posted by dermatica at
December 29, 2018
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The top 4 sunscreens, according to Consumer Reports:
posted by dermatica at
December 29, 2018
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The New York Post (12/26, Sparks) reports researchers found that "some common...personal care products" phthalates, parabens and phenols, "may be putting adolescent girls at a higher risk of certain cancers and other developmental issues." The findings were published in Human Reproduction. The article mentions that 96% of women tested positive for the chemicals, according to the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey.
posted by dermatica at
December 27, 2018
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The San Diego Union-Tribune (12/26, Fikes) reports researchers found that as skin ages, "skin cells called fibroblasts lose their ability to make fat cells that reside under the surface," and these "cells give the skin a smooth, youthful appearance, and also secrete an antibacterial substance." The researchers then tested a treatment in mice that increased the number of fat cells under the skin and increased the skin's "resistance to Staphylococcus infection." The findings were published in Immunity.
posted by dermatica at
December 27, 2018
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HealthDay (12/26, Reinberg) reports that tofacitinib "appeared to cure one woman of a rare but potentially life-threatening condition known as sarcoidosis," research indicated. In the case "a 48-year-old woman with sarcoidosis took" tofacitinib "twice a day over several months. Over that time, her skin lesions nearly disappeared," the study revealed. The findings were published in the New England Journal of Medicine.
posted by dermatica at
December 27, 2018
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(Reuters Health) - The epinephrine in emergency allergy shots like the EpiPen can deteriorate when exposed to heat, so they shouldn't be left in the car on a hot day, researchers warn.
"We work with hundreds of patients with histories of anaphylaxis, who carry epinephrine on a daily basis," lead author Piotr Lacwik, who works at the Medical University of Lodz in Poland, said in an email. "I noticed that not all of them have their epinephrine on them at all times and, alarmingly, some leave injectors in the car."
For the study, Lacwik and his team purchased 12 EpiPen Senior injectors from the same lot to ensure consistency. They distributed nine EpiPens between the glove compartment, cabin shelf and trunk of a car parked in a treeless area. The remaining three were stored in a dark, air-conditioned room at a constant temperature.
After half a day, the researchers retrieved the EpiPens from the car and cooled them to room temperature before testing their contents.
They found that the concentration of epinephrine in the autoinjectors was reduced by 3.3% in samples placed in the trunk, 13.3% in those placed in the cabin and 14.3% in those left in the glove compartment.
Most guidelines recommend 0.3 mg or 0.5 mg as an initial dose for an adult. Because the EpiPen Senior has a total dose of 0.3 mg, any deterioration puts the dose below the recommended threshold, Lacwik said.
The EpiPens in the glove compartment were noticeably warm to the touch when retrieved, researchers noted. This was because the enclosed space likely reduced the dissipation of heat even when ambient temperatures began to drop, they explain in The Journal of Allergy and Clinical Immunology: In Practice, in a report online November 28.
Paradoxically, epinephrine in low concentrations can worsen anaphylaxis, the authors write, but Lacwik notes the decreases seen after a single exposure to heat in the study are unlikely to produce that effect.
A spokeswoman for EpiPen manufacturer Mylan said that while the company was not involved in the study, "its findings are consistent with the storage guidelines outlined in the FDA-approved label for EpiPen Auto-Injector."
"Per the label, EpiPen Auto-Injector is to be stored at 20°C to 25°C (68°F to 77°F)," she said.
The report notes that although prescribing and patient information available online includes a warning against glovebox storage of EpiPens, the leaflet enclosed with the devices did not.
Allergist Dr. Purvi Parikh, spokeswoman for the Allergy and Asthma Network, pointed out that the study tested only one brand of autoinjectors, in only one make and model of car. Still, she called the results "concerning," as many patients keep their autoinjectors in their cars for convenience.
"Patients likely are not aware of this risk in general and need to be advised," Parikh, who was not involved in the study, told Reuters Health.
