Vitamina D no reduce el riesgo de cancer de piel.

Vitamin D: No Beneficial Role Against Skin Cancer

PLoS One; ePub 2016 Aug 24; Park, Li, et al

August 31, 2016  

Vitamin D intake was positively associated with risk of basal cell carcinoma (BCC), while null associations were found with squamous cell carcinoma (SCC) and melanoma, according to a recent study. Researchers prospectively evaluated whether total, dietary, and supplemental vitamin D intake were associated with skin cancer risk based on 63,760 women in the Nurses' Health Study (1984 to 2010) and 41,530 men in the Health Professionals Follow-up Study (1986 to 2010). They found:

• During the follow up, 20,840 cases of BCC, 2,329 cases of SCC, and 1,320 cases of melanoma were documented.

• Vitamin D consumption was not associated with risk of SCC or melanoma was modestly positively associated with BC.

• Stratified analysis according to sun exposure related factors showed similar results.

In conclusion, the data do not support a beneficial role of orally taken vitamin D on skin cancer carcinogenesis.

Citation: Park SM, Li T, Wu S, Li WQ, Qureshi AA, Cho E. Vitamin D intake and risk of skin cancer in US women and men. [Published online ahead of print August 24, 2016]. PLoS One. doi:10.1371/journal.pone.0160308.

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Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

2224-0654

2208-8206

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Perdida de cabello en los hombres favorece cancer de piel...más en la cabeza.

Male Pattern Baldness Linked with Skin Cancer Risk

Int J Cancer; ePub 2016 Aug 20; Li, Cho, et al

August 31, 2016  

Male pattern baldness may be associated with increased risk of skin cancer, but the associations may only exist for those occurring at head and neck, particularly at scalp, a recent study found. Researchers examined the association between male pattern baldness and risk of incident skin cancer, including invasive melanoma, invasive squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) in a prospective analysis consisting of 36,032 participants. They found:

• During the follow-up, 327 melanoma cases, 1,324 SCC cases, and 8,438 BCC cases were identified.

• Male pattern baldness was not significantly associated with risk of incident melanoma, but was significantly associated with increased risk of SCC and BCC.

• Analyses by body sites found significant associations between frontal plus moderate-to-severe vertex baldness and risk of melanoma and SCC at head and neck; the associations were particularly stronger for scalp melanoma, but not for non-scalp head and neck sites.

Citation: Li WQ, Cho E, Han J, Weinstock MA, Qureshi AA. Male pattern baldness and risk of incident skin cancer in a cohort of men. [Published online ahead of print August 20, 2016]. Int J Cancer. doi:10.1002/ijc.30395.

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Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

2224-0654

2208-8206

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Muchos productos que afirman protección del sol sin necesidad de aplicar cremas no presentan evidencia contundente.

Scant Evidence Exists For Effectiveness Of Alternative Sunscreen Products.

The New York Times (8/29, Krueger) "Well" blog reports an increasing number of "outdoors enthusiasts are turning to" alternative "sunscreen products that are said to protect the skin from harmful rays without the need to apply – and reapply – messy lotions and gels." These products include beverages and vitamin cocktails. As of right now, however, "there is scant scientific evidence that the products actually work, or whether they have potentially harmful side effects." Meanwhile, "a study released by the American Academy of Dermatology last year found that only 14.3 percent of men and about 30 percent of women reported that they regularly used sunscreen."

Suplemento Marino reduce la caída del cabello en hombres y mujeres.

Published in Dermatology

News · August 29, 2016

Marine Complex Supplement Beneficial in Male Hair Thinning

Significant increases in total hair count, total hair density, terminal hair density after 180 days

THURSDAY, Aug. 25, 2016 (HealthDay News) -- A marine complex supplement is beneficial for men with thinning hair, according to a study published online Aug. 9 in the Journal of Cosmetic Dermatology.

Noting that an oral nutraceutical supplement based on a marine complex formation has been reported to increase the number of terminal hairs in women with thinning hair, Glynis Ablon, M.D., from the Ablon Skin Institute and Research Center in Manhattan Beach, Calif., confirmed the beneficial effects of a similar marine complex supplement in men with thinning hair. Healthy adult men with thinning hair were enrolled and randomly allocated to receive the study drug or placebo twice daily.

