Combinacion tacrolimus y excimer para vitiligo

Published in Dermatology

Journal Scan / Research · September 21, 2016

Combination Therapy With 308-nm Excimer Lamp and Topical Tacrolimus or Clobetasol 17-Propionate for Localized Vitiligo

Photodermatology, Photoimmunology & Photomedicine

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• In this retrospective study, 82 vitiligo patients were treated with 308-nm excimer lamp (previously found to have no superior efficacy over excimer laser) as a monotherapy or in combination with either topical tacrolimus or topical clobetasol applied twice daily. Median healing after 24 sessions was higher in the excimer + tacrolimus group (69%) compared with excimer lamp alone (42.5%) and excimer lamp + clobetasol (44%). Excimer + tacrolimus was superior to excimer + clobetasol in multivariate regression analysis.

• Repigmentation rates in vitiligo were higher in patients treated with excimer lamp plus topical tacrolimus than in those treated with excimer lamp alone or in combination with clobetasol.

  
  

Microscopia Confocal Muy Util herramienta en la Detección temprana del cancer de piel.

Reuters Health Information

Confocal Microscopy Helps Spot Skin Cancer Noninvasively

By David Douglas

September 12, 2016

NEW YORK (Reuters Health) - Reflectance confocal microscopy (RCM) can provide effective noninvasive cellular assessment of skin lesions suspected of being cancerous, according to two new studies.

Dr. Alon Scope, co-author of an accompanying editorial, told Reuters Health by email the new technology "is fundamentally changing the way we diagnose skin cancer. We can now image the cells that make up a skin lesion, without cutting into the skin's surface, and determine more precisely if the lesion is malignant."

Importantly, added Dr. Scope of Tel Aviv University, Israel, "this 'optical biopsy' can spare many benign skin lesions from the surgical knife, and is thus useful for diagnosing lesions on cosmetically sensitive areas like the face."

Both reports were published online August 31 in JAMA Dermatology.

In the first, Dr. Caterina Longo of Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia, Italy, and colleagues describe their prospective evaluation of a total of more than 1,200 equivocal skin lesions in 1,147 patients referred for RCM imaging.

RCM's main application was in deciding whether a given lesion should be biopsied. Overall, 52.2% of these lesions were excised after RCM evaluation to rule out skin cancer. The remaining lesions, which were not excised, were deemed benign after a year of follow-up.

RCM had a sensitivity of 95.3% and a specificity of 83.9%. The approach, say the researchers, was "most useful for lesions located on the head and neck, lesions with clinical evidence of sun damage, and those with evidence of regression on dermoscopy."

Dr. Longo told Reuters Health by email, "Our study highlights the role of confocal microscopy in clinical real practice: in particular, it emphasizes the best clinical situations for which a dermatologist not equipped with RCM could refer the patient to a tertiary center for confocal evaluation."

In the second study, Dr. Thaís Corsetti Grazziotin of Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil, and colleagues retrospectively examined use of RCM in morphologic patterns of melanomas in multiple primary and familial melanomas.

"Specific phenotypic features of high-risk patients were associated with dendritic-cell and round-cell type melanomas upon confocal microscopy classification," Dr. Grazziotin told Reuters Health by email.

The team examined 57 melanomas from 50 patients. Among the most prevalent were dendritic-cell (40%) and round-cell (37%) melanomas. Nine (16%) were unclassifiable.

Patients with dendritic-cell melanoma were a mean of 10.5 years older than patients with round-cell melanoma. They were also characterized by phototype 2 and 3 disease, more intense solar exposure, and moderate to severe solar lentigines.

Round-cell melanomas were identified more often in a familial context (61.9%) than dendritic-cell melanomas (34.8%). Phototype 1 was also more prevalent (24% versus none).

No significant association was found between the presence of CDKN2A mutations and a specific confocal melanoma type. Thus, say the researchers, "CDKN2A mutation carriers may develop any RCM type of melanoma."