"With anaphylaxis, timing of epinephrine dosing is crucial in saving lives and so if the epinephrine is ineffective (it) can be deadly for patients."
Lacwik too said the results might not translate precisely to other formulations of epinephrine in other climates or car models. But "while our study did not check any of those alternatives, we believe that the general conclusion- a warning against leaving autoinjectors in the heat - can be applied to all formulations of epinephrine available on the market," he said.
SOURCE: http://bit.ly/2Pv42hC
J Allergy Clin Immunol In Practice 2018.
Reuters Health Information © 2018
Cite this article: EpiPens Less Effective After Heat Exposure - Medscape - Dec 11, 2018.
posted by dermatica at
December 18, 2018
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posted by dermatica at
December 14, 2018
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posted by dermatica at
December 14, 2018
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Eczema, long thought to be a childhood disease, is also common among older adults, a population-based study has found.
"We have shown that rates of active atopic eczema (as defined by diagnosis and treatment codes applied by physicians) increase with age among adults in primary care, addressing a gap in evidence about the epidemiology of this condition after childhood," the researchers write.
The study by Katrina Abuabara, MD, MSCE, and Alexa Magyari, BA, both from University of California, San Francisco, and colleagues was published online December 3 in Annals of Internal Medicine.
The authors analyzed data from the Health Improvement Network, a primary care cohort that is representative of the United Kingdom population, from between 1994 and 2013. In the United Kingdom, primary care physicians manage 97% of patients with atopic eczema, also known as atopic dermatitis or eczema.
The study included 8,604,333 persons aged 0 to 99 years. The researchers first identified patients with physician-diagnosed eczema. "Because atopic eczema is an episodic disorder that may remit for years, we then calculated the prevalence of active disease requiring a physician visit or prescription during each year of follow-up," they explain.
The cumulative lifetime prevalence of the disorder was 9.9%. The highest rates occurred among children and older adults.
The mean prevalence was highest among those aged 0 to 17 years, at 12.3%. It then fell to 5.1% among those aged 18 to 74 years before rising again to 8.7% among those aged 75 years and older.
Across all ages, patients each year received a median of six prescriptions for the treatment of atopic eczema (interquartile range, two to 13 prescriptions). Therapies included topical steroids and systemic treatments.
The highest rates of comorbid atopic disease, including asthma and allergies/rhinitis, were seen among adults aged 18 to 74 years.
Although the study cohort is representative of the population in the United Kingdom, the researchers say the true prevalence of eczema may be higher than their estimates, because medical records do not capture over-the-counter treatments. In addition, providers may not document mild illness.
"Atopic eczema is known to substantially affect emotional and physical aspects of health-related quality of life but is often undertreated," the researchers write.
This may change with the availability of more therapies, they say. Two new agents were approved by the US Food and Drug Administration in 2016 and 2017, and "more than a dozen additional agents" are being tested, the authors note.
"As new targeted therapies become available, primary care providers will probably play a larger role in managing adults with atopic eczema. Attention should be paid to clinical testing in older adults, who may require special considerations for pharmacology, polypharmacy, and multimorbidity," the researchers conclude.
One coauthor has received grants from Valeant and personal fees from Sanofi/Regeneron and GSK, and another has received personal fees from TARGETPharma.
Ann Intern Med. Published online December 3, 2018. Abstract
Medscape Medical News © 2018
Cite this article: Eczema Rates Rise With Age Among Adults, Study Finds - Medscape - Dec 04, 2018.
posted by dermatica at
December 13, 2018
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NEW YORK (Reuters Health) - Dapsone is an effective second-line treatment for chronic spontaneous urticaria (CSU) patients in whom antihistamines and other first-line therapies have failed, researchers say.
Research fellow Erik Peterson and colleagues at NYU Langone Health in New York City studied medical records of 79 patients (mean age, 50; 65% women) treated with dapsone for CSU from 2005 to 2017. Forty-five patients (60%) had chronic idiopathic urticaria and 34 had chronic autoimmune urticaria.
