CS 2023 Plenary Sessions

It’s not often you can surround yourself with experts in your field who are as willing to engage with you as you are with them—not unless you attend DF’s annual Clinical Symposium. Year after year, the event gathers illustrious speakers as well as kudos. People come to converse, learn, and debate.

We’ve selected summaries of mini-symposia presentations delivered in 2023 by Dr. Adewole Adamson, Dr. Jennifer Huang, Dr. Megan Noe, and Dr. Aimee Payne.

Off to the Races: Engineering CA(A)R-T Cells for Skin Disease Therapy

CAR T cell therapy is a personalized immunotherapy technology. A patient’s T cells are collected, genetically altered to express chimeric antigen receptors, and reinfused. CAR T cells seek out and kill target cells that express the specified antigen, such as CD19 or B cell maturation antigen (BCMA). Additionally, CAR T cells are programmed to proliferate and produce memory CAR T cells in the presence of target cells. Ongoing research into chimeric antigen receptor (CAR) T cell therapy and chimeric autoantibody receptor (CAAR) T cell therapy for cancers and autoimmune diseases, including pemphigus vulgaris (PV) may lead to clinical trials.

Don’t Miss it! Important Skin Diseases in Children

There are rare but important causes of neonatal blistering, diaper rash, and solitary skin nodules. Incontinentia pigmenti (IP), for example, is an X-linked dominant disorder affecting the skin, eyes, and central nervous system. IP is suspected when blisters occur in a blaschkoid distribution. Because IP is lethal in males, presentation of a female patient whose mother has a history of miscarriages can indicate this disease. IP can be diagnosed based solely on rash and skin biopsy results, without genetic testing. Early diagnosis and treatment can significantly reduce morbidity and mortality by preventing seizures and promoting development.

Top 10 Tips for Treating Skin Disease in Children with Cancer

Children with melanoma may present with different clinical characteristics than adults. They are more likely to present as amelanotic, rapidly growing nodules. Incorporate modified diagnostic criteria for pediatric melanoma and consider the evolution of a lesion. Pediatric melanoma is rare but often diagnosed too late.

Updates in Pustular Psoriasis

Pustular psoriasis is a group of inflammatory skin diseases characterized by visible, sterile pustules on inflamed skin. It appears in generalized and localized forms and can occur in patients with or without a history of psoriasis. Pustular psoriasis has distinct genetic risk factors, inflammatory profile, and response to treatment compared to psoriasis. Thus, it may be its own unique disease. PPP is characterized by sterile pustules on the palms and soles. There is no consensus on optimal treatment , although acitretin, methotrexate, and phototherapy are among the more common treatments.

Evidence-Based Vaccine Recommendations for Dermatology Patients

Although vaccines are typically discussed in primary care settings, dermatologists have an important role in vaccine education, especially when prescribing immunosuppressive medications that can increase risk of infections. Infections are more common in patients with chronic skin diseases due to disruption of the protective skin barrier, immune dysregulation associated with disease, and immunosuppressive treatments.

The Melanoma Epidemic: Real or Illusory

In 2023, the United States Preventive Services Task Force determined there was insufficient evidence to assess the balance of benefits and harms of screening for melanoma using a whole-body skin examination in the primary care setting in part due to the lack of randomized controlled studies. Such studies addressing the mortality benefit of screening for skin cancer would be a massive undertaking. On a practical level, there are not enough dermatologists in the country to screen all American adults for skin cancer.

Skin Cancer Disparities in Patients with Skin of Color

The incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma is significantly lower in darker skin types. In Black people, BCC is 2000-fold less common, and SCC is 500–1000-fold less common compared to non-Hispanic white people. Melanoma-related mortality rates in the US-based Black population has been declining during the past 20 years. Non-white race is associated with later melanoma detection and lower survival rates. Multiple risk factors have been proposed for skin cancers in skin of color including immunosuppression and previous scaring. More research is needed to understand the primary drivers of skin cancer in skin of color.