"Future studies are necessary to enhance our knowledge of the interaction of multiple coexisting causal factors that drive melanoma development," they conclude.

Dr. Scope and Michael Marchetti of Memorial Sloan Kettering Cancer Center, New York, say in their editorial that there is a bright future ahead for noninvasive imaging and diagnosis in dermatological practice.

However, they add, "Randomized clinical trials with longer follow-up periods are needed to best estimate the impact of RCM on diagnostic accuracy, costs, and potential for overdiagnosis and misdiagnosis."

SOURCE: http://bit.ly/2bYRmRa, http://bit.ly/2cKVzZR and http://bit.ly/2cI3QtN

JAMA Dermatol 2016.

Chupar hielo u otras sustancias frías durante infusiones de quimioterapia reduce el riesgo de mucositis.

Medscape Medical News > Oncology

A Cold, Hard Solution for Oral Mucositis

Kristin Jenkins

September 13, 2016

Oral cryotherapy, which is the cooling of the mouth with cold consumables, is effective for the prevention of oral mucositis in the setting of fluorouracil (FU)-based chemotherapy for solid cancers, say experts in a Clinical Evidence Synopsis published online September 1 in JAMA Oncology.

It also prevents severe oral mucositis in adults receiving high-dose melphalan-based chemotherapy before hematopoietic stem cell transplantation (HSCT), according to the synopsis, which is based on a 2015 Cochrane review.

"Oral cryotherapy offers a simple, noninvasive, non-toxic, and cost-effective prophylactic option for preventing oral mucositis," write the synopsis authors, led by Martin G. McCabe, PhD, from the Institute of Cancer Sciences at the University of Manchester, United Kingdom, and colleagues.

Should clinicians be advising their patients with cancer to pack a cooler of ice chips before heading to chemo?

"We don't know!" Dr McCabe told Medscape Medical News. "Oral cryotherapy is a bit of a mixed bag, and we don't yet know if there is a difference between, say, sucking ice cubes versus crushed ice versus flavored ice lollies."

"We also don't know the optimal timing, frequency or mode of delivery of the intervention, including whether it should be every day, several times a day, before, during or after treatment, and for how long it should be continued."

Most patients tend to experiment on their own with ice chips, said Anurag K. Singh, MD, professor of medicine at the University at Buffalo School of Medicine, New York, in an interview with Medscape Medical News. "Most do not continue the practice," he added.

Dr Singh, who was not involved in the synopsis, also noted that physicians should not be recommending oral cryotherapy for all chemotherapy patients because "the data are really just for 5-FU and melphalan BMT [bone marrow transplantation]."

Oral mucositis affects up to 75% of patients receiving chemotherapy, radiotherapy of the head and neck, or targeted therapy. The synopsis authors estimate that the associated costs, including increased use of opioid analgesics, hospitalization, nasogastric or intravenous nutrition, and possible disruption of cancer therapy, can add up to more than $42,000 per patient.

For the synopsis, the researchers looked at 14 randomized controlled trials conducted in the United States, Iran, Italy, Turkey, Canada, Denmark, Sweden, and China from the late 1980s to 2013 and published between 1990 and June 17, 2015.

A total of 1316 patients were randomly assigned to cryotherapy vs no treatment or standard oral care, one cryotherapy regimen vs another, cryotherapy vs chlorhexidine, and cryotherapy vs leucovorin rinses. In all, 1280 patients were analyzed, 60% of whom were male and 40% female. Median age ranged from 36 to 63 years.

In an interview, Nathaniel S. Treister, DMD, DMSc, from the Division of Oral Medicine and Dentistry at Brigham and Women's Hospital, Boston, Massachusetts, said that oral cryotherapy "appears to be used widely throughout US cancer centers for prophylaxis of oral mucositis. It is an effective, safe, and low-cost prophylactic intervention that can potentially reduce the severity of oral mucositis in select cancer patients undergoing chemotherapy."

