J Dermatolog Treat [journal]
- Reliability and Validity of the Psoriasis Itch Visual Analog Scale in Psoriasis Vulgaris. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 25.:1-23.
The single-item Psoriasis Itch VAS was developed to measure itch intensity within the last 24 hours in psoriasis vulgaris to assess treatment benefit. Its psychometric properties were explored in two trials.Data from two randomized, parallel-group phase 3 trials with subjects suffering from psoriasis vulgaris on the body (n = 426, 463) were analyzed. Cross-sectional distributional properties and construct validity of the Psoriasis Itch VAS as well as longitudinal test-retest reliability and sensitivity to change of the Psoriasis Itch VAS were investigated. All statistical tests were two-tailed.Across both trials, acceptable distributional properties were observed. Convergent-validity correlations between the Psoriasis Itch VAS and other patient-reported and clinician-reported outcomes provided strong endorsement for construct validity as did tests of known-groups validity. Longitudinal measurement properties, involving test-retest reliability and sensitivity to change, also offered evidence for the measurement integrity of the Psoriasis Itch VAS.Results from the assessment of validity, reliability, and sensitivity to change support the use of the Psoriasis Itch VAS to measure itch intensity in psoriasis vulgaris. Data from two trials provided evidence that the Psoriasis Itch VAS is well-defined and reliable for measuring itch in psoriasis vulgaris to assess treatment benefit (i.e., therapeutic response).
- A new topical panthenol-containing emollient: Results from two randomized controlled studies assessing its skin moisturization and barrier restoration potential, and the effect on skin microflora. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 18.:1-34.
Two randomized, intra-individual comparison studies were performed in healthy subjects to evaluate the skin moisturization and barrier restoration potential of a new topical panthenol-containing emollient (NTP-CE) (Study 1), and its effect on skin microflora (Study 2).In study 1 (N = 23), two skin areas, one challenged with 0.5% sodium dodecylsulfate solution (SDS) and one unchallenged, were treated with NTP-CE for three weeks. Transepidermal water loss (TEWL), skin hydration, and intercellular lipid lamellae (ICLL) organization were measured at regular intervals during the study. In study 2 (N = 20), quantitative bacterial cultures were obtained over six hours from a skin area undergoing wash stress with 10% SDS with subsequent single application of NTP-CE.In study 1, mean AUC for TEWL reduction from baseline was more pronounced with NTP-CE compared with control (-168.36 vs. -123.38 g/m(2)/h, p = 0.023). NTP-CE use was also associated with statistically significant improvements in stratum corneum hydration and an increase in mean ICLL length from baseline (day 22: 120.61 vs. 35.85 nm/1000 nm(2), p < 0.001). In study 2, NTP-CE use had no negative impact on bacterial viability.NTP-CE use has favorable and lasting effects on barrier function and repair as well as skin hydration without negatively influencing bacterial viability.
- The Extinction of Topical Erythromycin Therapy for Acne Vulgaris and Concern for the Future of Topical Clindamycin. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 17.:1-15.
This study aims to evaluate changes in topical antibiotic prescribing trends for acne.We retrospectively reviewed the National Ambulatory Medical Care Survey data from 1993 to 2012 for all visits in which acne vulgaris was the primary diagnosis.Acne vulgaris represented an estimated 94.5 million (92.3, 96.8) visits during the 20-year study period. Bivariate analysis showed that over time erythromycin use declined (p < 0.001) and clindamycin use rose (p = 0.10). Multivariate analysis showed that the likelihood of erythromycin use declined to near zero (p < 0.001), whereas clindamycin utilization increased (p < 0.05). PubMed searches of "erythromycin AND resistance" and "clindamycin AND resistance" demonstrated increasing publication frequency by year, fit with sigmoidal functions (erythromycin: R(2)=0.93 and clindamycin: R(2)=0.94). Yearly publications consistently exceeded 100 papers for erythromycin and clindamycin resistance in 1983 and 2003, respectively, roughly corresponding to the interval between reports of their utility in acne.Our findings suggest topical erythromycin use for acne has essentially ceased. By contrast, clindamycin use is increasing. Current recommendations discourage topical antibiotic monotherapy in favour of combination therapy with benzoyl peroxide and topical retinoids. Our group's previous work demonstrated that this trend is indeed occurring.
- Silver nitrate for Kaposi's sarcoma nodules: a new look at an old treatment. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 17.:1-9.