Ablon found that subjects indicated a significant improvement in three of six quality-of-life parameters at day 90, and a significant overall improvement in quality of life. Significant increases were seen for total hair count, total hair density, and terminal hair density after 180 days (all P < 0.001). Significant improvements were seen in terminal and vellus hair count and terminal hair density in investigator assessments. For study drug versus placebo, hair pull test results were significantly lower at days 90 (P < 0.05) and 180 (P < 0.01). No reports of treatment-emergent adverse events were observed.

"The results of this study showed for the first time that a dietary supplement containing a marine complex and other ingredients can decrease hair shedding and promote hair growth in men with thinning hair," Ablon writes.

The study was funded by Lifes2good, which manufactures the supplement used in the study.

Abstract
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Adalimumab es efectivo para hidradenitis supurativa.

Adalimumab Effective for Hidradenitis Suppurativa

The New England Journal of Medicine

BACKGROUND

Hidradenitis suppurativa is a painful, chronic inflammatory skin disease with few options for effective treatment. In a phase 2 trial, adalimumab, an antibody against tumor necrosis factor α, showed efficacy against hidradenitis suppurativa.

METHODS

PIONEER I and II were similarly designed, phase 3 multicenter trials of adalimumab for hidradenitis suppurativa, with two double-blind, placebo-controlled periods. In period 1, patients were randomly assigned in a 1:1 ratio to 40 mg of adalimumab weekly or matching placebo for 12 weeks. In period 2, patients were reassigned to adalimumab at a weekly or every-other-week dose or to placebo for 24 weeks. The primary end point was a clinical response, defined as at least a 50% reduction from baseline in the abscess and inflammatory-nodule count, with no increase in abscess or draining-fistula counts, at week 12.

RESULTS

We enrolled 307 patients in PIONEER I and 326 in PIONEER II. Clinical response rates at week 12 were significantly higher for the groups receiving adalimumab weekly than for the placebo groups: 41.8% versus 26.0% in PIONEER I (P=0.003) and 58.9% versus 27.6% in PIONEER II (P<0.001). Patients receiving adalimumab had significantly greater improvement than the placebo groups in rank-ordered secondary outcomes (lesions, pain, and the modified Sartorius score for disease severity) at week 12 in PIONEER II only. Serious adverse events in period 1 (excluding worsening of underlying disease) occurred in 1.3% of patients receiving adalimumab and 1.3% of those receiving placebo in PIONEER I and in 1.8% and 3.7% of patients, respectively, in PIONEER II. In period 2, the rates of serious adverse events were 4.6% or less in all the groups in both studies, with no significant between-group differences.

CONCLUSIONS

Treatment with adalimumab (40 mg weekly), as compared with placebo, resulted in significantly higher clinical response rates in both trials at 12 weeks; rates of serious adverse events were similar in the study groups.

• Article Citation

The New England Journal of Medicine

Two Phase 3 Trials of Adalimumab for Hidradenitis Suppurativa

N. Engl. J. Med 2016 Aug 04;375(5)422-434, AB Kimball, MM Okun, DA Williams, AB Gottlieb, KA Papp, CC Zouboulis, AW Armstrong, F Kerdel, MH Gold, SB Forman, NJ Korman, EJ Giamarellos-Bourboulis, JJ Crowley, C Lynde, Z Reguiai, EP Prens, E Alwawi, NM Mostafa, B Pinsky, M Sundaram, Y Gu, DM Carlson, GB Jemec 

TAKE-HOME MESSAGE

• Hidradenitis suppurativa is an inflammatory skin disease with common manifestations including recurrent abscesses and inflammatory nodules necessitating surgical management. The authors of these two randomized trials evaluated adalimumab in individuals with hidradenitis suppurativa, with the primary outcome being at least 50% reduction in abscess or inflammatory nodule count at 12 weeks. Treatment with adalimumab was associated with significant improvement in objective measures of disease burden 12 weeks after randomization. Additionally, adalimumab was associated with improvements in skin-related pain and Sartorius score, a measure of disease severity, in the second trial but not the first.

• Adalimumab appears to be an effective treatment option for individuals with moderate to severe hidradenitis suppurativa.

