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Decreasing trends in melanoma incidence in children and adolescents from 2000 to 2009: A SEER analysis
P5942 Relatively high Foxp3/CD4 ratios in the symptomless skin of psoriatic patients suggesting active immune controlling mechanisms at a distance from the psoriatic plaque Romy Keijsers, MD, Radboud University Nijmegen Medical Centre, Department of Dermatology, Nijmegen, Netherlands; Hans Koenen, Radboud University Nijmegen Medical Centre, Department of Laboratory Medicine, Laboratory of Medical Immunology, Nijmegen, Netherlands; Irma Joosten, Radboud University Nijmegen Medical Centre, Department of Laboratory Medicine, Laboratory of Medical Immunology, Nijmegen, Netherlands; Peter van de Kerkhof, Radboud University Nijmegen Medical Centre, Department of Dermatology, Nijmegen, Netherlands; Piet van Erp, Radboud University Nijmegen Medical Centre, Department of Dermatology, Nijmegen, Netherlands; Roelie de Boer-van Huizen, Radboud University Nijmegen Medical Centre, Department of Dermatology, Nijmegen, Netherlands Background: In the pathogenesis of psoriasis, proinflammatory T cells are strongly involved in the inflammatory process, where regulatory T cell (Treg) function is impaired. Objectives: Because effective Treg function is associated with a numerical balance between Treg and effector T cells, we wondered whether Treg/T helper cell ratios may be associated with certain stages of the inflammatory process. We opted for the margin zone model as a dynamic approach. Methods: From 9 patients with chronic plaque psoriasis, 3-mm punch biopsy specimens were obtained from the center and margin of the lesion, perilesional skin, and distant uninvolved skin. Skin biopsy specimens of 10 healthy volunteers were included as controls. Samples were analyzed by immunohistochemistry and immunefluorescence. Results: In the transition from symptomless to lesional skin, a significant increase for CD3+, CD4+, and Foxp3+ cells was found. In 7 of 9 patients, the ratio Treg (Foxp3+) versus CD4+ T-cells was higher in the distant uninvolved skin than in the perilesional and lesional skin. Interestingly, the Foxp3/CD4 ratio in the distant uninvolved skin was even higher than in the skin of healthy controls. Notably, we found that the majority of IL-17 expression was not related to CD4+ cells, but to mast cells. Conclusion: The relatively high Foxp3/CD4 ratio in symptomless skin of psoriatic patients suggests an active immune controlling mechanism distant from the psoriatic plaque. In the margin and center of the plaque, the ratio appears skewed towards effector cells associated with inflammation. IL-17, an important driver of the psoriatic process, was mostly related to mast cells, and only sporadically to T cells. Commercial support: None identified.
PD03—PEDIATRIC DERMATOLOGY P7140 Adverse cutaneous reactions to psychotropic medications in the pediatric population Misha Heller, MD, Emory University, Department of Dermatology, Atlanta, GA, United States; Jenny Murase, MD, Palo Alto Foundation Medical Group, Department of Dermatology and University of California San Francisco Medical Center, Department of Dermatology, Mountain View, CA, United States; Josephine Howard, MD, Private Practice, Psychiatry and University of California San Francisco Medical Center, Departments of Dermatology and Psychiatry, San Francisco, CA, United States; Meagan Barrett, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Stefani Takahashi, MD, Keck School of Medicine of the University of Southern California, Department of Dermatology, Los Angeles, CA, United States Background: Psychotropic medications, including mood stabilizers, antidepressants, anxiolytics, antipsychotics, and stimulants are increasingly being prescribed to pediatric and adolescent patients. These medications are known to cause adverse cutaneous reactions. Although most dermatologic manifestations of psychotropic medications are benign, some may require immediate medical attention. Objective: The purpose of this review is to discuss the presentation and management of various types of adverse cutaneous drug reactions seen with psychotropic medications, including those seen with mood stabilizing agents, antidepressants, anxiolytics, antipsychotics, and stimulants. Methods: We searched the PubMed Medline database from January 1966 to October 2011 combining key terms including ‘‘adverse cutaneous reactions,’’ ‘‘psychotropic medications,’’ ‘‘mood stabilizers,’’ ‘‘antidepressants,’’ ‘‘antipsychotics,’’ and ‘‘pediatrics.’’ The search was limited to articles published in English. We also searched the Litt’s Drug Eruption and Reactions Manual database to identify the various adverse cutaneous drugs reactions observed with psychotropic medications. Results: Adverse cutaneous reactions to psychotropic medications are estimated to occur in as many as 5% of patients. The clinical features of common adverse cutaneous reactions (ie, pruritus, exanthematous eruptions, urticaria and angioedema, fixed drug eruptions, photosensitivity, pigmentation, diaphoresis, alopecia, serious and life-threatening cutaneous reactions [ie, erythema multiforme, StevenseJohnson syndrome and toxic epidermolysis necrolysis, drug hypersensitivity syndrome, vasculitis, exfoliative dermatitis, and anaphylactoid reactions], and general dermatologic conditions [ie, acneiform eruptions, psoriasiform eruption, seborrheic eruption, and lichenoid eruption]) frequently associated with psychotropic medications are described in this presentation. Conclusion: Adverse cutaneous reactions to psychotropic medications are common. In a small yet significant proportion of these reactions, the dermatologic manifestations can be life threatening. It is imperative that dermatologists can recognize these clinical presentations, identify all probable offending agents, and offer appropriate therapeutic management. Commercial support: None identified.
P6960
Results: At 12 week, the mean (6SD) reduction in body weight was 9.69% 6 2.63. There was an improvement from baseline of $ 50% in the Psoriasis Area and Severity Index score in 50% of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by physician and the patients and in the Dermatology Life Quality Index. Conclusion: Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients.
Decreasing trends in melanoma incidence in children and adolescents from 2000 to 2009: A SEER analysis Laura Campbell, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Jeremy Bordeaux, MD, MPH, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Jill Barnholtz-Sloan, PhD, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, OH, United States; Kyle Strodtbeck, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, OH, United States Background: Melanoma incidence in adults has been increasing over the past 30 years. However, melanoma incidence in children and adolescents has not been widely studied. Objective: To examine melanoma incidence patterns in children, adolescents, and young adults from 1973-2009. Methods: Surveillance, Epidemiology, and End Results (SEER-9) registries data were used to calculate annual melanoma incidence from 1973 to 2009 for the age groups 0 to 4, 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years. SEER-18 registries were also used to calculate melanoma incidence for the same age groups from 2000 to 2009, because SEER-18 provided the most melanoma cases and most detailed, clinically relevant information. SEER-18 incidence rates were stratified by gender, tumor site, Breslow depth, ulceration status, lymph node involvement, and distant metastases, and ageadjusted incidence trends were calculated, generating the annual percent change. Results: From 1973 to 2002, melanoma incidence rates increased in adolescents (ages 15-19 years), peaked in 2002, then trended downward. Similarly, in 10- to 14year-olds, rates increased from 1973 to 2004, peaked in 2004, then trended downward. In young adults (ages 20-24), rates increased from 1973 to 2003, peaked in 2003, then trended downward. In 5- to 9-year-olds, rates seemed stable from 1973 to 2001, peaked in 2001, then decreased. In 0- to 4-year-olds, rates peaked in 1986, but otherwise seemed stable from 1973 to 2009. From 2000 to 2009 (SEER-18), there was a statistically significant decreasing trend in melanoma incidence in 15- to 19year-olds (P ¼.04). Significant decreasing melanoma incidence trends (P\.05) were also found in: males 15 to 19; nodular melanoma in 10- to 14-year-olds; truncal melanoma in 15- to 19-year-olds; melanoma with thin depth (0.01-1.00 mm) in 15- to 19-year-olds; melanoma without ulceration in 15- to 19-year-olds; and melanoma without distant metastases in 15- to 19-year-olds. Discussion: Melanoma incidence increased in children (10-14) and adolescents (15-19) from 1973 to 2004 and 2002, respectively, then decreased. From 2000 to 2009, incidence significantly decreased in 15- to 19-year-olds. This decreasing trend was significant in males and melanomas with better prognostic indicators. In contrast, past pediatric and adult studies reported increasing melanoma incidence over broader time periods. Decreasing trends, however, have been reported for other countries in both children and adults. Perhaps increased adherence to sun protective measures in 15- to 19-year-old males accounts for recent trends.