As reported online November 21 in JAMA Dermatology, dapsone resulted in improvement in CSU in 62 patients (78%): 36 (80%) with idiopathic and 26 (76%) with autoimmune disease. The mean time to improvement was about a month.
A complete response was achieved in 29 (47%) of the 62 responders: 16 (44%) with idiopathic and 13 (50%) with autoimmune disease. The mean time to complete response was 5.2 months.
Dapsone was tapered in 21 patients after a mean of 2.4 months and discontinued in 18. Ten patients followed for up to 10 months experienced remission with no subsequent flares, even after dapsone was discontinued.
Sixteen patients experienced mild adverse effects. Two patients had serious adverse events requiring cessation of therapy: one methemoglobinemia and one drug reaction with eosinophilia and systemic symptoms.
"As an efficacious, well-tolerated medication...dapsone merits further usage as a second-line therapy in the treatment of refractory CSU," Peterson said in an email to Reuters Health. "Comparative studies could evaluate dapsone's utility against other second-line agents, such as biologics like omalizumab, immunosuppressants like cyclosporine, or steroids like prednisone."
"However, many patients in our study had previously failed these second-line therapies and only achieved disease control with dapsone," he noted. "Furthermore, dapsone offers an advantage over other systemic medications due to its tolerability and low side-effect profile."
"Dapsone merits further investigation to determine the precise mechanism by which this anti-microbial agent can provide such a robust and durable response for patients suffering from CSU," he concluded.
Dr. Suzanne Friedler, a clinical instructor of dermatology at the Mount Sinai Health System in New York City, told Reuters Health by email, "Chronic idiopathic and autoimmune urticaria present a difficult therapeutic challenge when they do not respond to conventional therapy."
"Dapsone is an interesting alternative (to other second-line therapies) because it has anti-microbial and anti-inflammatory properties," she noted. "It is a fraction of the cost of biologic therapy and it may have lower side effects than long-term steroid use."
Because dapsone can cause a hemolytic anemia in patients with glucose 6 phosphate dehydrogenase deficiency, "patients are always screened for this before starting dapsone," she added.
SOURCE: http://bit.ly/2E7gAun
JAMA Dermatol 2018.
Reuters Health Information © 2018
Cite this article: Dapsone Useful for Chronic Spontaneous Urticaria - Medscape - Nov 30, 2018.
posted by dermatica at
December 11, 2018
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(Reuters Health) - Girls who are exposed before birth to chemicals commonly found in toothpaste, makeup, soap and other personal care products may hit puberty earlier than their peers who aren't exposed to these chemicals in the womb, a U.S. study suggests.
Many chemicals have been linked to early puberty in animal studies including phthalates, which are often found in scented products like perfumes, soaps and shampoos; parabens, which are used as preservatives in cosmetics; and phenols, which include triclosan, researchers note in a paper online December 3 Human Reproduction. While this is thought to interfere with sex hormones and puberty timing, few studies have explored this connection in human children.
For the current study, researchers followed 338 children from birth through adolescence. They tested mothers' urine during pregnancy and interviewed them about potential chemical exposures, then tested childrens' urine for chemical exposure at 9 years old and examined them for signs of puberty development every nine months between ages 9 and 13 years.
Over 90 percent of kids' urine samples showed concentrations of all the potentially hormone-altering chemicals, except for triclosan, which was found in 73 percent of pregnant mothers' urine samples and 69 percent of their kids' urine samples.
For every doubling in concentration of a phthalate indicator in mothers' urine, their daughters developed pubic hair an average of 1.3 months earlier, the study found. And with every doubling of mothers' urine concentrations of triclosan, girls started menstruating one month earlier.
Boys' puberty timing didn't appear to be influenced by prenatal exposure to these chemicals.
"There has been considerable concern about why girls are entering puberty earlier and hormone disrupting chemicals like the ones in personal care products that we studied have been suggested as one possible reason," said lead study author Kim Harley, associate director of the Center for Environmental Research and Children's Health at the University of California, Berkeley.