  – Matthew Resnick, MD

Timolol topico para Hemangiomas.

Timolol Maleate Safe and Effective for Infantile Hemangiomas

Pediatrics

BACKGROUND

There has been a dramatic increase in the off-label use of ophthalmic timolol maleate, a β-blocker used for infantile hemangioma (IH) treatment as a topical counterpart to oral propranolol. Its safety and efficacy in a pediatric population with IH have not been evaluated in a large cohort. Our goal was to retrospectively assess timolol's effectiveness, discern characteristics associated with response, and document reported adverse events.

METHODS

A multicenter retrospective cohort study of 731 patients treated with topical timolol was completed at 9 centers. Inclusion required an IH suitable for timolol in the treating physician's judgment and access to clinical details including photographs. Logistic regression analysis and descriptive statistics were performed. Primary outcome measures were efficacy assessed by using visual analog scales for color and for size, extent, and volume from review of digital photographs taken as standard of care.

RESULTS

Most IHs were localized (80.1%) and superficial (55.3%). Risk of disfigurement was the most common indication for therapy (74.3%). Duration of therapy (P < .0001), initial thinness (P = .008), and subtype (P = .031) were significant predictors of response. Best response occurred in superficial IHs <1 mm thick. Fifty-three (7.3%) required subsequent therapy with systemic β-blocker. Adverse events were mild, occurring in 25 (3.4%) patients. No cardiovascular side effects were documented.

CONCLUSIONS

Timolol seems to be a well-tolerated, safe treatment option with moderate to good effectiveness, demonstrating best response in thin, superficial IHs regardless of pretreatment size. Timolol can be recommended as an alternative to systemic β-blockers and watchful waiting for many patients.

• Article Citation

Pediatrics

Topical Timolol Maleate Treatment of Infantile Hemangiomas

Pediatrics 2016 Aug 15;[EPub Ahead of Print], K Püttgen, A Lucky, D Adams, E Pope, C McCuaig, J Powell, D Feigenbaum, Y Savva, E Baselga, K Holland, B Drolet, D Siegel, KD Morel, MC Garzon, E Mathes, C Lauren, A Nopper, K Horii, B Newell, W Song, I Frieden 

TAKE-HOME MESSAGE

• This international multicenter study was a retrospective analysis of the use of topical timolol in 731 patients with infantile hemangioma (IH). Over half of the IHs were superficial (55.3%) and the majority were localized (80.1%). Most (70%) of the patients were <6 months of age. Visual analog scales (VAS) were used to measure treatment response and the VAS for color showed a greater degree of improvement than for the VAS for size, extent, and volume. There was significantly improved treatment response with longer duration of topical timolol use. Other significant predictors of response included IH subtype and initial thinness. Adverse effects were evaluated and considered mild, most commonly involving local irritation such as scaling. There were no cardiovascular side effects.

• Topical timolol is a well-tolerated and effective treatment for thin (<1 mm thick), superficial infantile hemangiomas.

  – Sarah Churton, MD

Factores de riesgo para secuelas en Hemangiomas Infantiles.

Risk Factors for Sequelae After Involution of Infantile Hemangiomas

JAMA dermatology (Chicago, Ill.)

• IMPORTANCE

  Infantile hemangiomas involute to some extent, but they often leave sequelae that may cause disfigurement. Factors determining the risk of permanent sequelae after regression are of crucial importance in treatment decision making.

  OBJECTIVES

  To describe the sequelae left by infantile hemangiomas after natural involution and to identify clinical characteristics that could predict the most severe or a particular type of sequelae.

  DESIGN, SETTING, AND PARTICIPANTS

  Multicentric retrospective cohort study of images from 187 infantile hemangiomas that had not received systemic treatment and had follow-up pictures until regression that were selected from photographic files taken between 2003 and 2013 at 4 university hospitals with large vascular clinics in 3 different countries.

  MAIN OUTCOMES AND MEASURES

  Outcome measures were the type of sequelae classified as residual telangiectasia, anetodermal skin, redundant skin, persistent superficial component, and the degree of sequelae ranging from 1 to 4.

