Sexual Orientation and Lifetime Prevalence of Skin Cancer Across Racial and Ethnic Groups.

Importance: Sexual minority (SM) persons have been found to have differential rates of skin cancer, but limited data exist on differences across racial and ethnic groups and by individual sexual identities. Objective: To examine differences by sexual orientation in the lifetime prevalence of skin cancer among US adult females and males across racial and ethnic groups and by individual sexual identity. Design, Setting, and Participants: This cross-sectional study used data from the Behavioral Risk Factor Surveillance System from January 1, 2014, to December 31, 2021, for US adults from the general population. Data were analyzed from December 1, 2023, to March 1, 2024. Main Outcomes and Measures: Self-reported lifetime prevalence of skin cancer by sexual orientation. Age-adjusted prevalence and adjusted prevalence odds ratios (AORs) compared heterosexual and SM adults in analyses stratified by individual race. Results: Of 1 512 400 participants studied, 805 161 (53.2%) were heterosexual females; 38 933 (2.6%), SM females; 638 651 (42.2%), heterosexual males; and 29 655 (2.0%), SM males. A total of 6.6% of participants were Hispanic; 3.4%, non-Hispanic Asian, Pacific Islander, or Hawaiian; 7.5%, non-Hispanic Black; 78.2%, non-Hispanic White; and 4.3%, other race and ethnicity. Mean (SE) age was 48.5 (0.03) years (incomplete data for age of respondents ≥80 years). The lifetime prevalence of skin cancer was overall higher among SM males compared with heterosexual males (7.4% vs 6.8%; AOR, 1.16; 95% CI, 1.02-1.33), including specifically among Hispanic males (4.0% vs 1.6%; AOR, 3.81; 95% CI, 1.96-7.41) and non-Hispanic Black males (1.0% vs 0.5%; AOR, 2.18; 95% CI, 1.13-4.19) in analyses stratified by race and ethnicity. Lifetime prevalence rates were lower among SM females compared with heterosexual females among non-Hispanic White females (7.8% vs 8.5%; AOR, 0.86; 95% CI, 0.76-0.97) and were higher among Hispanic (2.1% vs 1.8%; AOR, 2.46; 95% CI, 1.28-4.70) and non-Hispanic Black (1.8% vs 0.5%; AOR, 2.33; 95% CI, 1.01-5.54) females in analyses stratified by race and ethnicity. Conclusions and Relevance: In this cross-sectional study of US adults, differences in the lifetime prevalence of skin cancer among SM adults compared with heterosexual adults differed across racial and ethnic groups and by individual sexual identity among both females and males. Both Hispanic and non-Hispanic Black and SM females and males had higher rates of skin cancer compared with their heterosexual counterparts. Further research addressing the individual factors contributing to these differences is needed to inform screening guidelines and public health interventions focused on these diverse, heterogeneous populations.

Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action.

Objectives: Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. Methods: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. Results: Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. Conclusions: Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.

Diversity and Career Goals of Graduating Allopathic Medical Students Pursuing Careers in Dermatology.

