Dermatología en Costa Rica

Tuesday, February 26, 2019

FDA Proposes Major Changes to Sunscreen Rules

FDA Proposes Major Changes to Sunscreen Rules

Kathleen Doheny

February 22, 2019

The FDA has issued a long-awaited plan to update regulations for sunscreen products marketed in the U.S. The move could mean major changes to some popular sunscreens, many of which include chemicals the agency says have not been proved safe.

The proposed rule covers the safety of sunscreen ingredients and various sunscreen dosage forms, SPF, and requirements for testing, labeling, and broad-spectrum protection.

The FDA is seeking more information on some popular sunscreen ingredients, including oxybenzone and avobenzone.

"This action is an important step in the FDA's effort to take into account modern science to assure the safety and effectiveness of sunscreens," FDA Commissioner Scott Gottlieb, MD, said at a news briefing Thursday.

The proposed rule would bring nonprescription, over-the-counter (OTC) sunscreens marketed without FDA-approved applications up to date with the latest science. The FDA wants to put into effect the final regulations for sunscreen drug products, known as OTC monograph regulations, as required by the Sunscreen Innovation Act. The OTC monographs allow certain drugs to be marketed without new drug applications because they are generally recognized as safe and effective, which the FDA refers to as GRASE.

Overview of Proposed Rules

Theresa Michele, MD, director of the Division of Nonprescription Drug Products in the FDA Center for Drug Evaluation and Research, said the new rules include:

  • Active ingredient safety. "First, we propose that of the 16 currently marketed active ingredients, two -- zinc oxide and titanium dioxide -- are great for use in sunscreens," she says. Two other ingredients, PABA and trolamine salicylate, are not considered safe, she said. These two ingredients are not currently on the U.S. market. "There are 12 ingredients for which we propose there are insufficient data [to make a positive GRASE determination]."

  • Dosage forms. Sprays, oils, lotions, creams, gels, butters, pastes, ointments, and sticks are considered GRASE. More information is needed on the safety of powders. Wipes, towelettes, body washes, shampoos, and other forms will be categorized as new drugs, as the FDA has not received data showing their eligibility yet.

  • SPF. The rule would raise the maximum SPF (sun protection factor) value on labels from 50 plus to 60 plus. "We believe there is not data to support benefit in an SPF above 60," Michele says. But the FDA proposes to permit products with SPF up to 80, to give manufacturers flexibility. Products with an SPF of 15 or higher must also provide broad-spectrum protection. As SPF increases, the protection against UVA rays must also increase.

  • Labeling. Active ingredients must be on the front of the product, which Michele says brings sunscreens in line with other OTC drugs. There should also be a notification on the front label to read the skin cancer and skin aging alert for products that have not been shown to help prevent skin cancers. The format for labeling SPF, broad spectrum, and water resistance will be revised.

  • Testing. The FDA will clarify what it expects from the industry for testing and record-keeping on their products.

  • Combination products. "We propose that products that combine sunscreen with insect repellents are not GRASE," Michele says.

More on the 12 Ingredients Needing More Study

According to the FDA, 12 sunscreen ingredients lack enough data to support whether they are GRASE. They are cinoxate, dioxybenzone, ensulizole, homosalate, meradimate, octinoxate, octisalate, octocrylene, padimate O, sulisobenzone, oxybenzone, and avobenzone.

Among the concerns are that oxybenzone ''is absorbed through the skin to a greater extent than previously understood," the rule says. There are questions about its potential to be an endocrine disrupter, a chemical that can cause cancer, birth defects, and other developmental disorders. Nearly all of the 12 have limited or no data about their absorption, the FDA says.

Several sunscreen makers did not respond to requests for comment. But a spokesperson for Johnson & Johnson, which makes sunscreens, said the company continues to "believe in the science that shows high SPF provides significantly greater protection, compared to lower SPF." 

The UV filters in its products, Kim Montagnino says, "meets or exceeds the rigorous testing standards of the U.S. FDA."

The company also supports the FDA's proposed changes to labeling that "reinforce the important role that sunscreens play in protecting against UV exposure, which is the leading cause of skin cancer," Montagnino says.