  RESULTS

  A total of 184 hemangiomas were included. The overall incidence of significant sequelae was 101 of 184 (54.9%). The most common sequelae after involution were telangiectasias (145, 84.3%), fibrofatty tissue (81, 47.1%), and anetodermic skin (56, 32.6%). The average age at which hemangioma completed involution was 3.5 years. Superficial and deep hemangiomas left significantly fewer sequelae than combined hemangiomas (Mann-Whitney; superficial vs deep, OR, 1.6; 95% CI, 0.6-3.8; P = .81; superficial vs combined, OR, 3.3; 95% CI, 1.7-6.3; P < .001; deep vs combined, OR, 2.1; 95% CI, 0.9-5.1; P < .001). Hemangiomas with a step or abrupt border of the superficial component left more severe sequelae than those with a smooth border (χ2,OR, 3.4; 95% CI, 1.8-6.6; P < .001). Superficial hemangiomas with a cobblestone appearance or rough surface left more severe sequelae than those with a smooth surface (Kruskal-Wallis; α, 0.05; P < .001). Using multivariate analysis, combined hemangiomas with a superficial component and a step border were associated with more sequelae.

  CONCLUSIONS AND RELEVANCE

  In this retrospective study of sequelae in a large cohort of untreated infants, we quantified the prevalence of permanent scarring and identified clinical features predictive of permanent sequelae. Our observations provide useful information at a time when the treatment paradigm for hemangiomas has changed. Such knowledge may help primary care physicians predict the risk of sequelae and identify high-risk lesions to implement early treatment.Article Citation

JAMA dermatology (Chicago, Ill.)

Risk Factors for Degree and Type of Sequelae After Involution of Untreated Hemangiomas of Infancy

JAMA Dermatol 2016 Aug 17;[EPub Ahead of Print], E Baselga, E Roe, J Coulie, FZ Muñoz, LM Boon, C McCuaig, A Hernandez-Martín, I Gich, L Puig 

TAKE-HOME MESSAGE

• This retrospective study reviews 185 cases of untreated infantile hemangiomas to identify features predictive of long-term sequelae. In these cases, the incidence of permanent sequelae considered significant to severe was 55%.

• The type of border was predictive of sequelae in hemangiomas with a superficial component (either superficial or combined), with step-off borders being most associated with long-term sequelae (found in 70.5% of cases compared with 41.3% of cases with smooth borders). 

  – Anna Wile, MD

Es importante hacer el diagnóstico y tratamiento del carcinoma basocelular en forma temprana!

The British Journal of Dermatology

Is Early Detection of Basal Cell Carcinoma Worthwhile? Systematic Review Based on the WHO Criteria for Screening

I. Hoorens; K. Vossaert; K. Ongenae; L. Brochez

Disclosures

The British Journal of Dermatology. 2016;174(6):1258-1265. 

Abstract and Introduction

Abstract

The incidence of basal cell carcinoma (BCC) has risen three- to fourfold over the last 30 years and is expected to continue to increase with ageing of the population. Although BCC has a good prognosis, it causes significant morbidity and has an important impact on the public health budget due to direct treatment costs. Based on the existing evidence, a systematic evaluation of the World Health Organization criteria was performed to determine whether earlier detection of BCC could reduce morbidity and cost. BCC slowly increases in size, with a median increase in diameter of 0·5 mm over 10 weeks. There is an important delay in diagnosis ranging from 19 to 25 months. In several studies BCC size was the main determinant of treatment cost, surgical complexity, reconstruction technique and the specific surgical procedure performed, such as Mohs micrographic surgery or surgical excision. One study showed that size also seems to affect the cost per treatment for other nonsurgical options. The use of vismodegib, an inhibitor of the hedgehog pathway, is confined to locally advanced or metastatic BCC. Delays in diagnosis and appropriate treatment are the most important underlying causes in the occurrence of giant BCC and/or BCC with metastasis. Although the latter represent only a very small fraction of all BCCs, the majority of them are located in the facial region. The available data point to a slow increase in the size of BCCs over time. Size is one of the major determinants in choice of treatment and the associated cost, especially for facial BCC. Therefore we conclude that current data support early detection and adequate management of BCCs on the face
.

Condilomas anogenitales pueden esconder lesiones de alto riesgo o malignas en hombres que tienen sexo con hombres.

