Skin cancer perception among vitiligo patients
Skin colour, gender, amount of depigmentation will have a bearing on perceived risk and sun protective behaviour (1,500 words, 7 minutes 30 seconds)
Recent studies indicate that the perceived risk of skin cancer and sun-protective behaviours among individuals with vitiligo differ according to skin colour, gender, and the extent of depigmentation.
The findings come from a paper published in the Archives of Dermatological Research.
“Many individuals with vitiligo are uncertain about their skin cancer risk, phototherapy risks, and recommended sun protective practices,” the authors write.
To better understand this population's perception of skin cancer risk and sun protective behaviours, researchers conducted a prospective cross-sectional study using an online survey distributed to vitiligo support group leaders globally. Those group leaders then shared the survey with their members.
There were 209 total survey respondents. Of those, the majority were between the ages 35 to 54 years (45.5%, n=95), female (70.8%, n=148), and White (66.0%, n=138).
Survey findings showed nearly half of respondents believed they were at increased risk of skin cancer because of their vitiligo (45.5%, n=95), and almost one-quarter (22.5%, n=47) believed that phototherapy increased their risk of skin cancer. Their beliefs contrast with evidence in the literature indicating a decreased risk of skin cancer in individuals with vitiligo and supporting the safety of narrowband ultraviolet B phototherapy, the authors write.
Vitiligo affects sun-protective practices. Less than one-quarter (24.4%, n=51) of respondents reported using sunscreen daily or often before their vitiligo diagnosis, compared to most respondents (60.3%, n=126) using it after their vitiligo diagnosis.
The three most common sources where patients obtained information were the internet and social media (46.4%, n=97), vitiligo support groups (23.4%, n=49), and dermatologists (20.6%, n=43).
The investigators also found differences in sunscreen usage based on gender, skin colour, and per cent depigmentation. Most of those who reported using sunscreen regularly, at higher SPF levels and reapplying sunscreen were White and female. Most individuals with more than 50% depigmentation reported reapplying sunscreen, wearing UPF clothing, and selecting sunscreens with higher SPF levels.
The researchers note that one limitation of the study is the small number of participants, which may limit the generalizability of the findings.
Bottom line: There are demographic differences in how patients with vitiligo perceive their risk of skin cancer and how often they engage in sun-protective behaviours. However, misunderstanding the role of vitiligo and phototherapy in skin cancer risk is fairly widespread. Dermatologists are only the third-most common source of vitiligo health information for individuals with the skin condition.
From the literature on pigment disorders in skin of colour
Representation of skin of colour in social media discussions on melasma, keloids, and vitiligo
This study evaluated the nature of social media content related to vitiligo, melasma and keloids.
In March 2023, researchers identified the top five hashtags for vitiligo, melasma, and keloid on the social media platforms Instagram and TikTok. They then selected the 10 most popular posts for each hashtag and categorized them as Educational, Promotional, or Inspirational. Researchers further classified the posts by content creator type.
The investigators found for the top 50 posts related to melasma on Instagram, the majority were promotional (58%), with the most common source being non-dermatologist social media influencers (50%). Dermatologists were the primary content creators for specific hashtags, such as #Melasma on TikTok, where the content was predominantly educational.
They conclude that considering the high prevalence of dermatologist-creator content on TikTok, it is crucial to continue shifting toward dermatologist-driven educational content as social media platforms grow.
The lifetime risk and impact of vitiligo across socio-demographic groups: UK.. population-based cohort study
The authors of this paper estimated the lifetime incidence of vitiligo overall by ethnicity and across other socio-demographic subgroups. They also investigated the impacts of vitiligo on mental health, work, and healthcare utilization.
Using theU.K.. Optimum Patient Care Database of primary care records, researchers identified incident vitiligo cases between Jan. 1, 2004, and Dec. 31, 2020. They estimated lifetime vitiligo incidence at age 80, overall and stratified by ethnicity, sex, and deprivation. Investigators also assessed depression, anxiety, sleep disturbance, healthcare utilization and work-related outcomes in the two years after vitiligo diagnosis and compared them to matched controls.
There were 9,460 adults and children newly diagnosed with vitiligo. The researchers found the overall cumulative lifetime incidence was 0.92% at age 80 (95% Confidence Interval [CI] 0.90, 0.94). Cumulative incidence was similar in females, 0.94% (95%CI 0.92, 0.97) and males, 0.89% (95%CI 0.86, 0.92). There were substantial differences in lifetime incidence across ethnic groups: Asian 3.58% (95%CI 3.38, 3.78), Black 2.18% (95%CI 1.85, 2.50), mixed 2.03% (95%CI 1.58, 2.47), other 1.05% (95%CI 0.94, 1.17) and White ethnicity 0.73% (95%CI, 0.71, 0.76). People with vitiligo had an increased risk of depression (adjusted Odds Ratio [aOR] 1.08; 95%CI 1.01, 1.15), anxiety (aOR 1.19; 95%CI 1.09, 1.30), depression or anxiety (aOR 1.10; 95%CI 1.03, 1.17) and sleep disturbance (adjusted Hazard Ratio [aHR] 1.15; 95%CI 1.02, 1.31) compared to matched controls. People with vitiligo also had more primary care encounters (adjusted incidence rate ratio 1.29; 95%CI 1.26, 1.32) and a greater risk of time off work (aHR 1.15; 95%CI 1.06, 1.24). There was little evidence of disparities in vitiligo-related impacts across ethnic subgroups.
