Racial differences in the use of extracorporeal photopheresis for mycosis fungoides.

BACKGROUND: Extracorporeal photopheresis (ECP) is an effective treatment option for mycosis fungoides (MF) and associated with few systemic side effects. OBJECTIVE: We sought to investigate whether there were differences in rates of ECP use between African-American and Caucasian patients with stage III/IV MF. METHODS: We conducted a retrospective review of all patients treated for MF at the Johns Hopkins Hospital main campus outpatient clinic between 1999 and 2011. RESULTS: We identified 65 patients with stage III or IV disease, 20 African-American and 45 Caucasian. Only 7 of 20 African-American patients (35%) compared with 30 of 45 (66%) of Caucasian patients were treated with ECP (p = 0.029). In addition, ECP was discussed as an option for 45% of African-Americans compared to 82% of Caucasians (p = 0.007). When discussed as an option, African-Americans and Caucasians had identical rates of ECP use (78% vs 81%, p = 0.841). CONCLUSIONS: Differences in rates of ECP use exist among African-American patients when compared to their Caucasian counterparts and may be related to how often ECP is offered as a treatment option. Improving physician awareness of the factors that influence treatment decision making may help diminish discrepancies in treatment regimens among patients with MF.

Social determinants of racial and ethnic disparities in cutaneous melanoma outcomes.

BACKGROUND: This article sought to elucidate how aspects of poverty and culture may contribute to race- and ethnicity-based disparities in cutaneous melanoma outcomes. METHODS: We identified published studies addressing the social determinants of melanoma. Selected review articles included US-based studies comprised of patients representing adults, children, and adolescents. RESULTS: African Americans and Hispanics diagnosed with cutaneous melanoma are more likely to present with more advanced stages of disease at diagnosis and have higher rates of mortality than their nonminority counterparts. These disparities may be a consequence of economic, social, and cultural barriers such as low income, public forms of health insurance, lower levels of education, lower levels of melanoma awareness and knowledge, and lower rates of participation in melanoma screening. No studies in the literature examined the potential impact of social injustice, English proficiency, immigrant status, and health literacy. CONCLUSIONS: Substantial gaps exist in our knowledge of the pathways linking social determinants and race- and ethnicity-based disparities in melanoma. More studies are warranted to inform the development of effective interventions aimed at narrowing inequities and improving cutaneous melanoma outcomes among minority populations.

Racial differences in mycosis fungoides: a retrospective study with a focus on eosinophilia.

BACKGROUND: Mycosis fungoides (MF) is often associated with eosinophilia and portends a poorer prognosis. MF is more common in blacks and follows a more aggressive course compared with whites. OBJECTIVE: We further elucidate racial differences between blacks and whites with MF, focusing on blood eosinophilia. METHODS: The records of 345 patients with MF were reviewed for demographic, clinical, and pathologic data and evaluated by analysis of variance. RESULTS: The average age at diagnosis for blacks was 45 years and was 55 years for white patients (P < .001). In the cohorts of patients with and without blood eosinophilia, the average maximum blood eosinophil count had a greater range in blacks. Independent of race, blood eosinophilia was predictive of more advanced disease (P < .0001), increased number of treatment types (P < .002), and less responsiveness to treatment (P < .0006). LIMITATIONS: This was a retrospective study at a single institution. CONCLUSIONS: These differences observed in eosinophil values may highlight disparities in MF diagnosis or a difference in pathophysiology between races.

Treatment of mycosis fungoides with total skin electron beam: response and relapse by ethnicity and sex.

OBJECTIVE: To determine whether clinical response to total skin electron beam (TSEB) and relapse after TSEB differs by ethnicity and sex. METHODS: Retrospective chart review of 77 patients with mycosis fungoides (MF), treated with TSEB in 2002 to 2008 at Yale University School of Medicine, Departments of Dermatology and Therapeutic Radiology. RESULTS: Women had better odds of response to TSEB than men (OR=6.4; 95% CI, 1.45-28.5; P=0.01). No significant difference was observed in response to TSEB between white and black patients (OR=0.69; 95% CI, 0.16-2.91; P=0.62). When stratified by race and sex, in comparison with black females, all other groups had lower odds of complete response (CR) to TSEB: black males (OR=0.39; 95% CI, 0.002-0.70; P=0.03), white females (OR=0.24; 95% CI, 0.02-2.53; P=0.24), and white males (OR=0.06; 95% CI, 0.006-0.60; P=0.02). Clinical CR was significantly predicted by the duration of symptoms (OR=0.98; 95% CI, 0.97-0.99; P=0.01); and nearly significant by clinical stage; stage III to stage I (OR=0.17; 95% CI, 0.02-1.02; P=0.07). Adjuvant treatment, previous treatment, and time from diagnosis to treatment have no significant effect on CR to TSEB. There was no statistically significant association between relapse after treatment and race, sex, clinical stage, or symptom duration. CONCLUSIONS: The odds of achieving a CR to TSEB decrease when diagnosis of MF is delayed and when patients present with advanced-stage disease. Women with MF were more likely to have a CR to treatment, and this response was even more significant in black women.