Anogenital Warts May Be Cancerous in HIV-Positive Men Who Have Sex With Men

By Marilynn Larkin

August 05, 2016

NEW YORK (Reuters Health) - Human papillomavirus (HPV)-induced anogenital warts in HIV-positive men who have sex with men (MSM) "may harbor high-grade dysplasia or even invasive squamous cell carcinoma," researchers from Germany report.

"HIV-positive patients, especially HIV-positive MSM, have a significantly increased risk for HPV-induced anogenital lesions such as condylomas, anogenital dysplasias, and invasive cancers," Dr. Alexander Kreuter of the University of Witten-Herdecke told Reuters Health by email. "Condylomas are usually considered benign, or low-grade, lesions, and some researchers have suggested a 'wait and see' strategy in the case of such lesions."

However, as reported by Dr. Kreuter and colleagues in JAMA Dermatology, online July 27, a substantial proportion of HPV-induced anogenital lesions that clinically appear as common warts may actually be cancerous.

The team conducted a retrospective viral analysis of tissue from dysplasia-containing anogenital warts from 25 HIV-positive MSM and tissue from anogenital warts from 22 HIV-negative patients.

Of 38 dysplasia-containing anogenital warts from the HIV-positive MSM, six (16%) exhibited low-grade dysplasia, 31 (81%) harbored high-grade dysplasia and one (3%) had areas of invasive anal carcinoma.

All low-grade lesions except one were negative for p16INK4a (a tumor suppressor protein), whereas 25 of 31 (81%) anogenital warts with high-grade lesions or an anal carcinoma were p16INK4a-positive.

Further analysis revealed only low-risk HPV-types were present in 11 samples (29%); low-risk and high-risk HPV types were present in 19 samples (50%); and eight samples (21%) had only high-risk HPV-types.

Dr. Kreuter observed, "In some of these lesions, only low-risk HPV-types were found. (Therefore), low-risk HPV types are not completely 'innocent' in immunosuppressed individuals, as was previously shown for giant condyloma of Buschke and Löwenstein."

The 22 anogenital warts from HIV-negative patients showed no signs of dysplasia, and p16INK4a-staining was consistently negative. All of these samples carried low-risk HPV types, although additional high-risk HPV-types were detected in two cases.

"We recommend treating all HPV-associated anogenital lesions and obtaining tissue for further histopathological analysis," Dr. Kreuter said. "We also suggest including Ki67 and p16 immunostaining of such lesions in order to exclude focal dysplasia. We think that a 'wait and see' strategy is inappropriate in immunocompromised patients."

Dr. Kurt Melstrom, a surgical oncologist at City of Hope in Duarte, California, told Reuters Health by email that the study findings have "important clinical implications for two sets of physicians. The first is the patient's primary HIV physician. He or she should be more diligent about the anal exam and should refer patients out to a surgical specialist when any abnormalities are seen."

"For the surgeon, the results of this study point to thorough anorectal exams with high-resolution anoscopy," Dr. Melstrom continued. "When any lesions are encountered, they should be biopsied and the location in the anal canal noted. This is a departure from current treatment, which is usually fulguration or destruction of the lesions without directed biopsies."

No commercial funding or conflicts of interest were reported.

SOURCE: http://bit.ly/2aWxjzT

JAMA Dermatol 2016.

 

Reuters Health Information © 2016 

Cite this article: Anogenital Warts May Be Cancerous in HIV-Positive Men Who Have Sex With Men. Medscape. Aug 04, 2016.

Quimíco nuevo encontrado contra 3 infecciones parasitarias...

Reuters Health Information

Compound Found to Treat Three Parasitic Tropical Diseases

By Reuters Staff

August 09, 2016

LONDON (Reuters) - Scientists have found a single class of drugs that can kill the parasites responsible for three tropical diseases that affect millions in Africa, Asia and Latin America - Chagas disease, leishmaniasis and sleeping sickness.

In a study published online August 8 in the journal Nature, scientists at the Genomics Institute of the Novartis Research Foundation found the compound can cure all three diseases in mice, and does not harm normal human cells in laboratory tests.

This provides a strong starting point for developing new drugs to replace existing treatments that are expensive, sometimes not very effective, and can also have side effects.

