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Understanding ultraviolet radiation dorsal foot injury at the beach
3791 The spectrum of skin disease at the Korle Bu Teaching Hospital dermatology clinic in Accra, Ghana Rebecca Klein, University of Chicago Pritzker School of Medicine, Chicago, IL, United States; Brooke Rosenbaum, New York University School of Medicine, New York, NY, United States; Paa Gyasi Hagan, MD, University of Ghana Medical School, Accra, Ghana; Margaret Lartey, MD, University of Ghana Medical School, Accra, Ghana; Maria Robinson, MD, New York University School of Medicine, New York, NY, United States; Marie Leger, MD, PhD, New York University School of Medicine, New York, NY, United States Background: Skin complaints are a frequent cause of outpatient visits in Ghana and other developing nations. Many skin diseases pose significant health problems for local populations and a financial burden for families. However, epidemiologic studies on the true burden of disease are lacking in many regions. The WHO has therefore solicited studies that expand geographic representation and add to the growing knowledge base of skin disease epidemiology. Objective: The purpose of this study is to document the types and frequencies of skin conditions seen at the outpatient dermatology clinic at Korle Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana. This information will be valuable in guiding educational efforts and resource allocation. Methods: We performed a retrospective chart review of all new patients presenting to the KBTH Dermatology Clinic, over a 1-year time period in 2014. Patient charts were reviewed for basic demographic data and clinical information such as referral diagnosis, diagnostic tests, diagnoses, treatments and number of follow-up visits. Ethical clearance was obtained from the local and US partner IRBs. Results: 632 new patients who were seen at the KBTH dermatology clinic met criteria for inclusion, and 529 had medical records available for review. The majority of the 529 patients studied were female (56.6%) and the mean age was 32.1 6 23.5 years. In total, 678 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis/eczema (24.4%). 18 biopsies were performed. The treatments most commonly prescribed to patients were antihistamines (44.2%), topical steroids (38.0%), and keratolytics (26.8%). Patients attended an average of 2.7 6 2.4 clinic visits, with many patients only attending one visit (40.6%). Conclusions: Our results are in agreement with earlier studies from Ghana and other developing countries. A 1995 study of skin disease in Kumasi, a central Ghanaian city, showed infectious etiologies and dermatitis to be common. Our study also showed that biopsies were infrequent, likely due to the lack of local dermatopathology resources. Local affordable formulary was limited, but generally adequate. Limitations: Frequency data were obtained retrospectively from a single outpatient clinic; therefore, results are subject to a selection bias and may not be generalizable to the general population.
GENODERMATOSES 3114 A case of mal de Meleda successfully treated with alitretinoin Eui Hyun Oh, MD, Hanyang University College of Medicine, Seoul, South Korea; Byeong Jin Park, MD, Hanyang University College of Medicine, Seoul, South Korea; Jae Min Shin, MD, Hanyang University College of Medicine, Seoul, South Korea; Jeong Eun Kim, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea; Joo Yeon Ko, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea; Young Suck Ro, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea Mal de Meleda (MDM), also known as keratoderma palmoplantaris transgrediens, is an autosomal recessive form of palmoplantar keratoderma, with mutations in the ARS gene, encoding SLURP-1. This condition is characterized by diffuse erythema and hyperkeratosis of the hands and feet that appears soon after birth and progressively extends to the dorsal aspect of the hands and feet. Since MDM is a rare genetic disorder, no standardized treatment has been established. Treatment options for MDM include topical keratolytic agents, propylene glycol, topical 5fluorouracil and surgical treatment. In addition, it has been reported that etretinate and acitretin, which are aromatic retinoids, usually produce improvement in MDM. However, early and long-term use of these retinoids associate with several wellknown adverse effects such as a long period of contraception and liver toxicity. A 20year old woman, previously diagnosed as MDM by gene mutation in SLURP-1, presented with extensive palmoplantar hyperkeratosis which extended on to the dorsal surfaces of the hands and feet since birth. She also complained of palmoplantar malodor and tinea pedis recurred intermittently, especially in summer. She administered oral acitretin 20 mg/day for 30 months, but the clinical features did not show the significant change. A modest improvement of pruritus and palmoplantar hyperkeratosis was observed, but most of lesion remained. After 3 months of treatment with alitretinoin 30 mg/day instead of acitretin, however, her symptoms and signs improved significantly. Especially, the extent and thickness of palmoplantar hyperkeratosis decreased significantly. No local or systemic adverse events were observed. In addition, she reported less mucocutaneous side effects after drug replacement. Alitretinoin (9-cis-retinoic acid) is thought to be more effective in disorders of keratinization as a pan-agonist of retinoic acid receptors. It also results in less mucocutaneous adverse effects than other retinoids and requires only 1 month of contraception once therapy is completed. Herein, we present a case of MDM which showed significant clinical improvement with alitretinoin, which could be a new and promising treatment option for MDM. Commercial support: None identified.
