Benzene Contamination and Boxed Warning Myths With Christopher Bunick, MD, PhD

In an interview with Dermatology Times®, Christopher Bunick, MD, PhD, physician-scientist, associate professor of dermatology at Yale University School of Medicine, and a Dermatology Times® editorial advisory board member, discusses his role in curating the 2023 South Beach Symposium (SBS) meeting as a member of the SBS Planning Committee. Bunick also shares key highlights from his sessions “Update on Contamination in Skincare Products: Benzene Returns to the News” and “Myths vs. Science.”

Transcript:

Christopher Bunick, MD, PhD: I'm Christopher Bunick, associate professor and physician-scientist of dermatology at Yale University.

Dermatology Times®: As a member of the SBS Planning Committee, what goes into coordinating a meeting like SBS?

Bunick: It's been a real honor to be a part of that South Beach Symposium Planning Committee. There's actually a lot of work that goes into planning a meeting. And we've had about six months to plan this meeting, because of COVID-related issues. Our last meeting was in August. So over the past six months, we have really focused on bringing in the most important educational topics to help all of the dermatologists attending the meeting. So, our first and foremost priority is making the educational content of extremely high value, because then all the dermatologists that are attending are going to be able to take these new things that are learned back into their practice, and help patients and that's the overall goal. And what really makes this meeting unique is that when we plan it, we're planning not just the medical breakthroughs, but also the aesthetic and cosmetic breakthroughs, and asking how can we blend these two areas together to give a very exceptional education and training behind medical and cosmetic dermatology. Being a part of the SBS Planning Committee, I have wonderful colleagues that are working with me and I think that what makes this a successful meeting is really having a diversity of minds and experiences. And that's definitely what we have on the SBS Planning Committee, which is a wealth of experience in different areas. And that really helps this meeting come together with cutting-edge ideas, topics that span a whole diversity of issues, ranging from oncology to psoriasis, atopic dermatitis to therapies to cosmetics, it really is a wonderful blend of a lot of expertise for some real leaders in dermatology. And I've got the real pleasure of working with all of them.

Dermatology Times®: What are the highlights from your session, "Update on Contamination in Skincare Products: Benzene Returns to the News?"

Bunick: I was really excited when South Beach Symposium asked me to give an update on my benzene contamination and personal skin care product talk, which I originally gave at the last South Beach Symposium meeting. So the update that I just gave, really focused on a deeper dive into what was new in benzene contamination and products over the past year. And one of the biggest stories was in fact, benzene contamination and dry aerosolized shampoos or dry shampoo products. I remember actually, my own cousin texted me when the news broke, "Chris, what's happening, you're taking away my dry shampoos." And so this is a topic that really affects everyday people that are using these products. And I think that what's really fascinating about the benzene contamination story is that there's product after product after product where there's being recalls, testing, and elevated levels. So this is not just a sunscreen issue, which was brought to the forefront a couple of years ago. This is actually a contamination through lots of products. And so in the talk I just gave, I really wanted to highlight a couple of new features of the story, which was that benzene contamination and aerosolized products can actually linger in the air and fill a room. So it's been shown that levels of benzene in the air can persist for actually significant periods of time that exceed the EPA threshold for increasing the risk of cancer. And so I think that that was one highlight that I wanted to bring to the audience today. And second, I highlighted in my talk, how there are actually new congressional efforts from the House of Representatives to further explore how supply chain and manufacturing contamination is occurring in these products. So, from a congressional and governmental level, there's heightened importance placed on figuring out this problem and fixing it because in the end, consumers cannot tell if the products on the shelves are contaminated by reading the label. And that is one of the things that really makes the story important is for the safety of all our patients and for all people is we need to be able to eliminate the problem because we're not going to learn it by reading the product on the shelf.

Dermatology Times®: What are the key highlights from your session, "Myths vs. Science?"

Bunick: It was really exciting to give my talk on boxed warnings, "Myths vs. Science." So over the past year, we've seen a number of new oral agents known as JAK inhibitors hit the market for a number of diseases ranging from atopic dermatitis to alopecia areata, but the thing that has captured a lot of the attention or narrative in dermatology has been, what about the boxed warning? And so my particular talk that I gave was really focused on understanding box warnings from a larger perspective, not necessarily just a JAK inhibitor perspective, but a larger perspective to bring context to what we've been doing in dermatology and what really the JAK inhibitor boxed warning means. So some of the highlights of the talk were that dermatologists have been using almost 50 different boxed warning drugs for the last decade. We are incredibly experienced clinicians in dealing with medicines that have box warnings. So that's number one is that we're very experienced in this, we know how to do it. And so we shouldn't be scared or shy away from a medicine just because it has a boxed warning. Second, I highlighted that there are medicines that are over the counter that we use all the time that also have boxed warnings. In fact, they have boxed warnings for some of the same issues as the JAK inhibitors, but yet it's over the counter. So I really enjoyed highlighting over the counter medicines with boxed warnings. Thirdly, one of the medicines that we've commonly used in dermatology, when we don't know what else to try is systemic prednisone. I show data about systemic prednisone, that some of the risks for cardiovascular events and cancer are higher than the JAK inhibitors. Yet, one of the myths out there is that steroids that are well known to have certain side effects have a boxed warning; steroids do not have a boxed warning, but yet have a higher risk for some of the serious adverse events that we've been talking about the last year with the boxed warnings with JAK inhibitors, but yet, systemic prednisone does not have a boxed warning. So I think that that was a really interesting topic to discuss because it puts into context, dermatologic drugs that have and don't have a boxed warning, because a lot of times doctors don't think twice about using systemic prednisone when everything else has failed, or they don't know what else to do, or it's expedient for the patient. Lastly, one of the topics I was excited to talk about was actually the legal aspects of boxed warnings. What is actually in the United States code about boxed warnings in medicines? How do we actually use that code? How does the FDA use it and apply it to different medicines? And what do these boxed warnings actually mean for a physician or for a patient? So I definitely enjoyed diving into a little bit more of the specifics of what does a boxed warning mean? And then bringing it into the context of dermatologic medicines, over the counter medicines, the newest JAK inhibitors, as well as a lot of the other medicines that we've used in dermatology for the last several decades. And I think my hope is that the audience, dermatologists, walk away with a deeper understanding of what a boxed warning means. That there's no need to be afraid of the boxed warnings; it's important to have knowledge and context of boxed warnings because it ends up making that shared decision-making from physician and patient much easier when the physician is comfortable talking about boxed warnings and what it means. I do hope that the dermatologists today walked away with that from the talk, that they feel more comfortable talking these issues over with their patients.

Transcript edited for clarity