Chagas, leishmaniasis and sleeping sickness kill more than 50,000 people a year, but receive relatively little funding for research and drug development.

They have different symptoms but are all caused by parasites called kinteoplastids with similar biology and genetics.

Hoping to find a shared weak spot in that biology, the scientists tested around 3 million chemicals on them. They identified a compound, called GNF6702, that worked against the parasites, and then refined it to make it more potent before testing in it mice.

"We found that these parasites harbor a common weakness. We hope to exploit this weakness to discover and develop a single class of drugs for all three diseases," said Frantisek Supek, who led the work.

The fact that GNF6702 seems to have no adverse effects in mice suggests it might have fewer side effects than existing drugs, the researchers said, although this will need to be tested in human studies.

SOURCE: http://go.nature.com/2aVz3ID

Nature 2016.

Literatura Relevante en Dermatología Pediátrica!

Published in Dermatology

Expert Opinion / Conference Coverage · August 09, 2016

Pediatric Dermatology Literature Year in Review: Report From SPD 2016

Written by

 

 Sarah L Chamlin MD

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Dr. Kevin Boyd from the University of Alabama in Birmingham reviewed articles published over the past year relevant to pediatric dermatologists.1

Sutter DE, Milburn E, Chukwuma U, et al. Changing Susceptibility of Staphylococcus aureus in a US Pediatric Population. Pediatrics. 2016;137(4): e20153099.

• There are been a declining number of MRSA infections in adults, and this study reports decreasing rates of MRSA in children as well. Notably, susceptibility to oxacillin increased and resistance to clindamycin significantly decreased over the time period studied, 2005 to 2014. This is another wake-up call to avoid the overuse of clindamycin.

Trenchs V, Hernandez-Bou S, Bianchi C, et al. Blood Cultures Are Not Useful in the Evaluation of Children with Uncomplicated Superficial Skin and Soft Tissue Infections. Pediatr Infect Dis J. 2015;34(9):924-927.

• Obtaining blood cultures in immunocompetent children with uncomplicated superficial skin and soft tissue infections (impetigo, abscesses, and cellulitis) is not useful and is not suggested by the authors of this Spanish study.

Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics. 2015;136(3):600-604.

• Early introduction of peanut to infants at high risk for peanut allergy (ie, those with a history of egg allergy or severe eczema) is recommended to reduce this risk. The study reported an 11% to 25% absolute reduction in risk of developing peanut allergy in high-risk infants. While dermatologists should be aware of the LEAP trial,2 counseling for infant food introduction is most often left to the primary care provider or an allergist.

Chiu CY, Huang SY, Peng YC, et al. Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood. Pediatr Allergy Immunol. 2015;26(4):337-343.

• Maternal vitamin D levels are inversely related to allergic sensitization and atopic diseases in early childhood. Mothers with deficient vitamin D in this 4-year study had infants with a higher prevalence of allergen sensitization (food and dust mite) before the age of 2 years, and higher vitamin D levels were associated with a lower risk in offspring for asthma and eczema.

References:

1. Boyd K. The Year in Review: Pediatrics. Paper presented at: 42nd Annual Society for Pediatric Dermatology Meeting; July 14-17, 2016; Minneapolis, MN.

2. Du Toit G, Roberts G, Sayre PH, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. N Engl J Med. 2015;372(9):803-813.
3. Trenchs V, Hernandez-Bou S, Bianchi C, Arnan M, Gene A, Luaces C. Blood Cultures Are Not Useful in the Evaluation of Children with Uncomplicated Superficial Skin and Soft Tissue Infections. Pediatr Infect Dis J. 2015 Sep;34(9):924-7.
4. Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics. 2015 Sep;136(3):600-4.

Acne "Hormonal"... y adolescentes.

Published in Dermatology

Expert Opinion / Conference Coverage · August 09, 2016

Hormonal Therapy With Oral Contraceptives or Spirolactone for Adolescent Acne: Report From SPD 2016

Written by

 

 Sarah L Chamlin MD

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Dr. Diane Thiboutot from Penn State University spoke on the hormonal treatment of adolescent acne.1 Here are the "pearls" from her presentation.

