DAY 1 - DAILY SUMMARY
April 9, 2021
Cutaneous Lupus: Symposium for Inflammatory Skin Disease 2021® Highlights
Ruth Ann Vleugels, MD, MPH, MBA
In a case-based review of cutaneous manifestations of lupus, Dr Ruth Ann Vleugels started with the acute malar rash of systemic lupus erythematosus (SLE), noting the distinct sparing of the nasolabial folds as a diagnostic clue. She implored dermatologists to initiate a workup for systemic disease whenever seeing a patient with an acute malar rash. Next was a case of discoid lupus (DLE). Dr. Vleugels discussed that the risk of developing SLE in patients with DLE may be higher than previously thought. She recommended screening all patients with DLE for systemic disease and initiating hydroxychloroquine in patients with risk factors for developing SLE (such as extensive disease, positive ANA, positive family history). Lupus panniculitis was reviewed next, with a reminder that this entity can commonly occur on the face in addition to the fatty areas of the trunk and extremities. Pearls about subacute cutaneous lupus (SCLE) included a review of the most common agents causing drug-induced SCLE – terbinafine, anti-TNFs, antiepileptics, and proton pump inhibitors – and a reminder that offspring of female patients with positive Ro antibodies have a risk of neonatal lupus. 
 
The therapeutic ladder for cutaneous lupus includes photoprotection, smoking cessation, topical agents (corticosteroids and calcineurin inhibitors), and systemic agents (antimalarials first, followed by methotrexate, mycophenolate mofetil, thalidomide, or lenalidomide for more refractory patients). Hydroxychloroquine is key, as it has been shown to be a disease-modifying agent in SLE.
Skin of Color and Inflammatory Skin Disease: Symposium for Inflammatory Skin Disease 2021® Highlights
Amy McMichael, MD
Dr. McMichael gave an excellent overview of the most common inflammatory skin diseases in skin of color (SOC) patients (Fitzpatrick skin types 4-6). This population encompasses African Americans, Asians/Pacific Islanders, Hispanics, and Native Americans.
 
With regard to acne, a common concern in SOC patients is post-inflammatory hyperpigmentation (PIH), and Dr. McMichael stresses this is important to address at the first visit, even if PIH is not treated until a later visit. A study of 30 African American females who had mild comedonal lesions biopsied revealed marked inflammation, possibly explaining why mild-moderate acne leads to PIH in SOC patients. In these patients, a retinoid alone is not enough, and an anti-inflammatory agent should be used.
 
Discoid lupus may have a comedonal presentation in SOC patients, with 10 cases reported in the literature. It may be treated as acne initially and should be considered for biopsy and treatment with hydroxychloroquine if unresponsive to conventional acne medications. Systemic lupus should be ruled out. 
 
Finally, African American patients have 69% lower odds of receiving biologics for the treatment of psoriasis in comparison to Caucasian patients. Psoriasis commonly appears violaceous in SOC patients, and early biopsy should be considered in these patients if there is no response to treatment.
Psoriasis comorbidities: Symposium for Inflammatory Skin Disease 2021® Highlights
Jashin Wu, M.D.
Jashin Wu, M.D., discussed a new epidemiologic study that he lead using the 2013-2014 National Health and Nutrition Examination Surveys.  His team determined that the prevalence of psoriasis in U.S. adults is 2.8%.  Then he discussed some recent studies regarding COVID-19 and psoriasis.  One study showed that psoriasis patients on biologics did not have a higher rate of hospitalization or death when compared to the general population. 
 
Dr. Wu then reviewed several articles that indicated that biologics may improve cardiovascular disease.  TNF inhibitors are associated with a reduction in major adverse cardiovascular events (MACE). Secukinumab improves endothelial function measured by flow-mediated dilation. Biologics also improve atherosclerosis and lipid-rich necrotic core which is a high-risk coronary plaque feature.  However, large prospective trials are needed to determine if biologics truly reduce MACE.