BETHESDA, MD. — The Society for Investigative Dermatology has launched an ambitious multiyear, multidisciplinary research agenda focusing on skin disease comorbidities.
Initially, the Co-Morbidities of Skin Disease project will focus on three main areas: dermatotoxicity resulting from the use of cancer drugs; the association between psoriasis and cardiovascular disease; and the psychiatric and psychosocial aspects of dermatologic disease. With time, the SID aims to broaden both the research agenda and, ultimately, the scope of dermatologic practice.
At a “launch conference” sponsored by the SID with support from Abbott Laboratories, Amgen Inc., Centocor Inc., and OSI Pharmaceuticals Inc., participants met for a day and a half to review current knowledge, identify research priorities, and address potential avenues for collaboration and data collection. Over the next 6–9 months, the SID will publish the conference proceedings and post an online database at its comorbidities site, www.sidnetcommunity.org/como.htm
“At the most basic level, we recognize that patients affected by skin disease do not just have skin disease. … We've brought together people from cardiology, psychiatry, government, and industry. We want to develop new research communities,” said Dr. Robert Swerlick, chief of dermatology at Emory University, Atlanta, and director of the dermatology section at the Emory Clinic.
Collaboration is essential, noted conference chair Dr. Lowell A. Goldsmith, professor of dermatology at the University of North Carolina at Chapel Hill. “Dermatology can't do this by itself.”
More than 41 anticancer agents have been identified to cause 52 distinct dermatologic toxicities, which may affect the dose intensity of the antineoplastic regimen in a large proportion of cases. “The effect of this on clinical outcome hasn't been adequately studied … and there is a significant physical and psychosocial discomfort associated with these dermatologic toxicities,” said Dr. Mario E. Lacouture, who works in an interdisciplinary clinic involving dermatology, ophthalmology, and oncology at Northwestern University, Chicago.
Research efforts are focusing on therapies to treat or prevent these eruptions in patients undergoing chemotherapy, including oral tetracycline (Cancer 2008;113:847-53) and oral minocycline plus topical tazarotene (J. Clin. Oncol. 2007;25:5390-6). Currently there are 24 ongoing clinical trials in this area, he said.
The field of psychiatry and dermatology is potentially broader than the others but far less advanced. The literature often quotes the figure of 30% for the proportion of dermatology patients who have psychiatric comorbidities. However, that number has been repeated for decades with very little in the way of definitions or standardized measures, said Dr. Francisco Tausk, a professor in the departments of dermatology and psychiatry at the University of Rochester (N.Y.).
Included in this category are psychiatric diseases that affect the skin, such as delusions of parasitosis, trichotillomania, and skin picking, which can be extreme. The latter two are extremely common, but “we have no data on how prevalent they are or how to treat them,” Dr. Tausk said.
Then there are the skin diseases such as psoriasis, acne, and eczema that can be profoundly affected by psychiatric problems such as stress, depression, and anxiety.
Dr. Joel M. Gelfand, medical director of the clinical studies unit at the University of Pennsylvania, Philadelphia, summarized the current knowledge about the link between psoriasis and cardiovascular disease, his research focus. Data increasingly suggest that psoriasis is a chronic systemic inflammatory disease commonly associated with other conditions such as atherosclerosis and diabetes.
In a cohort study Dr. Gelfand and his associates recently published, patients with severe psoriasis who were seen by general practitioners in the United Kingdom in 1987–2002 had a threefold risk of mortality, compared with controls, even after adjustment for other mortality risk factors. Male patients with psoriasis died 3.5 years younger, and female patients, 4.4 years younger, an excess mortality similar to that of cardiovascular disease (Arch. Dermatol. 2007;143:1493-9).