• Screen prepubertal children who have clinical signs of androgen excess with a hand film for bone age. This screen can be done before specific hormone testing. If the bone age is advanced, further evaluation is needed, such as specific hormone testing.
  
  
• Specific hormone testing includes DHEAS (high in adrenal tumors and congenital adrenal hyperplasia), total and free testosterone (elevated in PCO and ovarian tumors), LH/FSH ratio, and 17-hydroxyprogesterone. It is suggested that this testing be an early morning draw and not done near ovulation, and a patient should be off oral contraceptives for at least 6 weeks.2
  
  
• Indications for hormonal therapy for acne in young females: ovarian or adrenal hyperandrogenism; as second-line/alternative therapy with moderate or severe acne and normal serum androgens; and as an alternative to repeat courses of isotretinoin or antibiotics.
  
  
• Hormonal treatment choices include oral contraceptives that will block ovarian androgen production and antiandrogens, such as spironolactone and flutamide, to block skin androgen receptors. In addition, patients with documented adrenal hyperandrogenism may benefit from low-dose oral corticosteroids for treatment of acne.
  
  
• Practitioners who prescribe oral contraceptives should review the WHO contraindication list. The most relevant contraindication for teens is headaches/migraines with focal neurological symptoms.
  
  
• Low-dose estrogen-containing oral contraceptives early in the teen years may undermine the accrual of bone mass. They should be avoided, in general, until within 2 years of starting menses and before the age of 14 years.
  
  
• Rifampin and griseofulvin are the only anti-infective agents that lessen the efficacy of oral contraceptives.
  
  
• Spironolactone dosing of 25 to 100 mg twice daily is suggested, with side effects of breast tenderness and menstrual irregularity.
  
  
• While animal studies suggest carcinogenicity, a large Danish study concluded that use of spironolactone did not increase the risk for breast, uterine, and ovarian cancer.
  
  
• Routine potassium monitoring was investigated in a 2015 study, and a rate of hyperkalemia of 0.72% was reported.3This was compared with the baseline rate of 0.76% in the control group, and the authors suggest that routine potassium monitoring is not needed in healthy young women.

References: 

1.  Thiboutot D. Hormonal Therapy for Adolescent Acne. Paper presented at: 42nd Annual Society for Pediatric Dermatology Meeting; July 14-17, 2016; Minneapolis, MN.

2. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.e33. 

3. Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol. 2015;151(9):941-944.

Dermatitis de Contacto en Niños, que es importante recalcar... Cobalto en cueros es el alergeno del 2016!

Published in Dermatology

Expert Opinion / Conference Coverage · August 09, 2016

Allergic Contact Dermatitis in the Pediatric Population: Report From SPD 2016

Written by

 

 Sarah L Chamlin MD

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Dr. Erin Warshaw from the University of Minnesota reviewed pediatric allergic contact dermatitis1 and, as part of her discussion, provided key points of how patch testing differs in children.

• In the largest and most recent 2014 study of allergic contact dermatitis in children, 62% of children had positive patch tests (PPT), with 58% relevant.2 These numbers are lower than those published for adults, and the presence of atopy in the children did not make a difference in the number of positive reactions.
  
  
• The top seven allergens reported for adults and children are nickel sulfate, cobalt chloride, neomycin sulfate, Myroxylon pereirae (balsam of Peru) lanolin, fragrance mix, and bacitracin.
  
  
• Notably 23% of children reacted to a supplemental allergen not included in the common patch tests, and 13% reacted only to a supplemental allergen, a non-standard allergen. A hypothetical TRUE Test sensitivity can be estimated to detect relevant PPTs in only 71% of children. Therefore, a TRUE Test is an acceptable screening test, but supplemental allergens may be needed, such as those in cosmetics, rubber, clothing, and preservatives.
  
  
• Important allergens that are not on a TRUE Test include methylisothiazolinone (MI), propolis, decyl glucoside, surfactants, tocopherol, oxybenzone, and botanicals.
  
  
• How is the approach to patch testing different in children?
  • Plastic IQ chambers are used in children <10 years old. Aluminum Finn chambers are avoided by Dr. Warshaw because children are exposed to aluminum as a vaccine excipient, and an irritant reaction to this may lead to difficulty with test interpretation.
  • Carefully interpret doubtful reactions, as children may have a higher rate of irritant reactions.
  • Patch testing can be beneficial in children with AD, but expectations should be reviewed with parents before testing. The patch testing goal in children with AD is to return the dermatitis to its baseline severity. Parents may also need to be reminded that patch testing is not for food allergies.
    
