Top 20 Trending Stories of 2021

For many, the past 12 months may have felt less fraught than 2020, but the COVID-19 pandemic continued to top headlines. The vaccine rollout prompted questions from both physicians and patients about reactions, including skin symptoms and guidelines. However, other news in the dermatology field also grabbed readers’ attention.

Sunscreen and photoprotection is always a hot topic, so it is no surprise that reports about benzene and sunscreen products were at the forefront of coverage. Dermatology Times® broke the news about benzene contamination in 78 aerosol sunscreen and after-care products, which eventually led to voluntary recalls of some products. The issue continues into the new year, as people seek guidance regarding which sunscreens are safe.

It was also a mixed year for innovation, with many advances stalling in the dermatology pipeline. However, the aesthetic industry did see advances, such as the ellacor system by Cytrellis for the treatment of moderate to severe wrinkles. There was also a need to combat misinformation, so a Pointers With Dr Portela video on brown spots debunked a TikTok post spreading false information on how brown spots are produced.

Based on analytics, here’s what Dermatology Times® readers considered 2021’s hottest trends.

1. Detectable Levels of Benzene Noted in Some Sunscreen Batches

Valisure, an independent laboratory that is now a pharmacy dedicated to batch testing medications before they reach consumers, found that 78 sunscreens and after-sun-care products contained benzene, a potential carcinogen.

Christopher Bunick, MD, PhD, associate professor of dermatology at Yale School of Medicine in New Haven, Connecticut, and a member of the Dermatology Times® editorial advisory board, commented on the situation: “There is not a safe level of benzene that can exist in sunscreen products. Even benzene at 0.1 ppm in a sunscreen could expose people to excessively high nanogram amounts of benzene.” 

2. Vaccine Patients Experiencing “Vaccine Arm” Days After Injection

There were increasing reports of vaccine recipients who experienced delayed cutaneous adverse effects (AEs) after receiving the first dose of a COVID-19 vaccine. Experts assured people that although the AE is uncomfortable, it is temporary and can be treated at home.

Esther Freeman, MD, director of global health dermatology at Massachusetts General Hospital in Boston, spoke with Dermatology Times® about her published case series in the New England Journal of Medicine¹ regarding these delayed reactions, which she suggested calling “vaccine arm.”

3. Device Improves Skin Cancer Images

A study published in Lasers in Surgery and Medicine, the official journal of the American Society for Laser Medicine and Surgery, examined the improvements in quality of the content-aware image restoration (CARE) technology.²

Reflectance confocal microscopy, an optical microscopy method, can examine cellular details of human skin noninvasively, but because of the high costs of the machines, a more affordable solution was investigated. 

4. Valisure Highlights Controversy of Benzene Contamination in Sunscreen Products

In this video interview, Light sat down with Dermatology Times® to discuss the findings about benzene in sunscreen products and the impact the news would have on the sun-protection industry. Light discussed how the carcinogen was found, starting with 1 product and expanding to 78. He also talked about other sun-protection products being tested and how the gravity of the findings are more than just concerning. 

5. Guidance Issued for COVID-19 Vaccine Side Effects in Dermal Filler Patients

The American Society for Dermatologic Surgery (ASDS) released the report “Guidance Regarding SARS-CoV-2 mRNA Vaccine Side Effects in Dermal Filler Patients.”³

“Patient safety is foremost in the practice of dermatology, and board-certified dermatologists take adverse effects seriously,” said Mathew Avram, MD, JD, immediate past president of the ASDS. “Although still very early in the vaccination process, this guidance is meant to be informational and helpful as we move forward during pandemic recovery efforts.”

6. The Cutaneous Connection: Episode 24—Benzene Found in Multiple Sunscreen Products

This podcast produced by Dermatology Times® dove deeper into the sunscreen controversy, as some products were found to have 3 times the FDA limit of 0.02 mg/day (2 ppm) benzene contamination.

Light highlighted key aspects of the news from his perspective as founder and CEO of Valisure, where benzene was discovered in multiple brands and batches of sunscreen.

7. Study: How Does AK Affect Long-Term cSCC Risk?

For a study published in JAMA Dermatology, investigators looked into the risk of cutaneous squamous cell carcinoma (cSCC) after diagnosis of actinic keratosis (AK) during long periods of follow-up.⁴ Patients 49 years or younger with AK were 7 times more likely to receive a cSCC diagnosis than those without AK.

8. Physician Weighs In on Sunscreen Contamination Controversy

In a video interview, Bunick discussed the report revealing that certain batches of various sunscreen and after-sun-care products were contaminated with benzene. He offered a dermatologist’s perspective on how concerned physicians and patients should be about the carcinogen. 

9. Study Reveals How Consumers Look at Sunscreen Labels

In response to an FDA proposed rule that would make ingredient lists more prominent and easier to understand, findings published in JAMA Dermatology revealed how consumers examine the package information on sunscreen’s active ingredients.

In 2019, the FDA issued a proposed rule, 84 FR 6204, which would be an amendment to the Sunscreen Innovation Act of 2014. The amendment would require listing active ingredients on the main panel of sunscreens, allowing consumers to more readily compare products and either select or avoid a given product accordingly.

Out of the 47 people in the study group, 13 participants (28%) said that sunscreen ingredients influenced their selection and 5 (11%) said it was the most importation information. However, 34 participants (72%) said that the sun protection factor (SPF) rating was the most important information.

10. Guidelines Address COVID-19 Vaccine Concerns Related to Dermal Fillers

After 3 patients in the Moderna COVID-19 vaccine trials reported facial or lip swelling after receiving the vaccine, the ASDA issued new guidelines stating that patients with a history of dermal filler injections should not avoid vaccinations.³

“Basically, what the FDA data showed was that there were 3 participants out of 15,184 patients who received 1 dose of the mRNA-1273 vaccine who developed either facial swelling or lip swelling, which was presumed to be related to the filler placement,” Sue Ellen Cox, MD, coauthor of the guidance and ASDS president, said.