The Consumer Healthcare Products Association (CHPA) says: ''We look forward to submitting comments and continuing the dialogue with FDA to reinforce the safety and efficacy of sunscreens." The industry group, which represents over-the-counter product manufacturers, notes that ''sunscreens save lives, that's why millions of Americans use sunscreen products on a daily basis.''

During the interim between the proposal and the final ruling, the association urges consumers to continue using sunscreens on the market.

"It's about time the FDA regulated sunscreens more and made it easier for consumers to understand the options," says Michele S. Green, MD, a Manhattan dermatologist. She reviewed the new proposed rules.

"A lot of companies are going to go nuts," she predicts, since many manufacturers include the 12 ingredients for which more data is called for. Meanwhile, she will tell her patients not to panic and not to throw away sunscreens. If they are worried, they should look for products with the two ingredients deemed safe by the FDA for now, she says.

But Henry W. Lim, MD, a dermatologist at Henry Ford Hospital in Detroit, says the research to date doesn't show problems with chemical sunscreens. Lim has done consulting for various sunscreen makers.

While the academy generally supports many of the proposed changes, he says the main challenge to him is the proposal for more data on the 12 ingredients to show they are safe and effective.  

"We have not seen any significant problems, health effects with sunscreens including endocrine effects," Lim says.

The concern that oxybenzone, a popular ingredient, may be an endocrine disrupter, is primarily based on animal studies, he says. Research on people does not demonstrate problems with endocrine disruption with oxybenzone use.

Lim and his colleagues looked at the 2001 study done in animals exposed to oxybenzone, which triggered concern because it found the ingredient increased uterine size in animals.

To put the finding in perspective, Lim's team considered the dose used in the animal study and the average use of oxybenzone products. They concluded that the application regimens and time periods required to get the same blood levels as found in the animal study are basically unattainable.

Bottom line, Lim says, is that a woman in the U.S. would have to apply a half ounce of oxybenzone-containing sunscreen, a typical amount used, to about 25% of her body, or the typically exposed areas, for 277 years to achieve the same blood levels.

"It's important to understand that the proposed rule does not conclude that the sunscreens currently on the market are unsafe," said Suzanne M. Olbricht, MD, president of the American Academy of Dermatology Association (AADA), in a statement.

Still, Scott Faber, senior vice president for government affairs at Environmental Working Group, said at a press briefing that the FDA's announcement will "cause a sea change in how sunscreens are formulated."

His organization welcomes the proposed regulations, especially the request for more information on products such as oxybenzone. On its website, EWG notes that, ''Over the course of 12 years, EWG has uncovered mounting evidence that one common sunscreen chemical, oxybenzone, poses a hazard to human health and the environment. It is an allergen and a hormone disrupter that soaks through skin and is measured in the body of nearly every American."

EWG wants companies to go oxybenzone-free by 2020.

Advice for Consumers

The FDA will accept comments from industry and others for 90 days after the proposed regulations are published in the Federal Register on Feb. 26.

Until the FDA gets more information, such as on the 12 ingredients they are seeking more data for, ''consumers should continue to use broad-spectrum sunscreens of 15 SPF or higher, along with other sun protection measures," Michele says.

Sources:

FDA media briefing, Feb. 21, 2019.

Michele S. Green, MD, Manhattan dermatologist; attending physician, Lenox Hill Hospital, New York.

Henry W. Lim, MD, dermatologist, Henry Ford Hospital, Detroit; spokesperson and immediate past president, American Academy of Dermatology.

American Academy of Dermatology statement, Feb. 21, 2019.

Environmental Working Group press briefing, Feb. 21,2019.

EWG: "EWG's Sunscreen Guide."

Consumer Healthcare Products Association

Tuesday, February 19, 2019

Recombinante mas costo efectiva que la viva...HZV

New Zoster Vaccine More Cost-Effective Than Old One

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The new recombinant zoster vaccine (RZV; Shingrix) is more cost-effective than the live attenuated vaccine (ZVL; Zostavax), according to a CDC-funded study in the Annals of Internal Medicine.

Using a simulation model, researchers examined the following among immunocompetent adults aged 50 and older:

  • Cost-effectiveness of RZV versus ZVL or no vaccination
  • Cost-effectiveness of RZV among people who've already received ZVL
  • Cost-effectiveness of preferential immunization with RZV over ZVL

RZV was consistently more cost-effective than ZVL, even in a scenario in which half the adults received just the first of the two RZV doses.