Half of the girls in the study started growing pubic hair when they were at least 9.2 years old and then began menstruating when they were 10.3 years old, the study found.
Phthalates, parabens and triclosan are not banned for use in personal care products, and there isn't solid evidence yet that they cause health effects in humans, Harley said by email.
But the current results add to increasing evidence from lab studies that suggests these chemicals can disrupt or interfere with natural hormones in the body like estrogen, Harley added.
"The fact that we find associations with earlier puberty in girls is additionally concerning," Harley said. "The good news is, that if women want to reduce their exposure to these chemicals, there are steps they can take."
Triclosan is no longer allowed in antibacterial soap in the U.S., but it is still in toothpaste, Harley said. Consumers should make sure it's not a listed ingredient on any toothpaste they buy, she advised.
Parabens are also on the ingredients list, often as methyl paraben, or propyl paraben, and consumers should avoid these products, too, Harley said.
Diethyl phthalate is harder to avoid, however, because it isn't listed on labels and is often used in fragrances, Harley said.
The study wasn't designed to prove whether or how prenatal exposure to these chemicals might have caused early puberty. And one limitation of the study is that researchers lacked data to know if girls going through puberty might be more likely to use these personal care products, and be directly exposed that way, the study authors note.
"The effects of these chemicals are very complex," said Dr. Luz Claudio of the Icahn School of Medicine at Mount Sinai in New York City.
"Their effects on the hormonal system is different with different chemicals, they have different potencies, their effects can be modulated by other factors such as genetic predisposition, and importantly, their effects can be different depending on the timing of the exposure," Claudio, who wasn't involved in the study, said by email. "With that said, this and other studies, together with the laboratory experimental evidence point to potential effects on children."
SOURCE: https://bit.ly/2OjsjqI
Hum Reprod 2018.
Reuters Health Information © 2018
Cite this article: Chemicals in Cosmetics, Soaps Tied to Early Puberty in Girls - Medscape - Dec 04, 2018.
posted by dermatica at
December 11, 2018
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In a collection of reviews published on the accuracy of tests used to diagnose skin cancer, experts have highlighted that melanomas are missed when making a visual inspection with only the naked eye.
For all types of skin cancer, it is important to make an early, accurate diagnosis to guide the appropriate management of the disease and to improve the outcome and survival of the patient. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers that can spread and lead to death. Although basal cell carcinoma (BCC) rarely spreads, it can damage surrounding tissue.
When examining for skin cancer, the aim is to detect all possible malignant cases. High-sensitivity tests can have false-positive results, so it is important that tests should be evaluated in the settings in which they will be used in practice. Although there is anxiety around missing a diagnosis of an early malignant lesion, it needs to be balanced against the risk of unnecessary referrals to specialists. A team of researchers examined a series of reviews on diagnostic tests to identify the most accurate approaches to the diagnosis of skin cancer.
The Cochrane Library published a series of 11 reviews on 6th December. This Special Collection of Cochrane Systematic Reviews has brought together a large body of research to look at the accuracy of different tests used to diagnose skin cancer. The reviews were led by Dr Jac Dinnes at the University of Birmingham, UK, and supported by the Cochrane Skin Group. The team included more than 30 researchers and expert advisors.
Dr Dinnes said in a press release: "The visual nature of skin cancer means that it can be detected and treated in many different ways and by a number of different types of specialists, therefore the aim of these reviews is to provide the world's best evidence for how this endemic type of cancer should be identified and treated."
