Dermatología en Costa Rica

Friday, March 30, 2018

Bacterias son gatillos para autoinmunidad en Lupus eritematoso sistemico.

Commensal Bacteria May Be Involved In Triggering SLE In Genetically Predisposed Individuals, Research Suggests.

Medwire News (3/29, Barnard) reports, "Commensal bacteria may be involved in triggering systemic lupus erythematosus (SLE) in genetically predisposed individuals," researchers concluded after examining "bacteria taken from skin, mouth, and stool samples of 13 patients with SLE and seven healthy controls." The findings of the "proof-of-concept" study were published in Science Translational Medicine. Rheumatology News (3/29, Collins) also covers the study.


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.

posted by dermatica at March 30, 2018 | 0 Comments

Mas toxicos en la comida no hecha en casa.


People Who Dine Out More Often May Have Higher Levels Of Phthalates, Research Suggests.

McClatchy (3/29, Berson) reports that research indicated that "people who said they dined out more often had higher levels of toxic chemicals called phthalates."

        Newsweek (3/29, Gander) reports that investigators looked at "data from 10,253 participants of the National Health and Nutrition Examination Survey (NHANES), collected between 2005 and 2014." The researchers "found levels of the chemicals were 35 percent higher in those who regularly ate at restaurants, cafeterias and fast-food places."

        HealthDay (3/29, Norton) reports that when the investigators "looked at particular types of food, they found that hamburgers and other meat sandwiches stood out: People who'd eaten those sandwiches the day before tended to have higher phthalate levels – but only if they'd gotten them from a restaurant or cafeteria." However, "the evidence was weaker when it came to fries and pizza." The findings were published online in Environment International.


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.

posted by dermatica at March 30, 2018 | 0 Comments

Wednesday, March 28, 2018

Uso de fototerapia a incrementado en los ultimos años.

Phototherapy Utilization Has Grown in the US

J Am Acad Dermatol; ePub 2018 Mar 22; Tan, et al


Phototherapy utilization has grown, though service mix has shifted towards UVB and laser excimer and away from psoralen and ultraviolet A (PUVA), according to a recent study that examined national and historical phototherapy utilization and costs among Medicare beneficiaries. Researchers conducted a longitudinal analysis of Medicare Part B National Summary Data File from 2000-2015 for phototherapy billing codes. Geographic distribution of clinics and provider type was obtained from Medicare Provider Utilization and Payment Data for 2012-2015.They found:

  • Overall volume of phototherapy services billed to Medicare from 2000-2015 increased 5% annually, from 334,670 to 692,093.
  • UVB comprised 77% of phototherapy volume, PUVA utilization declined 9% annually, and excimer laser services grew by 29% annually.
  • The number of phototherapy clinics is increasing but remains concentrated in only 11% of US counties.
  • Between 2012-15, dermatologists accounted for 92% of phototherapy volume.
Citation:

Tan S, Buzney E, Mostaghimi A. Trends in phototherapy utilization among Medicare beneficiaries in the United States, 2000-2015. [Published online ahead of print March 22, 2018]. J Am Acad Dermatol. doi:10.1016/j.jaad.2018.03.018.


posted by dermatica at March 28, 2018 | 0 Comments

Tuesday, March 27, 2018

Resistencia a Terbinafina!

Mycoses

 Volume 0, Issue ja
Original Article

High terbinafine resistance in Trichophyton interdigitale isolates in Delhi, India harbouring mutations in the Squalene epoxidase (SQLE) gene

Ashutosh Singh 
 
Aradhana Masih 
 
Ananta Khurana 
Pradeep Kumar Singh 
 ... See all authors 
First published: 25 March 2018
https://doi.org/10.1111/myc.12772

Abstract

In the last few years infections caused by dermatophytes along with a concomitant increase in the number of difficult to treat cases has increasingly been recognized indicating that dermatophytosis remains a challenging public health problem. The majority of infections are caused by Trichophyton rubrum and T. mentagrophytescomplex. Terbinafine, an allylamine antifungal used orally and topically is considered to be a first‐line drug in the therapy of dermatophyte infections. Terbinafine resistance has been predominately attributed to point mutations in the squalene epoxidase (SQLE) target gene a key enzyme in the ergosterol biosynthetic pathway leading to single amino acid substitutions. Here we report the largest series of 20 terbinafine resistant T. interdigitale isolates obtained predominately from cases of tinea corporis/cruris in three hospitals in Delhi, India exhibiting elevated MICs (1‐≥32 μg/ml) to terbinafine and all harbouring single point mutations Leu393Phe or Phe397Leu in the SQLE gene. In 12 (60%) T. interdigitale isolates the Phe397Leu substitution was observed whereas in the remaining 8 (40%) isolates the substitution Leu393Phe was reported for the first time in T. interdigitale. Further, 10 susceptible T. interdigitale isolates (0.125‐0.5 μg/ml) had a wild type genotype. Remarkably, a considerably high terbinafine resistance rate of 32% were observed among 63 T. interdigitale isolates identified by sequencing of the ITS region. This high level of terbinafine resistance of Indian dermatophyte isolates is worrisome warranting antifungal susceptibility testing and mutation analysis for monitoring this emerging resistance.