Importance: Dermatology is one of the least diverse specialties, while patients from minority racial and ethnic groups and other underserved populations continue to face numerous dermatology-specific health and health care access disparities in the US. Objectives: To examine the demographic characteristics and intended career goals of graduating US allopathic medical students pursuing careers in dermatology compared with those pursuing other specialties and whether these differ by sex, race and ethnicity, and/or sexual orientation. Design, Setting, and Participants: This secondary analysis of a repeated cross-sectional study included 58 077 graduating allopathic medical students using data from the 2016 to 2019 Association of American Medical Colleges Graduation Questionnaires. Main Outcomes and Measures: The proportion of female students, students from racial and ethnic groups underrepresented in medicine (URM), and sexual minority (SM) students pursuing dermatology vs pursuing other specialties. The proportions and multivariable-adjusted odds of intended career goals between students pursuing dermatology and those pursuing other specialties and by sex, race and ethnicity, and sexual orientation among students pursuing dermatology. Results: A total of 58 077 graduating students were included, with 28 489 (49.0%) female students, 8447 (14.5%) URM students, and 3641 (6.3%) SM students. Female students pursuing dermatology were less likely than female students pursuing other specialties to identify as URM (96 of 829 [11.6%] vs 4760 of 27 660 [17.2%]; P < .001) or SM (16 [1.9%] vs 1564 [5.7%]; P < .001). In multivariable-adjusted analyses, students pursuing dermatology compared with other specialties had decreased odds of intending to care for underserved populations (247 of 1350 [18.3%] vs 19 142 of 56 343 [34.0%]; adjusted odd ratio [aOR], 0.40; 95% CI, 0.35-0.47; P < .001), practice in underserved areas (172 [12.7%] vs 14 570 [25.9%]; aOR, 0.40; 95% CI, 0.34-0.47; P < .001), and practice public health (230 [17.0%] vs 17 028 [30.2%]; aOR, 0.44; 95% CI, 0.38-0.51; P < .001) but increased odds of pursuing research (874 [64.7%] vs 29 121 [51.7%]; aOR, 1.76; 95% CI, 1.57-1.97; P < .001) in their careers. Among students pursuing dermatology, female, URM, and SM identities were independently associated with increased odds of caring for underserved populations (eg, URM: aOR, 4.05; 95% CI, 2.83-5.80) and practicing public health (eg, SM: aOR, 2.55; 95% CI, 1.51-4.31). URM students compared with non-URM students pursuing dermatology had increased odds of intending to practice in underserved areas (aOR, 3.93; 95% CI, 2.66-5.80), and SM students compared with heterosexual students pursuing dermatology had increased odds of intending to become medical school faculty (aOR, 1.60; 95% CI, 1.01-2.57), to pursue administrative roles (aOR, 1.60; 95% CI, 1.01-2.59), and to conduct research (aOR, 1.73; 95% CI, 1.01-2.98). Conclusions and Relevance: The findings of this cross-sectional study suggest that diversity gaps continue to exist in the dermatology workforce pipeline. Efforts are needed to increase racial and ethnic and sexual orientation diversity and interest in careers focused on underserved care and public health among students pursuing dermatology.

Allergic Contact Dermatitis in Sexual and Gender Minority Patients: Disparities and a Call to Action.

OBJECTIVES: Sexual and gender minority (SGM) patients face health issues relevant to dermatologists, such as allergic contact dermatitis (ACD); however, there is a lack of information surrounding common allergens causing ACD that disproportionally affect SGM patients. METHODS: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying ACD in the SGM population. RESULTS: Common allergens associated with ACD in SGM patients include nitrates, fragrance mix, methylisothiazolinone, methylisothiazolinone-methylchloroisothiazolinone, topical antibiotics, and allergens seen in chest binders. Common anatomic sites included the chest, cheeks, perioral region, nasal orifices, and the anogenital region. CONCLUSIONS: Certain allergens and body sites affected by ACD are more common among the SGM community. This can help guide patch testing as a diagnostic tool. Further research must be conducted regarding ACD in SGM patients.

Clinical Features of Neutrophilic Dermatosis Variants Resembling Necrotizing Fasciitis.