Reliability of the Vitiligo Area Scoring Index measurement tool for vitiligo
In this prospective study, 12 raters evaluated images of 10 participants with vitiligo on two occasions using total body Vitiligo Area Scoring Index (T-VASI) and facial Vitiligo Area Scoring Index (F-VASI) scores after training. The participants’ Fitzpatrick skin types ranged from II to VI. Using intraclass correlation coefficients, investigators determined inter- and interrater reliabilities and accuracy vs digital scores. They evaluated VASI 10% scores separately for interrater reliability and accuracy.
The authors found that F-VASI interrater reliability improved from “moderate” to “good” between time points, while T-VASI was “good” at both time points. Intrarater reliability ranged from “good” to “excellent” for T-VASI and “poor” to “excellent” for F-VASI. The accuracy intraclass correlation coefficient was “good” to “excellent” for most raters. Interrater reliability using VASI was 10%, which was “moderate” for both T-VASI and F-VASI.
Racial and ethnic diversity in vitiligo clinical trials: A retrospective cross-sectional study assessing demographic reporting of participants
Researchers assessed demographic reporting trends in U.S. vitiligo clinical trials to determine whether participants are representative of the U.S. population.
Investigators searched clinicaltrials.gov for vitiligo clinical trials conducted between 2006 and Sept. 5, 2023, that either reached completion or were terminated.
Of the 15 trials that met the inclusion criteria, only 60% (n=9) reported participant race or ethnicity. These nine studies included 1,510 participants, of which only 25.43% (n=384) were non-White and 20.40% were Hispanic. There was disproportionately low representation of racial minorities, particularly Black, Native American, and Native Hawaiian groups.
At the intersection of skin and society
A director of New Zealand’s medicine funding agency, Pharmac, has resigned in protest of a government directive telling the agency that it no longer needed to consider the Treaty of Waitangi, the country’s founding document which upholds Māori rights, in its funding decisions, reports The Guardian.
The directive came from the country’s associate health minister, David Seymour, who also leads the Act political party.
According to the news report, Pharmac had been charged by the nation’s previous Labour government to consider the principles of the Treaty of Waitangi, also known as Te Tiriti o Waitangi, in its policies and decision-making. The treaty, signed by Māori chiefs and the Crown in 1840, included principles that ensured Māori well-being, health, and rights.
In a letter that conveyed the directive, Seymour said considering the treaty is not “an appropriate expectation to place on Pharmac.”
“Pharmac’s role should focus on delivering improved health outcomes underpinned by robust data and evidence, in accordance with its statutory responsibilities,” he said in the letter.
“This should serve all New Zealanders based on actual need, without assigning their background as a proxy of need.”
After the directive, Pharmac’s now-former director, Dr. Anthony Jordan, said he could not in good conscience continue in his role.
In an interview with the Guardian, Dr. Jordan said the decision did not “sit well” with his beliefs as a physician and Māori.
Dr. Jordan said he believed the government had ignored clear evidence that Pharmac’s past consideration of the treaty had improved health outcomes for Māori.
Registration is open for the 2024 Colloquium on the Black Patient
In recognition of persistent gaps in dermatologic training concerning skin of colour, the Colloquium on the Black Patient will discuss topics in dermatology specific to Black patients and recent progress in advancing the inclusion of diverse skin tones in research and medical education.
Chaired by Dr. Andrew Alexis (New York), this live discussion will be held virtually on Saturday, Aug. 17, 2024, from 10 a.m. to 1:30 p.m.E.TT.
Speakers include:
Dr. Renée Beach (Toronto)
Dr. Ncoza Dlova (Umhlanga, South Africa)
Dr. Marissa Joseph (Toronto)
Dr. Jenna Lester (San Francisco)
Dr. Monica Li (Vancouver)
Dr. Yvette Miller-Monthrope (Toronto)
Dr. Patricia Oyetakin (Atlanta)
Dr. Susan C. Taylor (Philadelphia)
Dr. Heather Woolery-Lloyd (Miami)
The Colloquium will cover the state of therapies, research, and education in dermatology for skin of colour, focusing on progress in Canada.
This non-accredited program will be available to attend at no charge, thanks to the support of our sponsors.
More details are available at this link.
This week
July 30 is World Day Against Trafficking in Persons
August is Hair Loss Awareness Month
Aug. 1 to 7 is National Minority Donor Awareness Week
Something to think about in the week ahead . . .
—John C. Maxwell, U.S. author of “The 21 Indispensable Qualities of a Leader” (1947-present)
Next week
In a talk at the 2024 Atopic Dermatitis Summit, Dr. Carloyn Jack (Montreal) discussed her experience supporting Cree patients with ADD.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jerry Tan (Windsor, Ont.) shares his thoughts on recent findings showing that benzoyl peroxide in acne products can break down into benzene when stored in high-temperature conditions.
Drs. Andrei Metelitsa (Calgary), Geeta Yadav (Toronto), and Rahul Shukla (Hamilton, Ont.) review several current innovations in cosmetic dermatology.
Drs. Jason Rivers (Vancouver), Cheryl Rosen (Toronto), Peter Hull (Halifax), and Jennifer Beecker (Ottawa) provide an overview of essential news in melanoma, including the use of artificial intelligence to support screening.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.