Commercial support: None identified.
2555 Understanding ultraviolet radiation dorsal foot injury at the beach Neil Jackson, The University of Texas Medical Branch, Galveston, TX, United States; Timothy Allen, The University of Texas Medical Branch, Galveston, TX, United States; Richard Wagner, MD, JD, The University of Texas Medical Branch, Galveston, TX, United States Background: The dorsal feet can be protected from ultraviolet radiation (UVR) injury at the beach by using shade, shoes, and sunscreen. However, efforts made to protect the dorsal aspect of the foot are currently unknown. Objective: The primary goal of the study was to determine if beachgoers protected the dorsal aspect of their feet as frequently as other anatomic sites. Additional information collected included subject demographics and general knowledge about skin cancer to determine if these variables were significantly correlated with dorsal foot protection from UVR injury. Methods: A convenience sample of 216 Galveston beachgoers completed anonymous surveys to assess whether the dorsal foot was at risk for UVR injury.
3797
Results: 112 of 215 participants (52.1%) did not apply sunscreen to their dorsal feet. 78% of nonusers explained, ‘‘I did not think about it.’’ The average number of applications of sunscreen per person to the dorsal feet was less than other anatomic body sites (1.19 body applications, 0.86 leg applications, and 0.58 average dorsal feet applications per person; P \.0001). Of 142 beachgoers using sunscreen on the lower extremity, 34.5% applied sunscreen to only the leg or dorsal foot. Additionally, 58% of females applied sunscreen to the top of their feet, compared to only 35% of men (P ¼ .001). Furthermore, individuals who characterized themselves as Fitzpatrick skin types (FST) 5-6 did not apply sunscreen to the dorsal foot as regularly as individuals with FST 1-4 (84.6% of FST 5-6 did not apply vs. 47.6% of FST 1-4; P ¼.0001). Discussion: In this population of beachgoers, only 47.9% used a topical UVR barrier on their dorsal feet. Men and subjects with higher FST were less likely to apply sunscreen to their dorsal feet. Current skin cancer epidemiology pairs the foot with the leg together as ‘‘lower extremity.’’ However, we found that 34.5% of beachgoers using sunscreen on the lower extremity only applied sunscreen to either the leg or foot. For epidemiologic purposes in UVR research, feet and legs should be considered to be distinct areas since they may differ in photoprotection strategies.
A case of multiple skin cancers in a patient with oculocutaneous albinism type 2 Liza McClellan, MD, Roger Williams Medical Center, Department of Dermatology, Providence, RI, United States; Jack Cossman, MD, Roger Williams Medical Center Department of Dermatology, Providence, RI, United States; John Fournier, MD, Roger Williams Medical Center, Department of Dermatology, Providence, RI, United States
Commercial support: None identified.
Commercial support: None identified.
MAY 2016
A 60-year-old woman with history of oculocutaneous albinism (OCA) type 2 presents with multiple nonmelanoma skin cancers. Patient was originally from Liberia and was treated as a child for her albinism with daily sun exposure. As an adult, she subsequently developed multiple skin cancers (four squamous cell carcinomas and three basal cell carcinomas have been diagnosed). OCA type 2 is caused by mutations in the OCA2 gene, also known as the P-gene, at chromosome 15q11-q13. OCA type 2 is the most common type of albinism, with high frequency in equatorial Africa. This case illustrates the importance of sun protection and proper counseling on sun exposure for patients with albinism. In addition, it also illustrates the importance of frequent screening skin exams for these patients as they are at higher risk of developing skin cancer.