Age, race, sex, stage, and incidence of cutaneous lymphoma.

UNLABELLED: The T- and B-cell cutaneous lymphomas (CLs) are relatively rare, and information regarding clinical presentation and differences among racial groups might be helpful in determining the best course of clinical care. Data from nearly 5000 patients with CL from the SEER (Surveillance, Epidemiology and End Results Program) registry were evaluated. Nonwhite racial groups present with mycosis fungoides (MF) at an earlier age compared with white, and African American (AA) have increased risk of presenting with higher T-stage compared with white patients. These findings have significant implications regarding need for earlier diagnosis and understanding the reasons for racial disparity in age and stage of presentation. BACKGROUND: The incidence of the T- and B-cell CLs has been well documented, but information pertaining to racial incidence by age, and by burden of disease (stage) have not been extensively documented. MATERIALS AND METHODS: The SEER 2004-2008 public use database was investigated. The relative incidence of CL in different races and age groups was examined. Univariate and multivariate stepwise logistic regression was performed for the likelihood of presenting at a higher stage. RESULTS: Of 4496 patients diagnosed with CL between 2004 and 2008; 1713 patients were diagnosed with MF, 1518 with non-MF cutaneous T-cell lymphoma, and 1265 patients with cutaneous B-cell lymphoma. For MF, there was a trend for females to be less likely to present with a higher T-stage (T3-T4) than males (odds ratio [OR], 0.73) on multivariate analysis (P = .06). For race, AA had a significantly increased risk of presenting with higher T-stage (T3-T4) MF (OR, 1.72) on multivariate analysis (P = .02), compared with white patients. For white, AA, Asian/Pacific Islander, and Native American/other/unknown, the mean age at diagnosis was 59.2, 51.5, 51.3, and 53.8. These groups presented at a significantly different age than white (P = .0001, 0.0001, and 0.0006). CONCLUSION: Nonwhite racial groups present with MF at an earlier age compared with white, and AA have increased risk of presenting with higher T-stage compared with white. These findings have significant implications regarding need for earlier diagnosis and understanding the reasons for racial disparity in age and stage of presentation.

Primary cutaneous aspergillosis in an immunocompetent patient: successful treatment with oral voriconazole.

We report a case of primary cutaneous aspergillosis in an immunocompetent child that responded rapidly to oral voriconazole therapy. Voriconazole may be considered as a treatment option for pediatric patients with primary cutaneous aspergillosis.

Cutaneous T-cell lymphoma in skin of color.

Over the past three decades, there has been a marked increase in the incidence of cutaneous T-cell lymphoma (CTCL), with significant differences in the rates of CTCL by race and ethnicity. The overall incidence of CTCL has been shown to be higher among blacks than among whites and other racial groups. In addition, CTCL is thought to follow a more aggressive course in black patients. This article highlights the differences in clinical appearance and response to therapy, and discusses the differential diagnosis of CTCL in skin of color in an attempt to ensure earlier diagnosis and better outcomes for these patients.

A case of disseminate and recurrent infundibulofolliculitis responsive to treatment with topical steroids.

Disseminate and recurrent infundibulofolliculitis (DRIF) is an uncommon pruritic follicular eruption of unknown etiology that is predominantly seen in black men. This condition tends to affect the trunk and upper extremities and is usually unresponsive to local and systemic treatment. Recently, several investigators have reported successful treatment with isotretinoin. Herein, we report a case of a patient with disseminate and recurrent infundibulofolliculitis who was successfully treated with potent topical corticosteroids.

Malignancy and cancer treatment-related hair and nail changes.

The hair and nails are complex cutaneous adnexal structures influenced by the patient's physiologic state. Systemic diseases may affect either or both. Remote internal malignancies may induce skin changes that are neither genetically related nor part of a tumor syndrome. The treatment of cancer with chemotherapy and radiation therapy may also induce abnormalities of the hair and nails. In this article, various paraneoplastic and cancer treatment-related hair and nail changes are described. The proper evaluation of such abnormalities may allow for the prompt and efficient diagnosis and management of an internal malignancy. Establishing an understanding of hair and nail abnormalities can be vital in assessing a patient's overall health, especially in the context of cancer detection and treatment.

Persistent erythema multiforme and CMV infection.

Persistent erythema multiforme is a rare disorder with only 23 known cases reported in the literature. Persistent erythema multiforme has been reported in association with Epstein-Barr virus, herpes virus, hepatitis C virus, influenza, inflammatory bowel disease, and a variety of neoplasms. To our knowledge, this case is the first case of persistent erythema multiforme reported in association with cytomegalovirus infection.