Associations between season, climate, and pediatric alopecia areata flares in Providence, Rhode Island

Patients with alopecia areata (AA) may experience episodic hair loss that follows seasonal patterns. To assess associations between seasonal variation, climate factors, and AA flare frequency in pediatric AA patients, we performed a retrospective chart review of 123 pediatric AA patients at Brown Dermatology (Providence, Rhode Island) who experienced hair loss between January 2017 and December 2019. We assessed association of seasonal variation with monthly occurrence of AA flares. We then assessed association between climate variables and monthly AA hair loss frequency using Spearman rank correlation analyses. We conducted stratified analyses in patients with and without history of atopy. The greatest proportion of hair loss episodes occurred in winter (28.1%), followed by autumn (26.3%), spring (23.8%), and summer (21.7%). We found significant correlations between AA hair loss frequency and air pressure (R = 0.61) and hours of sunlight (R = - 0.60). These correlations remained significant among patients with no history of atopic disease but were not significant among those with history of atopy. Limitations include small sample size. This regional analysis supports the role of climate in AA hair loss episodes through assessment of seasonal occurrences and identification of correlations between climate characteristics and AA flare frequency.

Cutaneous Sporothrix globosa infection mimicking cryptococcosis in a patient with history of kidney transplant

Sporotrichosis is a subacute-to-chronic infection caused by Sporothrix species, a dimorphic fungus. Virulence varies by Sporothrix species and presentation can be region dependent. The patient had a history of immunosuppression as a result of a kidney transplant, and presented with a high disease burden on histopathological examination, but responded well to itraconazole. The case suggests considering Sporothrix speciation in immunocompromised patients to best determine treatment modality and duration.

Abstract 844: Immune-related diseases and risk of skin cancer

Introduction: The immune system plays an important role in skin cancer development, as evidenced by elevated rates in organ transplant recipients. However, there are limited studies on the association between immune-related diseases and skin cancer. This study prospectively evaluates the relationship between immune-related diseases and risks of melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) using two cohorts of women and men: the Nurses' Health Study (NHS) and the Health Professionals Follow-up Study (HPFS).

Methods: In the NHS and HPFS, participants completed biennial questionnaires that gathered information on lifestyle factors and medical history. In our study, the NHS data is comprised of 83,824 participants over a 26-year period (1986-2012), representing 1,738,926 person years. The HPFS data includes 48,277 participants over a 26-year period (1986-2012), representing 874,315 person years. Cox proportional hazard models were applied to estimate the associations between immune-related diseases (ulcerative colitis/Crohn's disease, multiple sclerosis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, hypothyroidism, hyperthyroidism, and vitiligo) and skin cancer risk, both individually and as one composite variable. Multivariate models were adjusted for age and other skin cancer risk factors (body mass index, smoking status, alcohol consumption, hair color, number of blistering sunburns, nevi count, sunburn reaction, family history of melanoma and cumulative UV exposure level). Due to the small number and lower skin cancer risk in the nonwhite population, the analysis was limited to white participants. Exclusion criteria were participants who had melanoma, SCC, BCC, or other cancers at baseline.

Results: During the follow-up period, 558 melanoma, 1,696 SCC, and 17,145 BCC incident cases were documented in the NHS and 589 melanoma, 1,388 SCC, and 9,962 BCC cases in the HPFS. When assessing individual diseases, there was a significantly increased risk for SCC and BCC among male participants with ulcerative colitis/Crohn's disease; relative risks (RR) were 1.69 (1.06, 2.67) and 1.38 (1.15, 1.66) respectively. Male participants with multiple sclerosis were also at a significantly increased risk of BCC; RR was 1.78 (1.17, 2.72) In female participants, participants with hypothyroidism and hyperthyroidism were at significantly decreased risk for BCC; RR were 0.88 (0.78, 0.99) and 0.81 (0.68, 0.96) respectively. There were no significant associations between diagnosis of skin cancer and immune-related diseases when evaluating them as one composite variable.

Conclusions: Risk of skin malignancy in patients with immune-related diseases is disease dependent. There is an increased risk of SCC/BCC and BCC in male patients with ulcerative colitis/Crohn's disease and multiple sclerosis, respectively.

Citation Format: Erica M. Lin, Rachel Lim, Tricia Li, Martin Weinstock, Abrar Qureshi, Eunyoung Cho. Immune-related diseases and risk of skin cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 844.

Potential risk for developing severe COVID-19 disease among anabolic steroid users

A severe case of COVID-19 was observed in an otherwise healthy 28-year-old man who had taken oxandrolone 40 mg/day as an anabolic steroid. The patient had been taking oxandrolone for enhanced bodybuilding 30 days prior to presenting to an outpatient clinic with COVID-19 symptoms. The patient reported that his symptoms have rapidly worsened over the course of 4 days prior to presenting at the clinic. As part of an experimental antiandrogen treatment for hyperandrogenic men suffering from COVID-19, he was administered a single 600 mg dose of the novel antiandrogen proxalutamide. Twenty-four hours after administration of this dose, marked improvement of symptoms and markers of disease severity were observed. To our knowledge, this is the first case that potentially links anabolic steroid use to COVID-19 disease severity.

