Faculty Bibliography

BACKGROUND:The value of additional photoprotection provided by use of high SPF sunscreens is controversial and limited clinical evidence exists. OBJECTIVE:To compare the sunburn protection provided by SPF100+ and SPF50+ sunscreen in conditions of actual use. METHODS:199 healthy men and women (≥18 years) participated in a natural sunlight, single exposure, split face, randomized, double blind study in Vail, Colorado. Each participant wore both sunscreens simultaneously during activities with no usage restrictions other than treatment area designation. Erythema was clinically assessed the day following exposure. Comparative efficacy was evaluated through bilateral comparison of sunburn between treatment areas and erythema score as evaluated separately for each treatment area. RESULTS:Following an average 6.1 ± 1.3 hours of sun exposure, investigator blinded evaluation identified 55.3% (110/199) of the participants as more sunburned on the SPF50+ and 5% (10/199) on the SPF100+ protected side. Post exposure, 40.7% (81/199) of the participants exhibited increased erythema scores ≥ 1 on the SPF50+ protected side as compared to 13.6% (27/199) on the SPF100+. LIMITATIONS/CONCLUSIONS:Single day exposure may not extrapolate to benefits of longer-term protection. CONCLUSION/CONCLUSIONS:SPF100+ sunscreen was significantly more effective in protecting against sunburn than SPF50+ sunscreen in actual-use conditions. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov(NCT02952235).

Background: Actinic keratosis is a very common disease that affects over 40 million people in the United States. In addition to the clinically visible lesion, patients may present with surrounding field cancerization based on their history of ultraviolet exposure. While lesiondirected therapy such as cryosurgery can effectively treat individual actinic keratoses it does not treat subclinical lesions or field cancerization. Objective: To create consensus recommendations on the role of field cancerization in selecting appropriate therapy for actinic keratoses. Methods: A comprehensive literature search of PubMed, Google Scholar, and Embase was conducted using the keywords "actinic keratos*," "treatment," and "field cancerization" for English-language original research articles without date restrictions. Articles were included that either discussed the role of FC in treating AKs or compared various AK field therapies. The relevant articles were then distributed to a panel of nine dermatologists with significant expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panel then convened on to discuss the studies and develop consensus statements on the role of FC in selecting AK therapy. The panel utilized a modified Delphi process to approve the adoption of each statement and gave each one a strength of recommendation based on SORT criteria. Results: The initial literature search produced 243 articles that met search criteria. After a thorough screening of these articles for relevance to the research question, 21 articles were chosen to be reviewed by the panel and assigned a level of evidence. Of the 21 articles that were reviewed, the panel assigned level 1 evidence to three articles, level 2 evidence to six articles, and level 3 evidence to twelve articles. The panel created seven consensus statements related to AK management and FC. All seven statements received a unanimous (9/9) vote for adoption. Each of the statements was given a strength of recommendation according to sort criteria. Conclusion: Field cancerization due to chronic ultraviolet exposure leads to subclinical AK lesions in addition to lesions that are clinically apparent. In order to address these lesions, field therapy is an important component of an adequate regimen and can be used in conjunction with lesion-directed therapy for optimal results.

BACKGROUND:COVID-19 has had significant negative economic ramifications on dermatologic care delivery, including curtailing live on-site physician-pharmaceutical-representative interactions (PPRI). OBJECTIVE:To determine the impact of COVID-19 and pandemic regulations on current and future PPRI. METHODS:Cross-sectional survey-based study that analyzed data from 400 surveyed dermatologists using a pre-validated questionnaire sent via email. Data regarding PPRI were collected over 1 week in July 2020 to compare demographics and practice standards from April 2019, April 2020, July 2020, and predictions for 2021. RESULTS:Virtual-only PPRI increased from 7.8% in April 2019 to 26.5% during April 2020 (mean difference, 18.8%; 95% confidence interval, 13.6%–23.9%). Virtual-only PPRI remained elevated at 24.5% while hybrid PPRI increased, eventually surpassing the April 2019 mark (27.0%). These trends persisted among all studied practice types and levels of experience. Practices predicted no significant percent differences in participation in PPRI (87.3% vs 90.3%; P=0.0834), but a significant shift in method of delivery where the odds ratio of incorporating a virtual component into PPRI in 2021 increased by a factor of 3. LIMITATIONS/CONCLUSIONS:Relatively small sample size, especially among subgroups. Responses may have been retrospective estimates. There may also be selection bias given slightly increased representation of more experienced dermatologists. CONCLUSION/CONCLUSIONS:PPRI materially decreased during the initial COVID-19 peak but will likely return to baseline volume moving forward with a significant component being hybrid PPRI. Further studies may better elucidate the economic and clinical impact associated with these changes and their effect on dermatologists’ ability to provide patients with samples and educational materials. J Drugs Dermatol. 2021;20(2):215-223. doi:10.36849/JDD.2021.5651.