Dermatology Journal Club With the main caveat of cross study comparisons, for context, every 6 months on voriconazole (another presumed photosensitizer, mechanism not fully elucidated) confers increased relative risk of 1.74. (Tang H et al., JAAD, 2019). #DermJC #BJDTalks

Dermatology Journal Club In general, increased risk of SCCs in OTRs are 65-100x versus general public. This study excluded OTRs and found a weight IRR of 1.95 for HCTZ, would be interesting to look a subset analysis in this cohort of OTRs + HCTZ vs. OTRs + CCBs --> skin cancer risk?

Primary care doctors, do you ask about a history of skin cancer prior to start a thiazide? x.com/AshleyWysongMD…

Q4: Short-term use of hydrochlorothiazide was associated with an increased risk of BCC but not long-term use. How do you interpret this finding? #DermJC #BJDTalks

Jonny Guckian Dermatology Journal Club Chantal Cotter Very cool. I'm sure prescribing patterns differ even WITHIN the UK, but I thought it was fascinating what small % HCTZ constituted among all thiazide monotherapy prescriptions in the UK (3.6% to be exact). Don't we use HCTZ all the time in the US, @mahrifai? #BJDTalks #DermJC

Roxana Daneshjou MD/PhD Dermatology Journal Club Roxana Daneshjou MD/PhD -- that is the million dollar question! How do we partner with #PCPs to help in #skincancer prevention efforts? #sunsafety #preventioniskey #HCTZ

Question 4⃣: hydrochlorothiazide and BCC risk...how do you interpret the finding explained below? 🗣️follow Dermatology Journal Club and use the hashtags #DermJC #BJDTalks to track the discussion Ashley Wysong MD, MS @mahrifai

Jonny Guckian @mahrifai Dermatology Journal Club Chantal Cotter bendroflumethiazide for the win!

Dermatology Journal Club In all epidemiologic studies of skin cancer, I like to see data on family history of skin cancer & sun exposure #UV but this is impossible without patient questionnaires and is ripe for #recallbias #DermJC #BJDTalks

Q5: The paper suggests bendroflumethiazide as a safer alternative to hydrochlorothiazide. Do you agree? #BJDTalks #DermJC

Dermatology Journal Club Our group @UNMCDermatology has published several papers showing association between #hypothyroidism and SCC and metastasis -- I would love to see this patient characteristic included in the analysis on HCTZ and skin cancer. pubmed.ncbi.nlm.nih.gov/35125444/ . #DermJC #BJDTalks

Ashley Wysong MD, MS Dermatology Journal Club @UNMCDermatology Fascinating re: hypothyroidism. Do you think this is because of clinicians being uncertain of their clinical lymph node exam?

Q6: Does this paper change your practice? #BJDTalks #DermJC

Dermatology Journal Club I would like to know the length of TIME to develop first #skincancer in this cohort; BCCs and melanomas may take more time to develop based on photosensitivity / UV exposure. SCCs have higher rates of p53 mutations and overall UV signatures (C-T mutations). #DermJC #BJDTalks

BJD Dermatology Journal Club Ashley Wysong MD, MS @mahrifai In an ideal world, other factors that we KNOW increase the risk of skin cancer: history of sunburns, chronic wounds, chronic inflammatory disease, prior radiation use, CLL.

Nour Kibbi, MD Dermatology Journal Club This is very important note for absolute risk increases/reductions as these are dependent on baseline characteristics…can be tough to compare absolute risks. Conditional relative risks can be more transportable assuming needed data given, but without direct comparison it’s hard

Dermatology Journal Club With increased IRR of squamous cell skin cancer a/w HCTZ, I will continue partnering with #PCP colleagues to look for alternative anti-hypertensives, particularly in high-risk skin cancer "chronic disease" patients. #MedTwitter #DermJC #BJDTalks ACP #dermtwitter

Thank you for joining our journal club with BJD! Feel free to keep the conversation going. #BJDTalks #DermJC

Ashley Wysong MD, MS Dermatology Journal Club ? for Ashley Wysong MD, MS is there a biologic mechanism to explain the differences in the results among the different classes? I.e. is there evidence that HCTZ is a stronger photosensitizer? #dermjc

Thanks for joining our journal club with Dermatology Journal Club - keep the discussion going! A big thank you to our wonderful guests Ashley Wysong MD, MS and @mahrifai for offering their time and expertise!🎉🌟🎉🌟 #dermtwitter #DermJC #BJDTalks