Fungating classic Kaposi's sarcoma (KS) tumors represent a therapeutic challenge given the increased risk of resistance to traditional local chemotherapy and the frequent concomitant skin infections.To study the effect and tolerability of silver nitrate cauterization in patients with fungating KS tumors.A single arm, prospective study in patients with soft, fungating, and/or oozing KS tumors cauterized with silver nitrate sticks. The application was repeated once every three weeks until the lesion became fibrous or after two consecutive applications without any clinical improvement.Eleven patients [10 male, 1 female, mean age of 75.8 years] with at least one fungating KS tumor of the lower limbs were treated. Complete or partial resolution of the KS lesion was achieved in 91% of patients after an average of 2.1 treatments (range, 1-4 treatments).fungating KS tumors can be treated simply, effectively and safely in the office with silver nitrate cauterization.
- Evaluation of thyroid function tests of acne vulgaris patients treated with systemic isotretinoin. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 17.:1-13.
Isotretinoin is a systemic retinoid used to treat acne and it binds receptors which are the member of steroid-thyroid hormone superfamily. Certain types of retinoids may cause abnormalities in serum thyroid function tests (sTFTs) by suppressing thyroid stimulating hormone (TSH). However, it is uncertain whether systemic isotretinoin has any effect on sTFTs.The aim of the study was to find out if there is any alteration in sTFTs of patients with acne vulgaris treated with systemic isotretinoin.51 patients (male/female: 22/29) with severe acne vulgaris treated with a total dose of 120 mg/kg isotretinoin were included into the study prospectively. Serum free T3 (fT3), free T4 (fT4), TSH levels were measured at baseline, 3(rd) and 6(th) months of treatment.Mean serum TSH levels at baseline, 3(rd) and 6(th) months of treatment were 1.57 ± 0.67, 2.07 ± 0.88 and 2.25 ± 0.86 uIU/mL, respectively. Mean serum TSH levels increased significantly following isotretinoin therapy (p < 0.01, p = 0.007 and p < 0.01, respectively). Mean serum fT3 levels at baseline, 3(rd) and 6(th) months of treatment were 3.59 ± 0.57, 3.19 ± 0.45 and 3.09 ± 0.61 pmol/L, respectively. Mean serum fT4 levels at baseline, 3(rd) and 6(th) months of treatment were 1.21 ± 0.19, 1.09 ± 0.16, 1.11 ± 0.19 pmol/L, respectively. Mean serum fT3 and fT4 levels decreased significantly at 3(rd) and 6(th) months compared to baseline levels (p < 0.01 and p < 0.01, p < 0.01 and p = 0.001, respectively).Systemic isotretinoin therapy causes significant alterations in sTFTs. Dose dependent or long-term effects of systemic isotretinoin on sTFTs needs further evaluation.
- Evaluation of the influence of pharmacists and GPs on patient perceptions of long-term topical corticosteroid use. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 17.:1-27.
To assess pharmacist and general practitioner (GP) advice and behaviors, as related to and reported by patients and parents of patients using topical corticosteroids (TCS) on a long-term basis.Multicenter cross-sectional survey of patients (aged 18+) and parents of pediatric patients (aged <18) with a history of long-term (≥ 1 month) TCS use, assessing: TCS treatment adherence and reasons for non-adherence; beliefs regarding TCS use and safety; messages regarding TCS received from community pharmacists, general practitioners (GPs), family/friends, and the Internet; and experiences of GP and pharmacist counseling regarding TCS use.A total of 123 patients and 78 parents completed the survey (n = 201). 76.6% of respondents reported consistently ('Often' or 'Always') receiving one or more message(s) regarding TCS 'risk' from a GP and/or pharmacist (n = 192). Respondents reported being told to 'try natural or complementary and alternative therapies before resorting to the use of TCS' significantly more often by pharmacists than by GPs (p = 0.039).High rates of consistently-delivered messages about TCS 'risk' from GPs and pharmacists affect patient/parent understanding about TCS safety and may lead to treatment non-adherence. This indicates a need for re-education of these groups on the safety of TCS use.
- Assessment of "corticophobia" as an indicator of non-adherence to topical corticosteroids: A pilot study. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 10.:1-8.