This article is protected by copyright. All rights reserved.


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.

posted by dermatica at March 27, 2018 | 0 Comments

Friday, March 23, 2018

adapaleno bajo oclusion para verrugas plantares...

Topical Adapalene in the Treatment of Plantar Warts; Randomized Comparative Open Trial in Comparison with Cryo-Therapy

Ramji Gupta and Sarthak Gupta1
Address for correspondence: Dr. Ramji Gupta, M-54, Jal Vihar Road, Lajpat Nagar-II, New Delhi - 110 024, India. E-mail: ni.oc.oohay@atpugijmarrd
Received 2013 Sep; Accepted 2014 Jan.
Copyright : © Indian Journal of Dermatology
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


posted by dermatica at March 23, 2018 | 0 Comments

Serlopitant for the Treatment of Chronic Pruritus | PracticeUpdate


bhidalgo@gmail.com
  • Benjamin Hidalgo-Matlock
  • Physician

Journal Scan / Research · March 06, 2018

Serlopitant for the Treatment of Chronic Pruritus

Journal of the American Academy of Dermatology

 TAKE-HOME MESSAGE

  • The authors assessed the safety and efficacy of serlopitant in patients with chronic pruritus associated with dermatologic and non-dermatologic conditions. Patients were randomized to receive either placebo (n = 64), or serlopitant 0.25 mg (n = 64), 1 mg (n = 65), and 5 mg (n = 64). No adverse events were detected. After 6 weeks, patients receiving 1 mg or 5 mg of serlopitant had a marked decrease in pruritus scores compared with patients receiving placebo. Differences emerged at 3 weeks after treatment initiation and remained at final follow-up visit 4 weeks after completing treatment. 

  • The results suggest that serlopitant is well-tolerated and reduces pruritus in patients with severe chronic pruritus from several dermatologic and non-dermatologic conditions that were refractory to antihistamines and corticosteroids.

    – Jeffrey F. Scott, MD

 Dermatology

Chronic pruritus poses a significant burden on society in terms of healthcare cost and treatment challenges.

Additionally, many systemic diseases are also known to be associated with pruritus. Currently, the pathophysiology of pruritus is unclear, but we do know that the substance P/neurokinin 1 receptor (NK1R) pathway is critical in chronic pruritus.

In this original article, the authors evaluated the safety and efficacy of novel agent serlopitant, an NK1R antagonist, for treatment of chronic pruritus in patients with disparate dermatologic diseases and idiopathic pruritus.

In this study, serlopitant treatment resulted in a dose-dependent decrease in pruritus in all groups as well as improvement in the DLQI (quality-of-life assay). Nearly 45% of patients had a primary dermatologic disease. However, it should be noted that improvement in pruritus occurred in the treatment group regardless of the underlying dermatologic disease. This is particularly exciting as treatments for chronic pruritus are not particularly helpful. This was a small patient population, and the high placebo rates should not detract from the potential significance of this study.

This study also demonstrates that more research is needed in evaluating the basic pathophysiology of pruritus. If we are able to discover the key players and pathways in pruritus, we will be able to construct drugs that can target these pathways to block its effects.

Abstract

BACKGROUND

The substance P/neurokinin 1 receptor (NK1R) pathway is critical in chronic pruritus; anecdotal evidence suggests antagonism of this pathway can reduce chronic itch.

OBJECTIVE

To assess the safety and efficacy of the NK1R antagonist serlopitant in treating chronic pruritus.

METHODS

Eligible patients with severe chronic pruritus who were refractory to antihistamines or topical steroids were randomized to serlopitant 0.25, 1, or 5 mg, or placebo, administered once daily for 6 weeks as monotherapy or with midpotency steroids and emollients. The primary efficacy end point was percentage change in Visual Analog Scale (VAS) pruritus score from baseline.

RESULTS

Serlopitant treatment resulted in a dose-dependent decrease in pruritus. Mean percentage decreases from baseline VAS pruritus scores were statistically significantly larger for the 1- and 5-mg doses of serlopitant (P = .022 and P = .013) versus placebo at week 6. No significant safety or tolerability differences were detected among the groups.

LIMITATIONS

The sample size was insufficient for subgroup analyses of the efficacy of serlopitant for chronic pruritus based on underlying conditions.

CONCLUSIONS

Serlopitant 1 mg and 5 mg daily was associated with a statistically significant reduction in chronic pruritus and was well tolerated. 

Journal of the American Academy of Dermatology
Serlopitant for the Treatment of Chronic Pruritus: Results of a Randomized, Multicenter, Placebo-Controlled Phase 2 Clinical Trial
J Am Acad Dermatol 2018 Feb 17;[EPub Ahead of Print], G Yosipovitch, S Ständer, MB Kerby, JW Larrick, AJ Perlman, EF Schnipper, X Zhang, JY Tang, T Luger, M Steinhoff 

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.

posted by dermatica at March 23, 2018 | 0 Comments