Dr Treister is the author of an online report on chemotherapy-induced oral mucositis. Others agree. "Swishing ice chips in the mouth for 30 minutes around the time of chemotherapy…'may provide a very inexpensive and effective way to prevent or minimize mucositis," say Arjun Gupta, MD, and Howard (Jack) West, MD, in a Patient Page that accompanies the Clinical Evidence Synopsis.

Dr Gupta is a family physician in Valparaiso, Indiana, and Dr West is a thoracic oncologist at the Swedish Cancer Institute at Swedish Medical Center in Seattle, Washington.

Cryotherapy works by inducing vasoconstriction in connective tissue of the oral mucosa, reducing its exposure to chemotherapy, Dr Treister explained. "Despite our best understanding of the mechanism of oral cryotherapy, it is possible that there are other mechanisms involved," he said.

Cryotherapy probably isn't an option for patients receiving radiation therapy, he added. "Cryotherapy is unlikely to have any benefit as radiation is provided daily over 5 to 7 weeks. Radiation is delivered through the tissue, not via blood vessels, so local vasoconstriction is unlikely to have any physiological or clinical benefit."

When asked whether the Mayo Clinic Cancer Center in Jacksonville, Florida, makes a practice of using oral cryotherapy in patients undergoing radiation therapy, Robert C. Miller, MD, professor of radiation oncology, confirmed, "We do not. Cryotherapy alters drug delivery so it is chemotherapy focused."

More answers are needed, but the fact that a prospective study on the efficacy of oral cryotherapy can't be blinded is an obstacle. It's difficult to "draw conclusions regarding the secondary outcomes of this review, or other chemotherapies," Dr McCabe pointed out.

"This lack of blinding is particularly problematic when the endpoint is the patient's own report of how much pain they feel," Dr Singh said.

Despite the blinding challenge, "the key principles of short half-life and short infusion time must be met," said Dr Treister.

The synopsis authors have disclosed no relevant financial relationships. Dr Treister disclosed that he is director of education for clinical assistance programs, Framingham, Massachusetts. Dr Miller disclosed that he is chairman of the board of directors of Belluscura Ltd and a nonexecutive director of Tekcapital Ltd. Both are in the United Kingdom. Dr Singh has disclosed no relevant financial relationships.

JAMA Oncol. Published online September 1, 2016. Abstract

Exposición a antibióticos a edades más tempranas incrementa el riesgo de enfermedades alérgicas.

Medscape Medical News > Conference News

Early Exposure to Antibiotics Augments Allergy, Eczema Risk

Kate Johnson

September 09, 2016

LONDON, United Kingdom — Rates of hayfever and eczema are higher in children exposed to antibiotics in the first 2 years of life than in unexposed children, according to results from a systematic review and meta-analysis.

"We strongly suggest physicians take this into account when they prescribe antibiotics, especially for children in early life," said lead investigator Fariba Ahmadizar, PharmD, from Utrecht University in the Netherlands.

For their meta-analysis, presented here at the European Respiratory Society International Congress 2016, Dr Ahmadizar and her colleagues examined cohort, case–control, and cross-sectional studies published between January 1966 and November 2015.

They looked at 21 studies involving 394,517 children with hayfever, 22 studies involving 229,080 children with eczema, and 12 studies involving 64,638 children with both.

Overall, early antibiotic exposure was associated with an increased risk for hayfever (odds ratio [OR], 1.23) and for eczema (OR, 1.26). The highest risks for hayfever and for eczema were seen in cross-sectional studies.

Table. Odds Ratio for Condition by Type of Study

Type of Study	Hayfever	Eczema
Cohort	1.18	1.24
Case–control	1.14	1.15
Cross-sectional	1.56	1.41

 

However, "we did not find any statistically significant difference between different study designs or the child's age at exposure to antibiotics and diagnosis of allergies," Dr Ahmadizar reported.

