Tamizare por Clamidia y Gonorrea

Un alarmante estudio, propone y recomienda que todas las mujeres sexualmente activas menores de 25 años, sean examinadas por estas dos infecciones sexualmente transmisibles. Esto debido a la alta incidencia en la población norteamericana.

No sé si sea adecuado esta extrapolación a nuestros países, pero valdría la pena realizar un estudio similar en nuestro país, una vez que hallamos salido del estado de inquisición en que se encuentra la investigación en nuestro país.

• The authors report that the USPSTF evaluated three randomized clinical trials, all of which found a reduction in the incidence of pelvic inflammatory disease with screening of asymptomatic females for chlamydia. Based on these results, the USPSTF endorsed chlamydia and gonorrhea screening for all sexually active females younger than 25 years and at-risk older women. The authors also report that further studies are needed to evaluate screening in men.

• Because dermatologists treat sexually transmitted infections, most commonly herpes simplex virus and human papilloma virus, they have an opportunity to encourage screening for chlamydia and gonorrhea, thereby improving the rate of diagnosis of silent infections and decreasing the morbidity of untreated infections that can lead to pelvic inflammatory disease.

Screening Recommendations for Chlamydia and Gonorrhea

JAMA Dermatol 2015 Jul 15;[EPub Ahead of Print], VR Sharon, AW Armstrong 

5 años luego del estudio Espirit, tratamientos en psoriasis muestran seguridad y efectividad.

No new safety signals were observed with adalimumab treatment during an initial 5-year registry review, according to a study of 6,059 patients with moderate to severe, chronic plaque psoriasis. Researchers found:

• The rate of serious treatment-emergent adverse events per 100 patient-years of adalimumab exposure (E/100PY) was 4.3.

• Rate of serious infection was 1.0 E/100PY.

• Rate of malignancies was 0.9 E/100PY, including nonmelanoma skin cancers, 0.6 E/100PY and melanoma, < 0.1 E/100PY.

• Standardized mortality ratio was 0.3.

• Physician Global Assessment of "clear" or "minimal" was achieved by 57.0% at 12 months and 64.7% at 60 months.

Citation: Menter A, Thaci D, Papp K, et al. Five-year analysis from the ESPRIT 10-year postmarketing surveillance registry of adalimumab treatment for moderate to severe psoriasis. [Published online ahead of print July 16, 2015]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2015.06.038.

Carcinoma Epidermoide, recurrencia local y metástasis nodular, más numero de carcinomas más recurrencia y reisgo de metastasis.

Patients with multiple cutaneous squamous cell carcinomas (CSCCs) warrant frequent follow-up because they have an elevated risk of local recurrence (LR) and nodular metastases (NM), according to a study of 985 patients with dermally invasive primary CSCC. Researchers found:

• 727 patients had 1 CSCC, 239 had 2 to 9 CSCCs, and 19 had ≥10  CSCCs.

• Most patients with ≥10 CSCCs were immunosuppressed.

• Compared to patients with 1 CSCC, patients with > 1 CSCC had a higher risk of:

◊ LR (1.8 hazard ratio (HR) for 2 to 9 CSCCs and 3.8 HR for ≥10 CSCCs).

◊ NM (3.0 HR for 2 to 9 CSCCs and 4.2 HR to ≥10 CSCCs)

• 10-year cumulative incidence of LR and NM was higher in patients with 2 to 9 CSCCs  (LR, 3.0%; NM, 2.3%) and markedly higher in patients with ≥10 CSCCs (LR, 36.8%; NM, 26.3%).

Citation: Levine DE, Karia PS, Schmults CD. Outcomes of patients with multiple cutaneous squamous cell carcinomas: a 10-year single-institution cohort study. [Published online ahead of print July 15, 2015]. JAMA Dermatol. doi: 10.1001/jamadermatol.2015.1702.

Heparan de Bajo peso molecular mejora la piel en varios aspectos.