Illuminating insights into opsin 3 function in the skin

Because sunlight is essential for human survival, we have developed complex mechanisms for detecting and responding to light stimuli. The eyes and skin are major organs for sensing light and express several light-sensitive opsin receptors. These opsins mediate cellular responses to spectrally-distinct wavelengths of visible and ultraviolet light. How the eyes mediate visual phototransduction is well understood, but less is known about how the skin detects light. Both human and murine skin express a wide array of opsins, with one of the most highly expressed being the functionally elusive opsin 3 (OPN3). In this review we explore light reception, opsin expression and signaling in skin cells; we compile data elucidating potential functions for human OPN3 in skin, with emphasis on recent studies investigating OPN3 regulation of melanin within epidermal melanocytes.

Establishing mechanisms to conduct multi-institutional research--fatigue in patients with cancer: an exercise intervention

PURPOSES/OBJECTIVES

To describe the process of establishing a multi-institutional interdisciplinary team of oncology researchers and conducting a pilot study of an exercise intervention for fatigue.

DATA SOURCES

Project meeting minutes and records, research team members' logs, subjects' research records, the research study proposal, and team members' individual and collective shared experiences.

DATA SYNTHESIS

Site investigators established research teams at five academic medical centers. Fifty subjects were enrolled in the study and tested during their cancer treatment. Study methods, including instrumentation, were evaluated carefully and revised.

CONCLUSIONS

The multi-institutional network of researchers is an effective and efficient model for testing an intervention to manage fatigue during cancer treatment.

IMPLICATIONS FOR NURSING PRACTICE

Exercise is a feasible and potentially beneficial intervention to combat distressing cancer treatment-related fatigue. A pilot study is essential to determine the best methods for conducting a clinical trial and to develop the teams of researchers necessary for such a project.

The ambulatory oncology nurse's role

The increasing complexity of cancer care in the ambulatory setting results in the role of the ambulatory oncology nurse being pivotal to ensuring quality health care. Nurses have created a variety of multifaceted roles that include the staff nurse, advanced practice nurse, clinical trials nurse, office nurse, and the head nurse or nurse manager. Common issues encountered by the ambulatory oncology nurse are telephone triage, limitation of time, and transition of care.

A combined role of clinical nurse specialist and coordinator: optimizing continuity of care in an autologous bone marrow transplant program

Bone marrow transplant patients pose challenges to achieving continuity of care, as they have complex needs, care is chronic, and patients cross numerous health care settings. Traditionally, bone marrow transplant centers have attempted to meet patient needs by separating needs into preadmission, inpatient, and outpatient and by hiring two to three nurses to work within each of those time periods. This paper describes how one CNS working with bone marrow transplant patients enlarged the role to incorporate functions typically performed by a coordinator position in order to better meet the needs of patients along the entire illness continuum. This paper outlines the principles necessary to implement the combined position, and the operationalization and analysis of the effectiveness of this approach in order to achieve continuity of care.

Autologous bone marrow transplantation. A review of the principles and complications

High-dose chemotherapy and autologous bone marrow transplantation (ABMT) is now used routinely in an attempt to cure patients with poor-prognosis malignant diseases. This aggressive and intensive treatment requires a highly trained health-care team. Nurses specializing in the care of these patients are essential to maintain patient well-being and ensure a good outcome. High-dose therapy leads to myelosuppression and tissue damage, and the resultant infections, bleeding, and organ toxicities are frequently either unusual or more severe than those seen with conventional-dose antineoplastic therapies. Organ toxicities can affect both short-term and long-term functional status. Disabling or even fatal consequences of treatment can occur during the transplant or months or years later. A specialized knowledge base and an understanding of the way this therapy affects the patient is required not only for the acute inpatient period, but also for the long term. A team approach to these complex patients with a central role for the nurse clinician will lead to optimal patient care.

Improving ambulatory oncology nursing practice. An innovative educational approach

To meet the educational needs of ambulatory oncology nurses, an innovative and flexible program was created at a major cancer institute in Canada. Utilizing adult learning principles, standards of nursing practice, and departmental goals, the Clinical Nurse Specialists and Clinical Teachers creatively approached the need for extensive education. Five site specific educational workshops were provided to the nursing staff utilizing a self-directed learning style to capture the varied experiences, educational background, and motivations of the staff. This paper highlights the necessary program elements, implementation of, and evaluation of the educational program.

Nutrition support. Making the difficult decisions

Weight loss and cachexia are common characteristics associated with the cancer patient. Although the wasted appearance seems the same in each person, the causes are varied. Studying a patient's history and identifying surgical causes to weight loss or weight loss as a result of treatment complications assists in the consideration of nutritional support. Nutritional parameters combined with the oncology nurse's knowledge of the patient, disease process, and treatment side effects place the nurse in the position to help identify options for nutritional support. The oncology nurse's expertise assists in the decision making process, since it is often not appropriate to institute nutritional support in the inpatient setting nor extend it to the home situation. Objective assessment parameters for home parenteral nutrition assist the nurse in making some of these decisions. The conflicts that arise within the decision making process are usually not clearcut nor easily resolvable. Home parenteral nutrition brings to the forefront requirements and variables that are often not consciously addressed when hyperalimentation is instituted in the inpatient setting.