J AM ACAD DERMATOL
AB123
GENODERMATOSES 3114 A case of mal de Meleda successfully treated with alitretinoin Eui Hyun Oh, MD, Hanyang University College of Medicine, Seoul, South Korea; Byeong Jin Park, MD, Hanyang University College of Medicine, Seoul, South Korea; Jae Min Shin, MD, Hanyang University College of Medicine, Seoul, South Korea; Jeong Eun Kim, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea; Joo Yeon Ko, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea; Young Suck Ro, MD, PhD, Hanyang University College of Medicine, Seoul, South Korea Mal de Meleda (MDM), also known as keratoderma palmoplantaris transgrediens, is an autosomal recessive form of palmoplantar keratoderma, with mutations in the ARS gene, encoding SLURP-1. This condition is characterized by diffuse erythema and hyperkeratosis of the hands and feet that appears soon after birth and progressively extends to the dorsal aspect of the hands and feet. Since MDM is a rare genetic disorder, no standardized treatment has been established. Treatment options for MDM include topical keratolytic agents, propylene glycol, topical 5fluorouracil and surgical treatment. In addition, it has been reported that etretinate and acitretin, which are aromatic retinoids, usually produce improvement in MDM. However, early and long-term use of these retinoids associate with several wellknown adverse effects such as a long period of contraception and liver toxicity. A 20year old woman, previously diagnosed as MDM by gene mutation in SLURP-1, presented with extensive palmoplantar hyperkeratosis which extended on to the dorsal surfaces of the hands and feet since birth. She also complained of palmoplantar malodor and tinea pedis recurred intermittently, especially in summer. She administered oral acitretin 20 mg/day for 30 months, but the clinical features did not show the significant change. A modest improvement of pruritus and palmoplantar hyperkeratosis was observed, but most of lesion remained. After 3 months of treatment with alitretinoin 30 mg/day instead of acitretin, however, her symptoms and signs improved significantly. Especially, the extent and thickness of palmoplantar hyperkeratosis decreased significantly. No local or systemic adverse events were observed. In addition, she reported less mucocutaneous side effects after drug replacement. Alitretinoin (9-cis-retinoic acid) is thought to be more effective in disorders of keratinization as a pan-agonist of retinoic acid receptors. It also results in less mucocutaneous adverse effects than other retinoids and requires only 1 month of contraception once therapy is completed. Herein, we present a case of MDM which showed significant clinical improvement with alitretinoin, which could be a new and promising treatment option for MDM. Commercial support: None identified.
Commercial support: None identified.
2555 Understanding ultraviolet radiation dorsal foot injury at the beach Neil Jackson, The University of Texas Medical Branch, Galveston, TX, United States; Timothy Allen, The University of Texas Medical Branch, Galveston, TX, United States; Richard Wagner, MD, JD, The University of Texas Medical Branch, Galveston, TX, United States Background: The dorsal feet can be protected from ultraviolet radiation (UVR) injury at the beach by using shade, shoes, and sunscreen. However, efforts made to protect the dorsal aspect of the foot are currently unknown. Objective: The primary goal of the study was to determine if beachgoers protected the dorsal aspect of their feet as frequently as other anatomic sites. Additional information collected included subject demographics and general knowledge about skin cancer to determine if these variables were significantly correlated with dorsal foot protection from UVR injury. Methods: A convenience sample of 216 Galveston beachgoers completed anonymous surveys to assess whether the dorsal foot was at risk for UVR injury.
3797
Results: 112 of 215 participants (52.1%) did not apply sunscreen to their dorsal feet. 78% of nonusers explained, ‘‘I did not think about it.’’ The average number of applications of sunscreen per person to the dorsal feet was less than other anatomic body sites (1.19 body applications, 0.86 leg applications, and 0.58 average dorsal feet applications per person; P \.0001). Of 142 beachgoers using sunscreen on the lower extremity, 34.5% applied sunscreen to only the leg or dorsal foot. Additionally, 58% of females applied sunscreen to the top of their feet, compared to only 35% of men (P ¼ .001). Furthermore, individuals who characterized themselves as Fitzpatrick skin types (FST) 5-6 did not apply sunscreen to the dorsal foot as regularly as individuals with FST 1-4 (84.6% of FST 5-6 did not apply vs. 47.6% of FST 1-4; P ¼.0001). Discussion: In this population of beachgoers, only 47.9% used a topical UVR barrier on their dorsal feet. Men and subjects with higher FST were less likely to apply sunscreen to their dorsal feet. Current skin cancer epidemiology pairs the foot with the leg together as ‘‘lower extremity.’’ However, we found that 34.5% of beachgoers using sunscreen on the lower extremity only applied sunscreen to either the leg or foot. For epidemiologic purposes in UVR research, feet and legs should be considered to be distinct areas since they may differ in photoprotection strategies.
A case of multiple skin cancers in a patient with oculocutaneous albinism type 2 Liza McClellan, MD, Roger Williams Medical Center, Department of Dermatology, Providence, RI, United States; Jack Cossman, MD, Roger Williams Medical Center Department of Dermatology, Providence, RI, United States; John Fournier, MD, Roger Williams Medical Center, Department of Dermatology, Providence, RI, United States
Commercial support: None identified.
Commercial support: None identified.
MAY 2016
A 60-year-old woman with history of oculocutaneous albinism (OCA) type 2 presents with multiple nonmelanoma skin cancers. Patient was originally from Liberia and was treated as a child for her albinism with daily sun exposure. As an adult, she subsequently developed multiple skin cancers (four squamous cell carcinomas and three basal cell carcinomas have been diagnosed). OCA type 2 is caused by mutations in the OCA2 gene, also known as the P-gene, at chromosome 15q11-q13. OCA type 2 is the most common type of albinism, with high frequency in equatorial Africa. This case illustrates the importance of sun protection and proper counseling on sun exposure for patients with albinism. In addition, it also illustrates the importance of frequent screening skin exams for these patients as they are at higher risk of developing skin cancer.
J AM ACAD DERMATOL
AB123