Incorporating low molecular weight heparan sulfate into topically applied formulations may represent a new approach to improving the appearance of photodamaged skin, according to an 8-week study of 15 patients with photodamaged skin. Researchers found that patients using a topical formulation of low molecular weight heparin sulfate glycosaminoglycan showed improvement in:

• Skin hydration

• Skin firmness

• Skin elasticity

• Skin barrier function

• Global fine lines and wrinkles

Citation: Gallo RL, Bucay VW, Shamban AT, et al. The potential role of topically applied heparan sulfate in the treatment of photodamage. J Drugs Dermatol. 2015;14(7): 669-674.

Imiquimod para Lentigo Maligno, frecuencia y cantidad de aplicaciones llevan a la adecuada resolución.

Both cumulative dose and treatment intensity affect tumor clearance, according to a study of 347 patients with lentigo maligna who were treated with imiquimod monotherapy. Researchers found:

• Histologic clearance rate was 76.2%.

• Clinical clearance rate was 78.3%.

• Incidence of clinical recurrence was 2.3% at a mean follow-up of 34.2 months.

• Treatment with > 60 total applications was associated with an odds ratio of 8.4 for histological clearance.

• Treatment with > 5 applications per week was associated with an odds ratio of 6.0 for histological clearance.

Citation: Mora AN, Karia PS, Nguyen BM. A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance. [Published online ahead of print June 15, 2015]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2015.05.022.

Dieta y acné, sigue apilandose la evidencia.

Muchos pacientes al consultar por acné preguntan por la alimentación, yo les respondo, que es paciente dependiente, pero sí es relevante, aunque les hayan dicho o hayan leído que no.

Esté articulo nos da una idea, donde la cantidad de alimentos con alto  índice glicémico, o que tan rápido se convierte en azucares sencillos en sangre un alimento, correlaciona con el acné.

Recordando, que debemos evitar algunos alimentos, en especial si tenemos un acné resistente, tendemos hacia los ovarios poliquísticos, alta herencia para diabetes y/o obesidad.

Clinical and Experimental Dermatology

Low Glycaemic Diet and Metformin Therapy: A New Approach in Male Subjects With Acne Resistant to Common Treatments

Clin Exp Dermatol 2015 Jun 06;[EPub Ahead of Print], G Fabbrocini, R Izzo, A Faggiano, M Del Prete, M Donnarumma, C Marasca, F Marciello, R Savastano, G Monfrecola, A Colao 

Revisión sistemática de tratamientos en Rosacea...

Se publicó en la revista de Dermatología Británica un estudio donde analizan las publicaciones existentes para las herramientas y tratamientos empleados en el manejo de la Rosacea:

Tópicos:

1) Metronidazole y Ácido azleaico son efectivos con buena evidencia científica.

2) Brimonidina en vehículo muy efectiva para reducir enrojecimiento, con muy buen evidencia.

3) Ivermectina tópica es efectiva inclusive un poco más que el metronidazol con buena evidencia.

4) La cliclosporina en gotas oftálmicas para rosacea ocular parece efectiva con no muy buena evidencia.

Orales:

1) Doxicilina efectuvo en rosacea inflamatoria con buen nivel de evidencia en varias presentaciones.

2) Minociclina dosis baja con algún nivel de evidencia.

Tratamientos:

1) Laser y Luz para reducción de enrojecimeinto con alguna nivel de evidencia.

Recordar que todo esto, se toma con una cucharada de consideración, ya que no es santa palabra, si no que es de lo que se ha publicado en la literatura.

Algunos pacientes con medicamentos para el cancer presentan afectos adversos...

La capecitabina es un medicamento utilizado para algunos pacientes con cancer del tracto gastrointestinal y mama, que les puede dar un síndrome caracterizado por enrojecimiento, dolor ( ardor) y descamación de palmas y plantas de los pies. Algunas veces es un poco difícil de manejar, pero es importante de prevenir y manejar cuando se presente.