Commercial support: None identified.
Commercial support: None identified.
P5934 The effect of weight loss in obese patients with chronic stable plaque-type psoriasis Wanjarus Roongpisuthipong, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Chulaporn Roongpisuthipong, MD, Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Marinya Pongpudpunth, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Natta Rajatanavin, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective: The objective was to investigate whether moderate weight loss (ie, 5-10% of body weight) increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Methods: A 24-week clinical trial was conducted in 10 patients. The efficacy of a lowcalorie diet with topical treatment was compared with baseline in obese patients (body mass index, [30 kg/m2) with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index score at week 12 and 24.
AB4
J AM ACAD DERMATOL
APRIL 2013
PD03—PEDIATRIC DERMATOLOGY P7140 Adverse cutaneous reactions to psychotropic medications in the pediatric population Misha Heller, MD, Emory University, Department of Dermatology, Atlanta, GA, United States; Jenny Murase, MD, Palo Alto Foundation Medical Group, Department of Dermatology and University of California San Francisco Medical Center, Department of Dermatology, Mountain View, CA, United States; Josephine Howard, MD, Private Practice, Psychiatry and University of California San Francisco Medical Center, Departments of Dermatology and Psychiatry, San Francisco, CA, United States; Meagan Barrett, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Stefani Takahashi, MD, Keck School of Medicine of the University of Southern California, Department of Dermatology, Los Angeles, CA, United States Background: Psychotropic medications, including mood stabilizers, antidepressants, anxiolytics, antipsychotics, and stimulants are increasingly being prescribed to pediatric and adolescent patients. These medications are known to cause adverse cutaneous reactions. Although most dermatologic manifestations of psychotropic medications are benign, some may require immediate medical attention. Objective: The purpose of this review is to discuss the presentation and management of various types of adverse cutaneous drug reactions seen with psychotropic medications, including those seen with mood stabilizing agents, antidepressants, anxiolytics, antipsychotics, and stimulants. Methods: We searched the PubMed Medline database from January 1966 to October 2011 combining key terms including ‘‘adverse cutaneous reactions,’’ ‘‘psychotropic medications,’’ ‘‘mood stabilizers,’’ ‘‘antidepressants,’’ ‘‘antipsychotics,’’ and ‘‘pediatrics.’’ The search was limited to articles published in English. We also searched the Litt’s Drug Eruption and Reactions Manual database to identify the various adverse cutaneous drugs reactions observed with psychotropic medications. Results: Adverse cutaneous reactions to psychotropic medications are estimated to occur in as many as 5% of patients. The clinical features of common adverse cutaneous reactions (ie, pruritus, exanthematous eruptions, urticaria and angioedema, fixed drug eruptions, photosensitivity, pigmentation, diaphoresis, alopecia, serious and life-threatening cutaneous reactions [ie, erythema multiforme, StevenseJohnson syndrome and toxic epidermolysis necrolysis, drug hypersensitivity syndrome, vasculitis, exfoliative dermatitis, and anaphylactoid reactions], and general dermatologic conditions [ie, acneiform eruptions, psoriasiform eruption, seborrheic eruption, and lichenoid eruption]) frequently associated with psychotropic medications are described in this presentation. Conclusion: Adverse cutaneous reactions to psychotropic medications are common. In a small yet significant proportion of these reactions, the dermatologic manifestations can be life threatening. It is imperative that dermatologists can recognize these clinical presentations, identify all probable offending agents, and offer appropriate therapeutic management. Commercial support: None identified.
