News in brief: Adverse cutaneous reactions to HCQ; Liver function checks in psoriatic disease; Melanoma missed diagnoses

3 Mar 2021

Skin reactions to HCQ unexplained

Adverse cutaneous reactions (ACR) secondary to hydroxychloroquine are more common in patients with dermatomyositis than in other inflammatory skin conditions however there are no obvious predictors of any additional risk.

A US study compared the incidence of ACRs in 1,163 patients with dermatomyositis, 271 patients with cutaneous lupus erythematosus (CLE), and 74 patients with lichen planopilaris (LPP).

It found the incidence of ACRs was 9.2% in patients with dermatomyositis and 5% in patients with LPP. There were no ACRs in cutaneous lupus.

In contrast however, non-HCQ drug allergies were more common in patients with CLE (66.7%) versus dermatomyositis (50%) and LPP (47%).

“Specifically, hypersensitivity to sulfa was more common in CLE patients (p=.004),” the Research Letter said.

The study noted older patients were numerically more likely to develop a reaction to HCQ than younger patients and dermatomyositis patients on immunosuppression were less likely to have ACRs than those who were not.

“This is potentially clinically useful information as, if immunosuppressant use is protective, the addition of HCQ only after immunosuppression may help reduce the risk for allergy to HCQ.”

Journal of the American Academy of Dermatology

Patients with psoriatic disease susceptible to MTX hepatotoxicity

Patients with psoriasis and psoriatic arthritis are more likely to develop serious liver complications from methotrexate than patients with rheumatoid arthritis (RA) treated with the immunosuppressant, according to findings from a large Danish study.

The finding continued to be true even after adjusting for methotrexate dose and other risk factors for liver disease such as obesity and alcohol use.

Researchers compared the medical records  from a national Danish database of more than 28,000 patients with psoriasis, psoriatic arthritis or RA receiving methotrexate over a 20-year period, finding that the incidence rate of any liver disease was greatest for PsO, followed by PsA, and lowest for RA.

Patients with PsO were 1.6-3.4 times more likely to develop liver disease outcomes while those with psoriatic arthritis were 1.3-1.6 times more likely to develop mild liver disease and cirrhosis compared to patient with RA, the investigators report.

The findings have prompted investigators to urge clinicians ‘carefully and regularly’ monitor their patients’ liver health and function if they are on methotrexate.

Journal of the American Association of Dermatology

How many melanomas missed during pandemic?

Victoria’s pandemic restrictions in 2020 led to hundreds of melanoma diagnoses being either delayed or missed, according to modelling  of observed vs expected cases released by the Victorian Cancer registry.

Published in the MJA, the analysis found that 7168 melanomas were predicted for the period of 1 April – 15 October 2020 in Victoria but only 6217 pathology notifications were recorded. The difference of 13.3% translated into an estimated 511 undiagnosed melanomas in Victoria, the researchers said. There was an overall drop of 10% in cancer pathology reporting with the biggest reductions in notifications being for prostate (-26%), head and neck cancer (-15%) and breast cancer (-10%).

“Planning for a possible surge in cancer diagnoses over the coming 6-12 months, and media campaigns encouraging people to not further delay seeking medical attention, may ameliorate any negative impact of delayed cancer diagnosis,” the authors wrote.

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