Este estudio demostró la efectividad de una crema que contiene urea al 10% vs un producto tópico, con antioxidantes y humectantes, demostrando que la urea es más efectiva.

Urea Cream to Prevent Capecitabine-Induced Hand-Foot Syndrome

Journal of Clinical Oncology

TAKE-HOME MESSAGE

• In this randomized, open-label trial, the authors compared prophylactic use of Mapisal, an ointment containing a variety of antioxidants and nourishing oil extracts, with 10% urea cream for the prevention of capecitabine-induced hand–foot syndrome (HFS).

• Of 152 patients, 47 (30.9%) experienced HFS. The urea cream–treated group experienced significantly less HFS than those treated with Mapisal (22.4% vs 39.5%; P = .02).

  
  

  
  

  Journal of Clinical Oncology

  Mapisal Versus Urea Cream as Prophylaxis for Capecitabine-Associated Hand-Foot Syndrome: A Randomized Phase 3 Trial of the AIO Quality of Life Working Group

  J. Clin. Oncol 2015 Jun 29;[EPub Ahead of Print], RD Hofheinz, D Gencer, H Schulz, M Stahl, S Hegewisch-Becker, LM Loeffler, U Kronawitter, G Bolz, J Potenberg, F Tauchert, SE Al-Batran, A Schneeweiss 
  

No hay dejar de preguntar... ¿Dudas sobre filtros solares?

Un estudio demostro que solo un 55% de los encuestados sabian cuanto filtro solar ponerse.
Porcentajes menores conocian sus propiedades beneficios.

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica
4000-1054
2208-8206
Please excuse the shortness of this message, as it has been sent from a mobile device.

De nuevo, la dieta y acné

Un estudio demostro que una dieta baja en carbohidratos y el uso de un farmaco para normalizar glicemia;  beneficio en el manejo de acne.

Published in Dermatology

Journal Scan / Research · July 02, 2015

Low Glycemic Diet and Metformin Therapy for Resistant Acne

Clinical and Experimental Dermatology

TAKE-HOME MESSAGE

• This randomized trial examined the effects of metformin and a hypocaloric diet in comparison with continued standard treatment for patients with acne resistant to common therapies and with an altered metabolic profile. Patients were classified as having an altered metabolic profile based on having lower HDL cholesterol levels, raised total or LDL cholesterol levels, impaired fasting glucose levels, higher body mass index (at the upper limit of normal), and greater waist circumference (at the upper limit of normal). The group receiving metformin and dietary intervention had a significant improvement in acne, while the control group did not. Additionally, a measure of insulin resistance improved in the intervention group, but not in the control group.

• Treatment for acne patients focusing on insulin resistance may be beneficial, but larger studies to evaluate this and to differentiate between the effects of metformin vs dietary interventions are necessary. Impaired metabolic profiles may be present in male patients with acne resistant to therapy.

  - Joshua Arbesman, MD

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.

Presencia de Síndrome de Cuerpo Dismórfico en Pacientes que consultan por pérdida de cabello (alopecia).

Published in Dermatology

Journal Scan / Research · July 02, 2015

Body Dysmorphic Disorder Among Patients With Complaints of Hair Loss

International Journal of Dermatology

TAKE-HOME MESSAGE

• Using a validated body dysmorphic disorder (BDD) questionnaire, 150 patients with complaints of hair loss and 150 general dermatology (GD) patients were evaluated for the presence of concomitant BDD. BDD was diagnosed in 29.6% of patients with complaints of hair loss compared with 2.7% of the GD patients. Additionally, of all patients with complaints of hair loss, BDD was more commonly diagnosed in male patients (52.4%) than in female patients (25.6%).

• Patients with concerns regarding hair loss, particularly male patients, may have concomitant body dysmorphic disorder. Appropriate identification and potential referral will likely help with their care.

– Joshua Arbesman, MD

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.