Importance: Pyoderma gangrenosum and necrotizing Sweet syndrome are diagnostically challenging variants of neutrophilic dermatosis that can clinically mimic the cutaneous and systemic features of necrotizing fasciitis. Improved characterization of these rare variants is needed, as improper diagnosis may lead to inappropriate or delayed treatment and the potential for morbidity. Objective: To determine the characteristics of necrotizing neutrophilic dermatosis to improve diagnostic accuracy and distinguish from infection. Design, Setting, and Participants: A case series of patients with necrotizing neutrophilic dermatosis treated at 3 academic hospitals (University of California San Francisco, Oregon Health and Science University, and University of Minnesota) from January 1, 2015, to December 31, 2017, was performed along with a literature review of related articles published between January 1, 1980, and December 31, 2017. Data were obtained from medical records as well as Medline and Embase databases. All patients had signs resembling necrotizing infection and had a final diagnosis of pyoderma gangrenosum with systemic features or necrotizing Sweet syndrome. Patients were excluded if a diagnosis other than neutrophilic dermatosis was made, if key clinical information was missing, and if reported in a non-English language. Main Outcomes and Measures: Description of key characteristics of necrotizing neutrophilic dermatosis. Results: Overall, 54 patients with necrotizing neutrophilic dermatosis were included, of which 40 had pyoderma gangrenosum with systemic features and 14 had necrotizing Sweet syndrome. Of the 54 patients, 29 (54%) were male and 25 (46%) were female, with a mean (SD) age of 51 (19) years. Skin lesions commonly occurred on the lower (19 [35%]) and upper (13 [24%]) extremities and developed after a surgical procedure (22 [41%]) or skin trauma (10 [19%]). Shock was reported in 14 patients (26%), and leukemoid reaction was seen in 15 patients (28%). Of the patients with necrotizing neutrophilic dermatosis, 51 (94%) were initially misdiagnosed as necrotizing fasciitis and subsequently received inappropriate treatment. Debridement was performed in 42 patients (78%), with a mean (SD) of 2 (2 [range, 1-12]) debridements per patient. Four amputations (7%) were performed. Forty-nine patients (91%) received antibiotics when necrotizing neutrophilic dermatosis was misdiagnosed as an infection, and 50 patients (93%) received systemic corticosteroids; all patients responded to immunosuppressants. Conclusions and Relevance: A complex spectrum of clinical findings of pyoderma gangrenosum and Sweet syndrome with prominent systemic inflammation exists that defines a new subset of neutrophilic dermatoses, termed necrotizing neutrophilic dermatoses; recognizing the difference between this variant and severe infection may prevent unnecessary surgical procedures and prolonged disease morbidity associated with a misdiagnosis and may expedite appropriate medical management.

Characteristics and Skin Cancer Risk Behaviors of Adult Sunless Tanners in the United States.

Importance: Incidence rates of nonmelanoma and melanoma skin cancers are increasing rapidly in the United States likely because of increased UV light exposure. Sunless tanning is a safe alternative to achieve tanned skin that might help reduce skin cancer incidence by deterring risky behaviors. However, limited data exist on the characteristics and associated skin cancer risk behaviors of sunless tanners in the United States. Objective: To assess the demographic characteristics and skin cancer risk behaviors of sunless tanners among adults in the United States. Design, Setting, and Participants: This secondary analysis of a cross-sectional study used data from the 2015 National Health Interview Survey, a population-based survey of the US noninstitutionalized civilian population. Participants included 27 353 men and women 18 years or older. Main Outcome and Measures: Participant demographics and skin cancer risk behaviors, including indoor tanning, skin cancer screening, sunburn, and sun protection behaviors. Results: Of the 27 353 adults (representative of more than 198 million US adults; mean [SE] age, 46.0 [0.2] years) studied, 6.4% (SE, 0.2%) reported sunless tanning. Factors associated with sunless tanning included being young, female, non-Hispanic white, college educated, nonobese, and sun sensitive, living in the western United States, and having a family history of skin cancer. Sunless tanners were more likely to report indoor tanning (adjusted prevalence odds ratio [aPOR], 3.77; 95% CI, 3.19-4.43; P < .001), recent sunburn (aPOR, 1.55; 95% CI, 1.31-1.83; P < .001), use of sunscreen (ß = 0.19; 95% CI, 0.09-0.28; P < .001), and having had a full-body skin examination (aPOR, 1.77; 95% CI, 1.51-2.08; P < .001) but less likely to seek shade (ß = -0.12; 95% CI, -0.19 to -0.04; P = .001) or use protective clothing when outdoors (long pants: ß = -0.18; 95% CI, -0.26 to -0.11; P < .001; long sleeves: ß = -0.10; 95% CI, -0.18 to -0.03; P = .01). Among indoor tanners, sunless tanners compared with those who did not sunless tan reported increased frequency of indoor tanning (mean [SE], 19.2 [1.9] vs 14.9 [1.2] sessions in the past 12 months; P = .04) but no differences in other skin cancer risk behaviors. Conclusions and Relevance: This study suggests that sunless tanning is associated with risky skin cancer-related behaviors. Longitudinal studies are needed to assess whether sunless tanning changes UV exposure behaviors to better determine whether sunless tanning represents an effective public health strategy to reduce rates of skin cancer in the United States.

Prevalence of Atopic Diseases Among Sexually Diverse Adults in the US.

This cross-sectional study assesses the prevalence of asthma, allergic rhinitis, or atopic dermatitis among sexually diverse adults compared with heterosexual adults in the US.