For both hayfever and eczema, the association was stronger in children treated with two or more courses of antibiotics than in those treated with just one course. The researchers did not have sufficient data to look at the association between each condition and type of antibiotic.

These findings might be explained by the immunomodulatory effect of antibiotics, said Dr Ahmadizar.

"Gut microbiota are thought to play an important role in the development of the immune system early in life, and reduced gut microbial diversity by exposure to antibiotics in early infancy leads to the imbalanced Th1 and Th2 response, which is related to an increased risk of allergies and other immune-related disorders," she explained.

However, exposure to infection rather than treatment might also explain the results, she acknowledged.

 

Gut microbiota are thought to play an important role in the development of the immune system early in life.

 

"We also found an increased risk for food allergy by exposure to antibiotics in early life, but since we could only include three studies for this part of the meta-analysis, we did not include the results," she added.

"These findings are important and may potentially explain the increase in allergic diseases, which coincides with an increase in antibiotic usage," said Bryan Love, PharmD, from the South Carolina College of Pharmacy in Columbia.

Dr Love was involved in a recent study that revealed an association between early antibiotic exposure and food allergy (Allergy Asthma Clin Immunol. 2016;12:41).

"It is well known that antibiotics can disrupt the normal flora of the skin, respiratory system, and gastrointestinal tract, and researchers are just beginning to understand the potential effects that antibiotics may cause through alteration of the microbiome," he explained.

"We know that microbes that colonize these areas contribute to immune development, and studies like this suggest that antibiotics may interfere with proper immune development, possibly leading to allergic diseases," he added.

Dr Ahmadizar and Dr Love have disclosed no relevant financial relationships.

European Respiratory Society (ERS) International Congress 2016: Abstract P3639. Presented September 6, 2016.

El vivir en la granja, de verdad, ayuda a reducir enfermedades alérgicas.

Innate Immunity and Asthma Risk in Amish and Hutterite Farm Children 

Stein MM, Hrusch CL, Gozdz J, et al
N Engl J Med. 2016;375:411-421

Background 

The hygiene hypothesis of atopy was first introduced in 1989,^[1]but there has not been a uniform definition of the term. The surge in atopic disease has been ascribed to reduced childhood viral infections owing to vaccination, increased antibiotic use, reduced helminth exposure, and urban living.^[2]

Although some of these theories are debatable,^[3] the inverse correlation between farm animal exposure and atopy has been one of the more intriguing observations. However, the mechanism of and the degree of exposure necessary for this protection had not been established.

The Study 

Stein and colleagues compared the Amish community of Indiana with the Hutterites of South Dakota. These two insular farming communities are strikingly similar genetically and environmentally, except that the Amish practice "traditional farming" on single-family farms, whereas the Hutterites' farms are highly industrialized. Past studies have noted that the respective rates of atopy and asthma are much higher in the Hutterites (33% and 21%, respectively)^[4] than the Amish (7% and 5%).^[5]

The study looked at asthma prevalence and the clinical and immunologic characteristics of atopic disease of children in both groups, and assessed the human and mouse model responses to house dust. None of the 30 Amish children had asthma, but six of the 30 Hutterite children did (20%). The Amish children had much lower total and allergen-specific levels of immunoglobulin (Ig) E and eosinophil counts, despite having similar exposure to allergens. Amish children had higher neutrophil counts and lived in homes with much more endotoxin (levels nearly seven times higher) than those of the Hutterites. A pooled dust sample identified differences in bacterial profiles as well.

To investigate the suspicion that the house dust was in itself the immune-modifying agent, the investigators compared the effects of Amish vs Hutterite house dust in a classic ovalbumin mouse model of allergic asthma. Hutterite dust was not protective against ovalbumin-induced allergic inflammation. Amish dust extracts, however, were able to significantly inhibit ovalbumin-induced airway hyperresponsiveness, bronchoalveolar lavage eosinophilia, and serum ovalbumin-specific IgE.