    
• CAMP lists (of real and doubtful allergens) are available through the Contact Dermatitis Society and can be obtained in academic centers through a society member with a password. All real and doubtful allergen avoidance is suggested for 3 months followed by stepwise weekly addition of doubtful allergens.
  
  
• A few more pearls:
  • MI, which replaced formaldehyde as a common preservative, is a very common allergen in adults and children and is causing an epidemic in the contact dermatitis world. It was voted the 2013 allergen of the year, and "in-press" data will report it moving to the "Top 5" allergen list. Of note, the TRUE test includes methylchloroisothiazolinone (MCI) but not MI.
  • Decyl glucoside is another important and emerging allergen. This is in fragrance-free shampoos and soaps and is used as a sunscreen stabilizer in some products.
  • Polymyxin cross-reacts with bacitracin. Many parents frequently use topical antibiotics with no awareness of their allergenicity.
  • Cobalt, found in leather, will be the 2016 allergen of the year.

• References

1. 
   

   1. Warshaw E, Contact Dermatitis in Children. Paper presented at: 42nd Annual Society for Pediatric Dermatology Meeting; July 14-17, 2016; Minneapolis, MN.

   2. Zug KA, Pham AK, Belsito DV, et al. Patch testing in children from 2005 to 2012: results from the North American contact dermatitis group. Dermatitis. 2014;25(6):345-355.

Fototerapia en población pediátrica...

Phototherapy for Childhood Vitiligo, Atopic Dermatitis, and Psoriasis: Report From SPD 2016

Written by

 

 Sarah L Chamlin MD

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Leslie Castelo-Soccio, MD, PhD, from the Children's Hospital of Philadelphia, provided a review of phototherapy, both UVB and excimer, in pediatric patients with skin diseases including psoriasis, vitiligo, atopic dermatitis, and vitamin D deficiency.

• The biggest challenge when providing phototherapy to children with skin disease is safe delivery; often children do not keep eyewear on and have trouble staying still, and occurrence of acute side effects must be kept in mind.
• In addition, long-term risks of skin cancer must be considered, although there are few data showing a link between malignancy and phototherapy. There is one report of a child with psoriasis treated with PUVA therapy who developed two basal cell carcinomas before the age of 21 years.
• Often, repeat therapy and frequent doctor visits are inconvenient for school children, and this decreases compliance with visits. Home phototherapy should be considered in compliant patients, patients with no access to in-office light therapy, and those patients who have had success with in-office phototherapy. 
• Vitiligo 
  • Data support use of the excimer laser for childhood vitiligo, with a 2011 study showing >50% repigmentation in study participants; this study included good results in childhood segmental vitiligo. The mean number of treatments was approximately 80, and data suggest that if a patient is not responding by treatment number 40, he or she will likely not respond to more. 
  • Similar efficacy holds true for nbUVB therapy of vitiligo. Notably, early treatment may be more successful.
• Atopic dermatitis (AD)
  • UVB therapy should also be considered in AD, and published data support use in patients with severe AD.
  • There are no data on the efficacy of excimer in AD.
• Psoriasis
  • Both nbUVB and excimer are effective for pediatric psoriasis, with fewer therapies required for psoriasis and high numbers of near-complete or complete response.
• Vitamin D deficiency
  • UVB therapy can also be considered in certain instances for vitamin D deficiency, such as critically ill children without access to natural light and children with malabsorption and severe vitamin D deficiency.
• Pearls
• The best response is usually achieved after 40 treatments. If there is a suboptimal response, therapy should be discontinued after 6 months.
• Facial vitiligo seems have the best response to phototherapy.
• Interval increases of 20% per protocol with nbUVB and 10% to 20% for excimer were suggested.

1. Castelo-Soccio L. Medical Phototherapy in Childhood Skin Disease. Paper presented at: 42nd Annual Society for Pediatric Dermatology Meeting; July 14-17, 2016; Minneapolis, MN.