The reviews looked at a number of different methods for diagnosing skin cancer, including:
Visual inspection with the naked eye alone
Dermoscopy, where a handheld device zooms in on a mole and the underlying skin – it is often used by dermatologists to diagnose melanoma but not in primary care settings
Teledermatology, a remote specialist assessment of skin lesions using dermoscopic images and photographs
Computer-assisted diagnosis (CAD) techniques that analyse information about skin lesions provided by dermoscopy or other techniques
Reflectance confocal microscopy (RCM), a non-invasive image technique that can visualise deeper layers of the skin than dermoscopy, but it is not widely used in the UK
Following large-scale systematic reviews of research, the team made a number of conclusions. A news release has highlighted one in particular: a visual inspection of a skin lesion with the naked eye alone is not enough to ensure an accurate diagnosis of skin cancer. In one of the reviews, the team reported "error rates from visual inspection are too high for it to be relied upon alone".
Other key findings include:
Smartphone applications used for new or changing moles or other skin lesions currently have a high likelihood of missing melanomas.
Dermoscopy used by specialists is better at diagnosing melanoma than visual inspection alone and may also help diagnose BCCs.
Dermoscopy could also help GPs correctly identify suspicious lesions that should be seen by a specialist.
Teledermatology may be a good way to help GPs decide which skin lesions should be seen by a skin specialist.
CAD techniques can identify more melanomas than doctors, but some CAD systems can produce more false-positive diagnoses than dermoscopy, leading to increased unnecessary surgery.
RCM may be better than dermoscopy for diagnosing melanoma in difficult-to-diagnose lesions.
Other tests such as high-frequency ultrasound have shown some promise, especially for diagnosing BCCs, but there is currently not enough evidence base to make any conclusion.
The reviews have been shared with the National Institute for Health and Care Excellence (NICE) to inform a potential update of the NICE Melanoma guideline, last updated in 2015.
The researchers found that – with a few exceptions – the overall designs of the studies reviewed could have been more accurate, especially in terms of documenting where on the clinical pathway patients were tested.
Cochrane Skin Group founder Professor Hywel Williams, of the University of Nottingham, said in a news release: "Although some useful conclusions have emerged, for example, on the role of dermoscopy, the greatest value of the research is to serve as a yardstick for designing future studies evaluating skin cancer diagnosis techniques on patients who are typically seen in GP and specialist settings."
The research team suggested future studies should evaluate diagnostic skin cancer tests using patients recruited with suspicious lesions "at the point on the clinical pathway where the test under evaluation will be used in practice".
The research team also recommended further research to evaluate if checklists could improve accuracy of diagnosis by vision inspection alone and to identify how much the accuracy of diagnosis varies based on the level of expertise of the clinician performing the assessment.
Cochrane Special Collections: Diagnosing skin cancer. 6th December 2018. Paper.
Cite this article: Theresa Bebbington. Naked Eye Inspection 'Not Enough for Skin Cancer Diagnosis' - Medscape - Dec 07, 2018.
posted by dermatica at
December 11, 2018
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BACKGROUND: Eczema is a common chronic skin condition. Probiotics have been proposed as an effective treatment for eczema; their use is increasing, as numerous clinical trials are under way. This is an update of a Cochrane Review first published in 2008, which suggested that probiotics may not be an effective treatment for eczema but identified areas in which evidence was lacking.
OBJECTIVES: To assess the effects of probiotics for treating patients of all ages with eczema.
SEARCH METHODS: We updated our searches of the following databases to January 2017: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, the Global Resource of Eczema Trials (GREAT) database, MEDLINE, Embase, PsycINFO, the Allied and Complementary Medicine Database (AMED), and Latin American Caribbean Health Sciences Literature (LILACS). We searched five trials registers and checked the reference lists of included studies and relevant reviews for further references to relevant randomised controlled trials (RCTs). We also handsearched a number of conference proceedings. We updated the searches of the main databases in January 2018 and of trials registries in March 2018, but we have not yet incorporated these results into the review.
SELECTION CRITERIA: Randomised controlled trials of probiotics (live orally ingested micro-organisms) compared with no treatment, placebo, or other active intervention with no probiotics for the treatment of eczema diagnosed by a doctor.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. We recorded adverse events from the included studies and from a separate adverse events search conducted for the first review. We formally assessed reporting bias by preparing funnel plots, and we performed trial sequential analysis for the first primary outcome - eczema symptoms at the end of active treatment.We used GRADE to assess the quality of the evidence for each outcome (in italic font).
