facial dermatitis in male patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group Data, 1994 to 2016 [published online November 27, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.3531
Does Zinc Impact Inflammatory Disease Outcomes?
Zinc supplementation appears to have some beneficial effects on certain inflammatory skin disease, such as acne vulgaris and hidradenitis suppurativa, according to the findings of a recent article in American Journal of Clinical Dermatology. 
“Zinc has been used in patients with acne vulgaris for its anti-inflammatory effects; however, it is unclear if zinc supplementation is also beneficial in other inflammatory skin conditions,” the researchers said. They searched Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Ovid databases for trials that examined the use of zinc supplementation in the treatment of dermatologic conditions. A total of 22 trials that included adult and pediatric patients with acne vulgaris, atopic dermatitis, diaper dermatitis, hidradenitis suppurativa, psoriasis, and rosacea were included in the study.
Zinc supplementation was found to be beneficial in 10 of 14 studies on acne vulgaris, one of two studies on atopic dermatitis, the one study on diaper dermatitis, and all three studies on hidradenitis suppurativa, the researchers said. However, the researchers found zinc did not significantly benefit psoriasis or rosacea disease outcomes.
“Some preliminary evidence supports the use of zinc in the treatment of acne vulgaris and hidradenitis suppurativa; however, more research is needed with similar methodologies and larger sample sizes in these diseases,” the researchers concluded. “Further, zinc may be of some benefit in the treatment plan for atopic dermatitis and diaper dermatitis; however, additional studies should be conducted to further evaluate these potentially positive associations.”
“To date, no evidence is available to suggest that zinc may be of benefit in rosacea and psoriasis; however, limited data are available evaluating the use of zinc in these conditions,” they added.
Reference
Dhaliwal S, Nguyen M, Vaughn AR, Notay M, Chambers CJ, Sivamani RK. Effects of zinc supplementation on inflammatory skin diseases: a systematic review of the clinical evidence [published online November 19, 2019]. Am J Clin Dermatol. doi:10.1007/s40257-019-00484-0
Does Eczema Increase Fracture Risk?
Eczema may be associated with an increased risk of fractures, according to a study published in the Journal of Allergy and Clinical Immunology.
“Limited evidence has suggested increased fracture risk in people with atopic eczema, and any link could have substantial effect,” the researchers said. “Atopic eczema is common, and fractures have associated morbidity and mortality.”
Using data of 526,808 individuals with eczema compared with 2,569,030 individuals without eczema enrolled in Clinical Practice Research Datalink GOLD from 1998 to 2016, the researchers assessed the risk of fractures among those with vs those without eczema, as well as whether this risk was affected by disease severity.
Individuals with eczema had an increased risk of hip (hazard ratio [HR], 1.10; 99% CI, 1.06-1.14), pelvic (HR, 1.10; 99% CI, 1.02-1.19), spinal (HR, 1.18; 99% CI, 1.10-1.27), and wrist (HR, 1.07; 99% CI, 1.03-1.11) fractures, the researchers said. However, they found no evidence of increased proximal humeral fracture risk (HR, 10.6; 99% CI, 0.97-1.15).
In addition, the researchers found that fracture risk increased with increasing eczema severity. Compared with individuals without eczema, individuals with severe eczema had the strongest associations for spinal (HR, 2.09; 99% CI, 1.66-2.65), pelvic (HR, 1.66; 99% CI, 1.26-2.20), and hip (HR, 1.50; 99% CI, 1.30-1.74) fractures. These associations persisted after adjusting for oral glucocorticoid use, they added.
“People with atopic eczema have increased fracture risk, particularly major osteoporotic fractures,” the researchers concluded.
Reference
Lowe KE, Mansfield KE, Delmestri A, et al. Atopic eczema and fracture risk in adults: a population-based cohort study [published online November 19, 2019]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2019.09.015
Metabolic Conditions Increase Likelihood of Switching or Discontinuing Biologic Treatment
Patients with psoriasis and comorbid metabolic conditions were more likely to switch or discontinue treatment compared with those without metabolic conditions, according to an article published in Journal of Dermatological Treatment.
In the study, researchers analyzed data of 7773 adult patients with one or more prescriptions for secukinumab (Cosentyx), adalimumab (Humira), ustekinumab (Stelara), etanercept (Enbrel), or apremilast (Otezla) between January 1, 2015, and August 31, 2018. The researchers divided patients into treatment cohorts and stratified them by metabolic condition status. They compared treatment patterns, such as adherence, nonpersistence, switching, discontinuation, use of combination therapy, and reinitiation, as well as health care costs between those with and those without metabolic conditions.
About 47.5% to 56.7% of patients had a metabolic condition, the researchers said. Aside from the apremilast group, patients with metabolic conditions had higher discontinuation and switching compared with those without metabolic conditions.
Discontinuation among patients with metabolic conditions occurred in 50.6%, 53.9%, 41.9%, and 42.8% in secukinumab, adalimumab, ustekinumab, and etanercept groups, respectively, compared with 43.7%, 48.7%, 35.1%, and 41.2% in those without metabolic conditions. In the apremilast group, discontinuation was reported in 43.1% and 46.1% of patients with and without metabolic conditions, respectively.
Among patients with metabolic conditions, switching occurred in 48.1% of those treated with secukinumab, 47.8% of those treated with adalimumab, 34.5% of those treated with ustekinumab, 53.6% of those treated with etanercept compared with 41.2%, 41.9%, 25.3%, and 51.5% of those without metabolic conditions. Switching among patients on apremilast occurred in 45.8% and 44.6% of those with and without metabolic conditions, respectively.
In addition, the researchers found patients with metabolic conditions had significantly higher health care costs.
“Many psoriasis patients initiating biologics or apremilast had metabolic conditions. These patients had higher discontinuation and switching, and significantly higher healthcare costs,” the researchers concluded.
Reference
Feldman SR, Zhang J, Martinez DJ, et al. Real-world treatment patterns and healthcare costs of biologics and apremilast among patients with moderate-to-severe plaque psoriasis by metabolic condition status [published online November 26, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1698699
