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J Dermatolog Treat [journal]
- Delusions of Parasitosis; Suggested Dialogue between Dermatologist and Patient. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Dec 9.:1-15.
Abstract Delusions of parasitosis (DoP) is a psychocutaneous condition characterized by a fixed false belief that one is infested by skin parasites. Patients afflicted with DoP generally experience sensations of biting, stinging, or crawling in the absence of any objective evidence of infestation. The most definitive treatment for delusions of parasitosis is antipsychotic agents. Though the diagnosis and treatment options are rather straightforward, the difficulty lies in the art of building a therapeutic rapport with the patient in order to encourage acceptance of antipsychotic treatment. This article is a practical guide that suggests verbatim how dermatologists might talk to a delusional patient in order to establish a strong therapeutic rapport. Strategies on how to optimize the initial encounter, build rapport, and prescribe antipsychotic medications that are likely to be accepted by the patient are discussed.
- Self-Reported Quality of Life after Skin Cancer in Young Adults. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Dec 9.:1-15.
Abstract INTRODUCTION Skin cancer incidence is increasing in younger adults. Patient satisfaction and quality of life surveys are limited and more information is needed on the unique perspectives of these younger patients who may be affected differently. We sought to explore how skin cancer has affected life quality in younger adults.
METHODSA self-reported questionnaire was administered to skin cancer patients ages 20-50 years diagnosed from 2007 to 2008. Quality of life was measured using the Skin cancer Index and Skindex-16 with a transformed scale. Descriptive statistics with standard deviations were calculated.
RESULTSOne hundred sixty one patients were identified; 62 completed surveys (38.5%), with 47 patients eligible for inclusion. Forty participants (85%) reported having made lifestyle changes since being diagnosed with NMSC, most commonly habitual use of sunscreen (n = 34; 77.3%). Quality of life was most impacted by worries about their skin cancer (Skindex-16 score 24.5 (34.4 standard deviation)), including their future risk of developing further cancers (58.5 (31.8)). LIMITATIONS Limitations include small sample size and possible response bias.
CONCLUSIONSThere is a modest impact on quality of life in young skin cancer patients based on the Skindex-16 and Skin Cancer Index. Young skin cancer survivors may benefit from patient counseling which addresses risk assessment and future risk reduction.
- Methotrexate in pediatric plaque-type psoriasis: long-term daily clinical practice results from the Child-CAPTURE registry. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Dec 8.:1-25.
Background:Evidence on effectiveness and safety of methotrexate (MTX) in pediatric psoriasis is scarce.
Objectives:Study the effectiveness and safety of MTX in pediatric plaque-type psoriasis and its influence on quality of life (Qol) in daily clinical practice.
Methods:Subset analysis of prospectively collected data extracted from the Child-CAPTURE registry, a single center, longitudinal, long-term, observational daily practice cohort of pediatric psoriasis patients. A maximum dose between 0.14-0.63 mg/kg once weekly was prescribed in 25 children. Primary endpoints were percentages of patients with ≥75% improvement in the Psoriasis Area and Severity Index (PASI) at week 12 and 24.
Results:PASI75 was achieved in 4.3% and 33.3% of patients at week 12 and 24, whereas 40% and 28.6% reached PASI75 at week 36 and 48. Median PASI and BSA decreased from 10.0 (range 3.8-42.4) and 11.0 (range 3.5-72.0) at baseline to 4.3 (range 0-19.8) and 2.6 (range 0.0-39.6) at week 24 respectively. Physician Global Assessment improved significantly from 3.0 to 1.2 at week 24. A significant decrease in Children's Dermatology Life Quality Index from 9.0 to 3.8 at week 24 was found. Most reported adverse events were severe nausea (n=5), infections requiring antibiotics (n=5) and tiredness (n=4).
Conclusions:MTX shows a positive effect on PASI scores, improves Qol and has a reasonable safety profile.
- Symptomatic dermatographism treated with narrowband UVB phototherapy. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Dec 1.:1-6.
Abstract Dermatographism occurs when there is an exaggerated response to physical stimulus. There are both simple and symptomatic forms. Symptomatic dermatographsim can be exceedingly difficult to treat. Treatment modalities include H1 and H2 antagonists, leukotriene antagonists, cyclosporine and oral steroids. In a few small case series and studies phototherapy has been used. We report a further 2 patients who were treated successfully with TL01 UVB narrowband (NB) phototherapy.
- Treatment of 308nm Excimer Laser on Vitiligo: a Systemic Review of Randomized Controlled Trials. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 27.:1-21.
Background:Vitiligo is an acquired cutaneous hypopigmentary disorder which characterized by solitary or multiple depigmented maculae or patches. The 308-nm excimer laser has been used as phototherapy on vitiligo.
Objective:To evaluate the efficacy and safety of 308-nm excimer laser on vitiligo.
Methods:Randomized Controlled Trials (RCTs) were searched to conduct a systematic review. The keywords were identified as laser/ excimer laser/ quasimolecule/ XeCl" and "vitiligo".
Results:Seven studies with 390 vitiligo patients were included. No significant differences were seen between 308-nm excimer laser and 308-nm excimer lamp on either ≥75% or ≥50% re-pigmentation rate, or between 308-nm excimer laser and narrow band-ultraviolet B (NB-UVB) on either 100% or ≥75% re-pigmentation rate. More patients or lesions achieved ≥50% re-pigmentation rate by 308-nm excimer laser treatment than by NB-UVB treatment. The side effects of 308-nm excimer laser were slight and tolerable.
Conclusions:The 308-nm excimer laser showed equivalent efficacies to 308-nm excimer lamp control and NB-UVB control concerning of ≥75% re-pigmentation rate of vitiligo patches. More studies with high methodological quality, low risk of bias and more sample size are needed to confirm the conclusion.