P6960
Results: At 12 week, the mean (6SD) reduction in body weight was 9.69% 6 2.63. There was an improvement from baseline of $ 50% in the Psoriasis Area and Severity Index score in 50% of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by physician and the patients and in the Dermatology Life Quality Index. Conclusion: Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients.
Decreasing trends in melanoma incidence in children and adolescents from 2000 to 2009: A SEER analysis Laura Campbell, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Jeremy Bordeaux, MD, MPH, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Jill Barnholtz-Sloan, PhD, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, OH, United States; Kyle Strodtbeck, Case Comprehensive Cancer Center, CWRU School of Medicine, Cleveland, OH, United States Background: Melanoma incidence in adults has been increasing over the past 30 years. However, melanoma incidence in children and adolescents has not been widely studied. Objective: To examine melanoma incidence patterns in children, adolescents, and young adults from 1973-2009. Methods: Surveillance, Epidemiology, and End Results (SEER-9) registries data were used to calculate annual melanoma incidence from 1973 to 2009 for the age groups 0 to 4, 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years. SEER-18 registries were also used to calculate melanoma incidence for the same age groups from 2000 to 2009, because SEER-18 provided the most melanoma cases and most detailed, clinically relevant information. SEER-18 incidence rates were stratified by gender, tumor site, Breslow depth, ulceration status, lymph node involvement, and distant metastases, and ageadjusted incidence trends were calculated, generating the annual percent change. Results: From 1973 to 2002, melanoma incidence rates increased in adolescents (ages 15-19 years), peaked in 2002, then trended downward. Similarly, in 10- to 14year-olds, rates increased from 1973 to 2004, peaked in 2004, then trended downward. In young adults (ages 20-24), rates increased from 1973 to 2003, peaked in 2003, then trended downward. In 5- to 9-year-olds, rates seemed stable from 1973 to 2001, peaked in 2001, then decreased. In 0- to 4-year-olds, rates peaked in 1986, but otherwise seemed stable from 1973 to 2009. From 2000 to 2009 (SEER-18), there was a statistically significant decreasing trend in melanoma incidence in 15- to 19year-olds (P ¼.04). Significant decreasing melanoma incidence trends (P\.05) were also found in: males 15 to 19; nodular melanoma in 10- to 14-year-olds; truncal melanoma in 15- to 19-year-olds; melanoma with thin depth (0.01-1.00 mm) in 15- to 19-year-olds; melanoma without ulceration in 15- to 19-year-olds; and melanoma without distant metastases in 15- to 19-year-olds. Discussion: Melanoma incidence increased in children (10-14) and adolescents (15-19) from 1973 to 2004 and 2002, respectively, then decreased. From 2000 to 2009, incidence significantly decreased in 15- to 19-year-olds. This decreasing trend was significant in males and melanomas with better prognostic indicators. In contrast, past pediatric and adult studies reported increasing melanoma incidence over broader time periods. Decreasing trends, however, have been reported for other countries in both children and adults. Perhaps increased adherence to sun protective measures in 15- to 19-year-old males accounts for recent trends.
Commercial support: None identified.
Commercial support: None identified.
P5934 The effect of weight loss in obese patients with chronic stable plaque-type psoriasis Wanjarus Roongpisuthipong, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Chulaporn Roongpisuthipong, MD, Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Marinya Pongpudpunth, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Natta Rajatanavin, MD, Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Background: Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective: The objective was to investigate whether moderate weight loss (ie, 5-10% of body weight) increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Methods: A 24-week clinical trial was conducted in 10 patients. The efficacy of a lowcalorie diet with topical treatment was compared with baseline in obese patients (body mass index, [30 kg/m2) with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index score at week 12 and 24.
AB4
J AM ACAD DERMATOL
APRIL 2013