Concerns regarding topical corticosteroid (TCS) use, broadly known as "corticophobia", are highly prevalent among dermatology patients and often result in non-adherence to TCS. This non-adherence contributes to poor disease control and increased health care costs. However, it is unknown if assessment of these concerns might help to identify patients at risk of TCS-non-adherence. Clinical tools indicating non-adherence could be helpful to improve management of this patient group.To assess whether the available tools for measuring concerns regarding corticosteroids, the TOPICOP scale and the 0-10 Visual Analogue Scale (VAS), could help to detect non-adherence to TCS.In 75 patients with concerns regarding TCS use both the TOPICOP scale and VAS were anonymously assessed. A comparison was made between TCS-adherent and non-adherent patients regarding the intensity and characteristics of their concerns.The intensity and quality of the concerns varied broadly among the patients. When using the VAS, a score of ≥5 detected 87% of non-adherent patients. The answers to the TOPICOP scale did not discriminate non-adherent from adherent patients.Using the VAS to assess concerns to use TCS could help identify patients at risk of TCS-non-adherence and facilitate discussion with the patient about potential non-adherence in a more substantiated, non-judgemental way.
- Omalizumab therapy for treatment of recalcitrant chronic spontaneous urticaria in an Asian population. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 7.:1-6.
There are limited data regarding omalizumab in the treatment of recalcitrant chronic spontaneous urticaria (CSU) in Asian populations. This study evaluated the effectiveness and the proper dosage of omalizumab for Asian CSU patients in a real-life setting.We retrospectively reviewed recalcitrant CSU patients seeking treatment at the Skin Allergy Clinic, Siriraj Hospital during the 3-year period. All patients were treated with omalizumab as an add-on therapy. Standard seven-day urticaria activity score (UAS7) and medication score were used to assess omalizumab response.Of 13 patients, 9 patients (70%) responded well to 150 mg omalizumab injection every month, whereas 4 patients requiring updosing to 300 mg. In the 150 mg group, one patient achieved complete symptom control without antihistamine intake. Most of them required antihistamines without prednisolone and ciclosporin. Onset of omalizumab was fast, usually within the first week. Though only two patients in the 300 mg group achieved complete absence of symptoms, ciclosporin and oral corticosteroids could be discontinued. No patients reported adverse effects.Omalizumab at an initial dosage of 150 mg was effective in the treatment of recalcitrant CSU among Asians. Updosing to 300 mg was required to achieve satisfactory outcomes.
- Onychophagia: A nail-biting conundrum for physicians. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 7.:1-7.
Onychophagia, defined as habitual nail biting, is a common disorder affecting 20-30% of the population and all age groups. It may lead to significant psychosocial problems, have a negative impact on quality of life, and cause complications involving both the nail unit and the oral cavity. The objective of this paper is to review the prevalence, etiology, history, physical examination, complications and management of nail biting. Since onychophagia is a challenging disorder to treat, a multi-disciplinary approach should be taken involving dermatologists, internists, pediatricians, psychiatrists and dentists.
- Oral Chinese herbal medicine versus placebo for psoriasis vulgaris: A systematic review. [JOURNAL ARTICLE]
- J Dermatolog Treat 2016 Jul 1.:1-11.
Psoriasis is a chronic inflammatory skin disorder and the efficacy and safety of Chinese herbal medicine (CHM) treatments is unclear. This review evaluates oral CHM for psoriasis vulgaris clinical trial evidence.The Cochrane Library, PubMed, EMBASE, CINAHL, AMED, CBM, CNKI, CQVIP and Wanfang databases were searched from inception to June 2015. Randomised controlled trials (RCTs) of oral CHM compared to placebo data were included and analysed using Review Manager 5.2.Seven studies were included, no study utilised identical CHM intervention. Four studies data were subgrouped (decoction or capsule/pill) and pooled in meta-analysis to evaluate treatment effective rate for PASI60 or above (RR: 2.74 [0.92, 8.21] I(2 )=( )65%). Another five studies were subgrouped and evaluated for PASI score change, (MD -7.00 [-10.74, -3.27] I(2 )=( )98%). Only one study presented Dermatology Life Quality Index data, which favoured CHM (MD: -4.08 [-7.56, -0.60]). Two studies presented data on psoriasis-related inflammatory cell-signalling protein tumour necrosis factor-a (TNF-a) (MD: -4.92 [-5.31, -4.53]). No serious adverse events were reported.While CHMs appear to be safe and may have benefit for psoriasis, variation between CHM interventions, outcome measures and the quality of included studies limit the conclusions of this review. Further rigorous RCTs utilising reliable, validated symptom and QoL outcome measures are recommended.