11. Researchers Study Connection Between Psoriasis and COVID-19

At the American Academy of Dermatology Virtual Meeting Experience 2021 (AAD VMX 2021), Jeffrey Liu, BS, a medical student at Keck School of Medicine of the University of Southern California in Los Angeles, presented data on the association between systemic treatments and COVID-19 infection risk in patients with psoriasis.⁴

The study’s objectives were to assess the risk of COVID-19 infection in adult patients with psoriasis vs the general population and assess risk of infection in patients treated with systemic therapies compared with those treated with topical therapies within the Symphony Health database, which is a cloud-based server.

12. Relation Between Skin Cancer Medication and Dermatologic Adverse Events

Jordan Siad, BA, a fourth-year medical student and researcher at Harvard Medical School in Boston, presented a retrospective study at AAD VMX 2021 on the association between female sex and higher rates of dermatologic AEs among patients with melanoma receiving immune checkpoint inhibitor therapy.

13. COVID-19 Induced Skin Challenges

Zoe Diana Draelos, MD, adjunct assistant professor in the Department of Dermatology at Duke University School of Medicine in Durham, North Carolina, and chief medical editor of Dermatology Times®, covered COVID-19–related skin challenges, including chapped lips, maskne (mask-related acne), and dry hands from excessive handwashing. She offered best-practice recommendations for treating these issues.⁵ 

14. ellacor System Cleared by FDA

The ellacor system by Cytrellis received the FDA’s clearance for the treatment of moderate to severe wrinkles. The minimally invasive device removes micro areas of excess skin without surgery, thermal energy, or scarring.

15. The Cutaneous Connection: Episode 21—Oxytocin and Skin Aging

In this podcast episode, Nicole Hayre, MD, FAAD, a board-certified dermatologist and founder of the Cosmetic Dermatology Center in Tysons Corner, Virginia, discussed her research on the link between the so-called love hormone, oxytocin, and younger-looking skin.⁶

16. Study: SGX301 Demonstrates Efficacy for Treatment of Cutaneous T-Cell Lymphoma

Ellen Kim, MD, professor of dermatology at the University of Pennsylvania in Philadelphia, presented results of the FLASH study (NCT02448381) at AAD VMX 2021.⁷

The phase 3, multicenter, randomized, double-blind, placebo-controlled study aimed to determine the efficacy of SGX301(synthetic hypericin ointment 0.25%; Soligenix), a topical photosensitizing agent, and radiation from fluorescent bulbs to treat patients with plaque or patch phase cutaneous T-cell lymphoma—specifically, mycosis fungoides.

17. Emerging Agents Augment Melasma Modalities

Pearl E. Grimes, MD, director of The Grimes Center for Medical and Aesthetic Dermatology, director of the Vitiligo and Pigmentation Institute of Southern California, and clinical professor of dermatology at the David Geffen School of Medicine at UCLA, all in Los Angeles, as well as a Dermatology Times® editorial advisory board member, spoke about this topic at Maui Derm 2021. Her presentation highlighted new solutions to optimize melasma management and identified cautions that could negatively affect outcomes.

18. FDA Grants Orphan Drug Status to ITIL-168 for Melanoma

The FDA granted an orphan drug designation to the investigational tumor-infiltrating lymphocyte (TIL) therapy ITIL-168 for the treatment of patients with stage IIB to IV melanoma. ITIL-168 is described as an investigational, autologous cell therapy composed of TILs.

19. Master Techniques to Treat Eye Issues

In her Cosmetic Conundrums column, Draelos answered questions regarding undereye pigmentation and undereye edema, as well as facials to treat these issues. 

20. Pointers With Dr Portela: How to Get Rid of Brown Spots

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology and Skin Cancer Center in Boise, Idaho, highlighted a TikTok video poster’s claim that brown spots on the skin, caused by lipofuscin, can be prevented by avoiding seed oils. He explained why this information is misleading in the video. 

References

1. Blumenthal KG, Freeman EE, Saff RR, et al. Delayed large local reactions to mrna-1273 vaccine against SARS-CoV-2. N Engl J Med. 2021;384(13):1273-1277. doi:10.1056/NEJMc2102131

2. Zhao J, Jain M, Harris UG, Kose K, Curiel-Lewandrowski C, Kang D. Deep learning-based denoising in high-speed portable reflectance confocal microscopy. Lasers iSurg Med. 2021;53(6)880-891. doi:10.1002/lsm.23410

3. Avram M, Bertucci V, Cox SE, Jones D, Mariwalla K. Guidance regarding SARS-CoV-2 mRNA vaccine side effects in dermal filler patients. American Society for Dermatologic Surgery. December 28, 2020. Accessed January 19, 2021. https://www.asds.net/Portals/0/PDF/secure/ASDS-SARS-CoV-2-Vaccine-Guidance.pdf

4. Madani S, Marwaha S, Dusendang JR, et al. Ten-year follow-up of persons with sun-damaged skin associated with subsequent development of cutaneous squamous cell carcinoma. JAMA Dermatol. Published online March 24, 2021. doi:10.1001/jamadermatol.2021.0372

5. Liu J. Association between biologic therapy and COVID-19 infection risk in patients with psoriasis. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.

6. Siad J. Female sex is associated with higher rates of dermatologic adverse events among patients with melanoma receiving immune checkpoint inhibitor therapy: a retrospective cohort study. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.

7. Kim E. Visible light-activated topical hypericin ointment in CTCL: FLASH study results. Presented at: American Academy of Dermatology Virtual Meeting Experience 2021; April 23-25, 2021; virtual.