- Treatment Refusal Among Patients With Psoriasis. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 27.:1-17.
Background.Treatment refusal, which is defined as a patient actively refusing to take treatment despite physician recommendations, has never been evaluated in psoriasis.
Objective.To investigate refusal of topical treatments by patients living with psoriasis in France.
Methods:Using responses to an internet study, participants who refused topical treatment (n = 50) were compared to those who applied topical treatment (n = 205). Participants undergoing phototherapy, biotherapy, and oral treatment were excluded. Spearman rank correlations completed by Fisher's exact tests and Student's t-tests were performed.
Results.Comorbidities, localization of lesions, and symptoms associated with psoriasis were not significant predictors of treatment refusal. Compared to patients who accepted treatment, more patients who refused treatment believed that psoriasis is not manageable (80.0% versus 61.5%; p=0.01), that psoriasis treatments never work (58.0% versus 27.5%; OR: 2.09 p<0.0001), and that all creams have the same effects (54.0% versus 31.7%; OR: 1.7, p=0.003). Among patients who reported seeking medical attention from physicians, more patients in the treatment refusal group reported some level of dissatisfaction with their relationship with their physician than in the treatment acceptance group. Limitations. The validity of the self-reported treatment refusal could not be evaluated.
Conclusion.Treatment refusal is an important element to be taken into consideration in the management of psoriasis.
- Polyphenols as novel treatment options for dermatological diseases: A systematic review of clinical trials. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 26.:1-17.
Background:Polyphenol phytochemicals demonstrate biological properties in vitro and in vivo that have led to the development of novel treatments for certain dermatological conditions.
Objective:We sought to provide clinicians with an overview of clinical trials evaluating the effectiveness of polyphenol-based therapies, and highlight novel treatments and the evidence available supporting their use.
Methods:PubMed and Embase databases were systematically searched to July 4, 2014. Two independent reviewers reviewed abstracts for inclusion. References were also manually searched for relevant studies. Data were extracted independently from eligible studies and discrepancies were adjudicated by consensus.
Results:Our search yielded 356 unique abstracts, of which 17 studies met inclusion and exclusion criteria. Polyphenols were used in topical and oral forms. High quality evidence suggests that green tea polyphenols may be effective in treating anogenital warts. Limited available evidence indicates that polyphenols may also benefit patients with alopecia, acne vulgaris, fungal infections, hyperpigmentation, or photoaged skin. Conclusions and Relevance: Evidence-based knowledge regarding the effectiveness, indications, and side effects of polyphenol-based phytochemicals is needed as their clinical use increases within dermatology. We qualitatively conclude that polyphenols may be effective in treating certain dermatological conditions. Additional rigorously conducted clinical trials are needed to further evaluate efficacy.
- Topical clobetasol in conjunction with topical tretinoin is effective in preventing scar formation after superficial partial-thickness burn ulcers of the skin: a retrospective study. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 26.:1-19.
Background:Deep erythema and inflammation after re-epithelialization of superficial wounds is a sign of scar formation. Corticosteroids may prevent scarring by suppression of inflammation and fibroblast activity. Tretinoin may increase the efficacy of corticosteroids in this setting.
Objective:To evaluate the efficacy of corticosteroids plus tretinoin for prevention of scars after superficial wounds.
Methods:In a retrospective study of patients with superficial partial thickness thermal skin burn, we compared the patients who received clobetasol plus tretinoin after re-epithelialization with patients who did not receive any medication. Clobetasol propionate 0.05% ointment was used twice daily with overnight occlusive dressing in conjunction with twice weekly topical tretinoin 0.05% cream.
Results:Among 43 patients who had light pink or no erythema after re-epithelialization and consequently did not receive clobetasol+tretinoin, no scar was developed. Among patients who had deep erythema after re-epithelialization, rate of scar formation was significantly higher in 14 patients who did not receive clobetasol+tretinoin than in 21 patients who received clobetasol+tretinoin (64% and 19% respectively; P=0.01).
Conclusion:Clobetasol+tretinoin can significantly decrease the incidence of scar formation in patients with inflammation after re-epithelialization of superficial wounds.
- An Emerging Treatment: Topical Ivermectin for Papulopustular Rosacea. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 26.:1-8.
Abstract Ivermectin shows broad-spectrum anti-parasitic activity. It kills the Demodex mites that reside in the pilosebaceous units of patients with papulopustular rosacea. Ivermectin also has anti-inflammatory effects, it decreases cellular and humoral immune responses. Inflammatory mechanisms appear to play a dominant role in development of rosacea inflammatory lesions. Additionally, there is some evidence that it has antimicrobial activity, against Myobacterium tuberculosis and Chlamydia trachomatis. In recent clinical studies of ivermectin on rosacea show that it was superior to vehicle in reducing inflammatory lesion counts, and tolerability was excellent.Ivermectin displays antimicrobial, antiparasitic, antibacterial, and anti-inflammatory activities.
- Safety of conventional systemic therapies for psoriasis on reproductive potential and outcomes. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Nov 26.:1-24.
Abstract The effects of conventional systemic therapies for psoriasis on pregnancy outcomes, lactation, male fertility and mutagenicity are common concerns in the clinical setting. There is relatively little evidence to guide clinician and patient. Here, we review the safety profile of the commonly used conventional systemic therapies used for psoriasis in individuals of reproductive potential. Safety data are derived from large scale registries, adverse-event reporting databases, clinical trials and case reports. We assess the effect of each therapy on adverse pregnancy outcomes, including congenital malformations, and lactation with maternal administration. We also assess the effect of the therapies on male fertility and potential mutagenicity with paternal administration. We provide applicable guidance to inform clinician and patient before and after conception.