MAIN RESULTS: We included 39 randomised controlled trials involving 2599 randomised participants. We included participants of either gender, aged from the first year of life through to 55 years (only six studies assessed adults), who had mild to severe eczema. Trials were undertaken in primary and secondary healthcare settings, mainly in Europe or Asia. Duration of treatment ranged from four weeks to six months, and duration of follow-up after end of treatment ranged from zero to 36 months. We selected no standard dose: researchers used a variety of doses and concentrations of probiotics. The probiotics used were bacteria of the Lactobacillus and Bifidobacteria species, which were taken alone or combined with other probiotics, and were given with or without prebiotics. Comparators were no treatment, placebo, and other treatments with no probiotics.For all results described in this abstract, the comparator was no probiotics. Active treatment ranged from six weeks to three months for all of the following results, apart from the investigator-rated eczema severity outcome, for which the upper limit of active treatment was 16 weeks. With regard to score, the higher the score, the more severe were the symptoms. All key results reported in this abstract were measured at the end of active treatment, except for adverse events, which were measured during the active treatment period.Probiotics probably make little or no difference in participant- or parent-rated symptoms of eczema (13 trials; 754 participants): symptom severity on a scale from 0 to 20 was 0.44 points lower after probiotic treatment (95% confidence interval (CI) -1.22 to 0.33; moderate-quality evidence). Trial sequential analysis shows that target sample sizes of 258 and 456, which are necessary to demonstrate a minimum mean difference of -2 and -1.5, respectively, with 90% power, have been exceeded, suggesting that further trials with similar probiotic strains for this outcome at the end of active treatment may be futile.We found no evidence suggesting that probiotics make a difference in QoL for patients with eczema (six studies; 552 participants; standardised mean difference (SMD) 0.03, 95% CI -0.36 to 0.42; low-quality evidence) when measured by the participant or the parent using validated disease-specific QoL instruments.Probiotics may slightly reduce investigator-rated eczema severity scores (24 trials; 1596 participants). On a scale of 0 to 103 for total Severity Scoring of Atopic Dermatitis (SCORAD), a score combining investigator-rated eczema severity score and participant scoring for eczema symptoms of itch and sleep loss was 3.91 points lower after probiotic treatment than after no probiotic treatment (95% CI -5.86 to -1.96; low-quality evidence). The minimum clinically important difference for SCORAD has been estimated to be 8.7 points.We noted significant to extreme levels of unexplainable heterogeneity between the results of individual studies. We judged most studies to be at unclear risk of bias; six studies had high attrition bias, and nine were at low risk of bias overall.We found no evidence to show that probiotics make a difference in the risk of adverse events during active treatment (risk ratio (RR) 1.54, 95% CI 0.90 to 2.63; seven trials; 402 participants; low-quality evidence). Studies in our review that reported adverse effects described gastrointestinal symptoms.
AUTHORS' CONCLUSIONS: Evidence suggests that, compared with no probiotic, currently available probiotic strains probably make little or no difference in improving patient-rated eczema symptoms. Probiotics may make little or no difference in QoL for people with eczema nor in investigator-rated eczema severity score (combined with participant scoring for eczema symptoms of itch and sleep loss); for the latter, the observed effect was small and of uncertain clinical significance. Therefore, use of probiotics for the treatment of eczema is currently not evidence-based. This update found no evidence of increased adverse effects with probiotic use during studies, but a separate adverse events search from the first review revealed that probiotic treatment carries a small risk of adverse events.Results show significant, unexplainable heterogeneity between individual trial results. Only a small number of studies measured some outcomes.Future studies should better measure QoL scores and adverse events, and should report on new probiotics. Researchers should also consider studying subgroups of patients (e.g. patients with atopy or food allergies, adults) and standardising doses/concentrations of probiotics given.
posted by dermatica at
December 01, 2018
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