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P-118 Skin Protective Activities by Inflammatory Bowel Disease Patients on Immunosuppressive Therapy May Be Practiced Less Often by African-Americans

BACKGROUND: There has been an increased incidence of non-melanoma skin cancer during the past decade. Data has revealed that immunosuppressants are associated with an elevated risk for the development of skin cancer. It is recommended that individuals with inflammatory bowel disease who are maintained on immunosuppressants be advised to participate in skin protective activities to mitigate their risk for development of a cutaneous malignancy. This study evaluated activities employed by inflammatory bowel disease patients treated with immunosuppressants to protect their skin from the development of cancer. METHODS: Consecutive inflammatory bowel disease patients maintained on immunosuppressants seen in a 2 month period at a university medical center were evaluated. There were no exclusion criteria. Patient age, gender, disease type and medication regimen were obtained. Skin protective activities were evaluated. Skin protective activities included sun avoidance, protective clothing, use of sunscreen, and skin examinations. A database, maintaining patient confidentiality, was created. Analysis as performed using Fisher Exact test with statistical significance set at P < 0.05. The study was approved by the university institutional review board. RESULTS: Twenty-four patients were included. There were 19 women and 5 men. Twelve patients were Caucasians (8 women, 4 men) and 12 African-Americans (11 women, 1 man). The mean age was 46.6 years. Seventeen patients had Crohn’s disease and 7 had ulcerative colitis. Thirteen patients were on 6-mercaptopurine, 1 on azathioprine, 5 on infliximab, 1 on adalimumab, 1 on chronic budesonide and 3 on a combination of methotrexate and infliximab or adalimumab. Sixteen of 24 patients (66.7%) practiced at least one skin protective activity, with 12 patients utilizing more than one method to decrease their skin cancer risk. The use of sunscreen (in 15 patients) and sun avoidance (in 12 patients) were the most common skin protective practices. Sunscreen was used significantly more than using a hat (P = 0.0077), wearing protective shirts and/or pants (P = 0.0027) or skin examination (P = 0.0189). There was a significant difference (P = 0.04) in the rate that 8 of 12 Caucasians (66.6%) and 4 of 12 African-Americans (33.3%) practiced sun avoidance. There was a significant difference (P = 0.0003) in the rate that 11 of 12 (91.7%) Caucasians and 4 of 12 African-Americans (33.3%) used sunscreen. CONCLUSIONS: Immunosuppressive therapy significantly increases the risk for development of skin cancer. It is advised that skin protective activities are performed by individuals maintained on immunosuppressants. It has been suggested that individuals who are pharmacologically immunosuppressed may be inconsistently aware of their skin cancer risks. This study revealed that two-thirds of inflammatory bowel disease patients maintained on immunosuppressants practiced at least one skin protective activity. However, African-Americans are less likely to protect their skin than Caucasians. It is important that all patients on immunosuppressants are informed of their increased risk for the development of skin cancer and are reminded to employee skin protective activities.