The results clearly show that something in Amish house dust is capable of preventing allergic sensitization, probably owing to endotoxin or other microbial products. Those in turn act on the innate immune system. The study found differences in proportions and gene-expression profiles of peripheral blood immune cells and in the genes involved in innate immune responses to microbes. The amount and phenotypes of neutrophils, eosinophils, and monocytes were also different. Genes associated with innate immune pathways seem to have been turned on by the microbes in the Amish environment.

Viewpoint 

These are exciting times in the field of allergy and asthma. Expensive biologicals offer hope for patients with severe asthma, but who will pay for them? Primary prevention of atopy and asthma is the best way to contain costs, and now it appears that there may a way—but only if the innate immune-stimulating elements of the microbes can be isolated.

Manejo Vitamina D en Norwich UK, en pacientes con Melanoma.

0. "At our centre, baseline vitamin D is measured at time of melanoma diagnosis. When levels are within normal range, dietary advice is given. If levels are <50nmol/L, vitamin D3 supplementation of 1200IU (30micrograms) is commenced once daily for at least 6 months. If severe deficiency is detected (<20nmol/L), then supplementation is increased. Calcium levels are monitored six weeks after to ensure no unmasking of hyperparathyroidism. Vitamin D levels are re-checked at 6 months. If levels have moved into normal range, supplementation of 400IU (10micrograms) is advised during the winter months. There remains debate to ideal levels of vitamin D. Our local range is 50-120nmol/L, though higher level (60-85nmol/L), depending on the season, has been suggested as at this level, parathyroid hormone reach a basal level and is not reduced with vitamin D supplementation (6,9)

   Our data suggests that measuring vitamin D levels may be of benefit in melanoma patients, with appropriate supplementation prescribed according to local/NICE guidance (8,10). In future, as vitamin D testing becomes more widely available and the correction of deficiency more commonplace, this service is likely to be undertaken in primary care. "

   
   

   Monitoring vitamin D in the melanoma patient – impact of sun avoidance on vitamin D levels of melanoma patients at a tertiary UK referral melanoma service
   M.C.I. Lo, J. Maraka, J. Garioch, W.G. John and M. Moncrieff
   Accepted manuscript online: 17 SEP 2016 09:46AM EST | DOI: 10.1111/bjd.15062
   

Uso de altos Factores de Protección Solar demostró beneficios en la reducción de melanoma.

Uso de altos Factores de Protección Solar demostró beneficios en la reducción de melanoma en Mujeres en un estudio Noruego.

• © 2016 by American Society of Clinical Oncology

Sunscreen Use and Subsequent Melanoma Risk: A Population-Based Cohort Study

1. Reza Ghiasvand⇑, 
2. Elisabete Weiderpass, 
3. Adele C. Green, 
4. Eiliv Lund and 
5. Marit B. Veierød

+Author Affiliations

1. Reza Ghiasvand and Marit B. Veierød, Institute of Basic Medical Sciences, University of Oslo; Elisabete Weiderpass, Cancer Registry of Norway, Oslo; Elisabete Weiderpass and Eiliv Lund, University of Tromsø–The Arctic University of Norway, Tromsø, Norway; Elisabete Weiderpass, Karolinska Institutet, Stockholm, Sweden; Elisabete Weiderpass, Folkhälsan Research Center, Helsinki, Finland; Adele C. Green, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; and Adele C. Green, University of Manchester, Manchester, United Kingdom.

1. Corresponding author: Reza Ghiasvand, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122 Blindern, N-0317 Oslo, Norway; e-mail: reza.ghiasvand@medisin.uio.no.

Abstract

Purpose To assess melanoma risk in relation to sunscreen use and to compare high– with low–sun protection factor (SPF) sunscreens in relation to sunbathing habits in a large cohort study.

Materials and Methods We used data from the Norwegian Women and Cancer Study, a prospective population-based study of 143,844 women age 40 to 75 years at inclusion with 1,532,247 person-years of follow-up and 722 cases of melanoma. Multivariable Cox proportional hazards regression was used to estimate the association between sunscreen use (never, SPF < 15, SPF ≥ 15) and melanoma risk by calculating hazard ratios and 95% CIs. The population attributable fraction associated with sunscreen use was estimated.

Results Sunscreen users reported significantly more sunburns and sunbathing vacations and were more likely to use indoor tanning devices. SPF ≥ 15 sunscreen use was associated with significantly decreased melanoma risk compared with SPF < 15 use (hazard ratio, 0.67; 95% CI, 0.53 to 0.83). The estimated decrease in melanoma (population attributable fraction) with general use of SPF ≥ 15 sunscreens by women age 40 to 75 years was 18% (95% CI, 4% to 30%).

Conclusion Use of SPF ≥ 15 rather than SPF < 15 sunscreens reduces melanoma risk. Moreover, use of SPF ≥ 15 sunscreen by all women age 40 to 75 years could potentially reduce their melanoma incidence by 18%.

Footnotes

• Supported by the Norwegian Extra Foundation for Health and Rehabilitation through Extra funds and the Norwegian Cancer Society (project number 2011/2/0228). The funding sources had no involvement in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

• Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

PRP no efectivo en alopecia femenina de patrón androgenetico.

Dermatologic Surgery:

Post Author Corrections: September 07, 2016

doi: 10.1097/DSS.0000000000000883

Original Article: PDF Only

Double-Blind, Placebo-Controlled Pilot Study on the Use of Platelet-Rich Plasma in Women With Female Androgenetic Alopecia.

Puig, Carlos J. DO; Reese, Robert DO; Peters, Michelle EdD

Published Ahead-of-Print

Abstract

BACKGROUND: Platelet-rich plasma (PRP) has been suggested as a therapeutic intervention for female androgenetic alopecia.

OBJECTIVE: To perform a pilot study on the effect of PRP scalp injections in women with female androgenetic alopecia.

MATERIALS AND METHODS: This double-blind, multicenter, placebo-controlled study compared the effect of PRP with that of saline placebo as scalp injection. The endpoints were hair count and hair mass index (HMI), along with patient-opinion survey responses. Platelet-rich plasma was manufactured from patients' blood using the Angel PRP system.

RESULTS: Hair mass index or hair count did not statistically significantly differ between the study and placebo groups. However, 13.3% of the treatment subjects (vs 0% of the placebo subjects) experienced substantial improvement in hair loss, rate of hair loss, hair thickness, and ease of managing/styling hair, and 26.7% (vs 18.2% of the placebo group) reported that their hair felt coarser or heavier after the treatment.

CONCLUSION: Platelet-rich plasma failed to demonstrate any statistically significant improvement in HMI or hair count in women with congenital female pattern hair loss. The patient survey results suggest a therapeutic advantage of PRP as perceived by patients but not according to hair count or HMI.

(C) 2016 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Aparato para detectar gluten en los alimentos...

Reuters Health Information

Want to Detect Gluten on the Go? There's a Device for That

By Ben Gruber

August 31, 2016l

SAN FRANCISCO (Reuters) - A California startup has developed a portable technology that will allow consumers to test their food for gluten on the go.

"Even when you go out and see these labeled menu items, you are still playing Russian roulette," said Shireen Yates, co-founder and chief executive of NIMA, which was founded in 2013.

Designed in San Francisco by a team from MIT, Stanford, Google and Nike, NIMA can analyze any type of food or beverage for gluten down to 20 parts per million, the Food and Drug Administration (FDA) classification for gluten-free products.

"There is still cross contamination, there is miscommunication, you just never know," Yates added.

An estimated 15 million people in the United States have some form of food allergy or sensitivity, a statistic that is on the rise, according to the Centers for Disease Control and Prevention.

Users of the device are instructed to fill a disposable cartridge with a pea-sized sample of food and then load it into the device, which is about half the size of a smartphone.

Roughly two minutes later, after the device measures the chemical reaction between antibody proteins and gluten, the screen will display a happy face if no gluten was detected.

Conversely, a wheat icon and text that reads "gluten found" will appear if any gluten is detected.

According to Yates, the antibodies bind to the presence of gluten if it is present in the sample, triggering a change that a sensor picks up on, Yates said.

To date, the company has raised $14 million in total with the help of a $9.2 million Series A round of venture capital funding earlier this year.

The funding, Yates said, will drive the company's next generation sensor, which consumers will be able to purchase as soon as 2017 if they want to detect milk and peanut allergens in their food as well.

Yates is launching an iPhone application to complement the device, allowing users to share their results.

The first orders of the gluten device, priced at $199, are expected to ship out to customers by the end of the year.

Los antibacteriales fueron prohibidos por la FDA...

Triclosan and Other Antibacterial Ingredients Banned from OTC Soaps

By the Editors

Over-the-counter hand soaps and body washes can no longer contain certain antibacterial ingredients, including triclosan and triclocarban, the FDA announced on Friday.

Despite the abundant use of these 19 ingredients in consumer products, the manufacturers have not shown that these ingredients are more effective than nonantibacterial soap and water for illness prevention, the FDA said. In addition, they have not shown that these ingredients are safe for frequent, long-term use — recent data suggest that widespread antiseptic use could increase bacterial resistance.

The new rule doesn't apply to hand sanitizers or antibacterial wipes.

FDA news release (Free)

Background: Physician's First Watch coverage of antibacterial soaps and washes (Free)

Leche y Acne?

LaRosa CL, Quach KA, Koons K, et al
J Am Acad Dermatol. 2016;75:318-322

Viewpoint 

This large case-control study echoes prior reports linking low-fat and skim milk intake to a higher prevalence of acne vulgaris in teenagers. This effect may be due, at least in part, to stimulation of sebaceous glands via transient milk-induced elevations in insulin and insulin-like growth factor-1.^[4]

As LaRosa and colleagues note, this modest association between low-fat dairy intake and acne does not establish causality. Furthermore, dairy-restriction diets have yet to show any clinically measurable benefit in reducing acne. Because milk contains a complex mixture of fatty acids, proteins such as casein, and the fat-soluble vitamins A and D, it remains unclear which, if any, of these components has a pro-acne effect. This is especially important because whole milk appears to show no pro-acne effects. In contrast, low-fat/skim milk elimination may benefit some teenagers with refractory acne, but clinical trials are needed to quantify this effect and to tease out which specific components of milk are responsible.

• Total dairy consumption was slightly higher in the acne group.

• Low-fat/skim milk consumption correlated with having acne (0.61 servings of low-fat/skim milk per day in the acne group versus 0.41 servings of low-fat/skim milk per day in the control group; P =.01).

• In contrast, whole milk consumption did not correlate with having acne.

• Investigators found no link between acne and the mean dietary glycemic index; total daily calorie intake; intake of saturated or trans-fat; total carbohydrates; total protein; total fat; or percentage of calories from fat, protein, or carbohydrates.

La importancia de dos dosis de vacuna para varicela.

Chickenpox Cases Continue To Decline In US Since Start Of Two-Dose Vaccine, CDC Says.

HealthDay (9/1, Steele) reports, "Chickenpox – which is caused by the varicella-zoster virus – has continued declining in the United States since 2006, when doctors began routinely recommending a second dose of chickenpox (varicella) vaccine," CDC health officials announced yesterday. In fact, "states reporting vaccination data noted an 85 percent drop in the highly contagious disease between 2005-2006 and 2013-2014, according to a" CDC study published in the CDC's Morbidity and Mortality Weekly Report. The biggest drop in cases was seen among children "aged 5 to 14, health officials said."