The findings align with CDC recommendations, which advise that RZV be preferred over ZVL and that RZV be given to those who've previously received ZVL.

Asked to comment, infectious diseases specialist Dr. Paul Sax said: "The results of this analysis are not surprising given the greater efficacy of the RZV over the live virus vaccine. Clinicians have already embraced this new recommendation, with the largest barrier to implementation the ongoing national shortage of the vaccine."

Annals of Internal Medicine article (Free abstract)

Annals of Internal Medicine editorial (Subscription required)

Background: NEJM Journal Watch General Medicine coverage of comparison of zoster vaccines (Your NEJM Journal Watch subscription required)


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Saturday, February 16, 2019

Y las sodas? En el AVC...

Artificially Sweetened Drinks Linked to Stroke, Heart Disease

By Kelly Young

Consumption of artificially sweetened beverages like diet soda is associated with elevated risk for cardiovascular disease, suggests an observational study in Stroke.

As part of the Women's Health Initiative, researchers asked 80,000 women aged 50 to 79 about their consumption of artificially sweetened beverages over the past 3 months and followed them for a mean of 12 years.

After multivariable adjustment, consumption of two or more artificially sweetened beverages a day was associated with higher risks for ischemic stroke (hazard ratio, 1.31), coronary heart disease (HR, 1.29), and all-cause mortality (HR, 1.16), compared with drinking less than one a week. The findings remained significant when women with cardiovascular disease or diabetes were excluded.

Editorialists emphasize that water is the best substitute for sugar-sweetened beverages. However, if artificially sweetened beverages are used to help patients limit sugary beverages, they "should be viewed as a time-limited intermediate in the transition to water and other healthier beverages."

Stroke article (Free abstract)

Stroke editorial (Subscription required)

Background: Physician's First Watch coverage of diet beverages and stroke risk (Free)


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Cannabis y depresión

Meta-Analysis: Cannabis Use in Adolescence Linked to Later Depression, Suicide

By Amy Orciari Herman

Adolescents who use cannabis face increased risks for depression and suicidality in young adulthood, according to a meta-analysis in JAMA Psychiatry.

Researchers examined data from 11 prospective studies that assessed the association between any cannabis use at age 18 or younger and depression, anxiety, or suicidality at ages 18 through 32. After adjustment for depression and anxiety at baseline, those who used cannabis in adolescence were significantly more likely than those who didn't use it to experience later depression (odds ratio, 1.4), suicidal ideation (OR, 1.5), and suicide attempts (OR, 3.5). Cannabis use was not significantly associated with anxiety.

The researchers cite data indicating that over 20% of U.S. teens report using cannabis in the past month. They conclude, "Although individual-level risk remains moderate to low ... the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern."

Why We Chose This as Our Top Story

William E. Chavey, MD, MS: As the social and regulatory climate surrounding marijuana use changes, the debate should center on science. Studies such as this become increasingly important.

Andre Sofair, MD, MPH: Many states, including my own, are considering legalization of recreational marijuana. I feel that it is important for both physicians and public health practitioners to participate in this public discourse.

JAMA Psychiatry article (Free abstract)

Background: NEJM Journal Watch Psychiatry coverage of one of the studies used in the meta-analysis (Your NEJM Journal Watch registration required)


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Friday, February 15, 2019

CE en no blancos

Risk Factors for Keratinocyte Carcinoma Skin Cancer in Nonwhite Individuals

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

Abstract

BACKGROUND

Topic Alerts

Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.

Visit your Preferences and Settings section to Manage All Topic Alerts 


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Thursday, February 14, 2019

Scd

www.medscape.com
COMMENTARY
The Triggers of Systemic Contact Dermatitis
Graeme M. Lipper, MD February 07, 2019 Deciphering Dermatitis
When evaluating a patient with eczematous dermatitis, clinicians rely heavily on clinical history. Is the dermatitis acute or chronic? Is there a childhood or family history of atopy (eczema, asthma, hay fever, food allergies)? Does the patient's occupational or cosmetic history point to potential contact allergen triggers? These questions all get at the same fundamental unknown: is the eczema "intrinsic" or "extrinsic"? Genetic or acquired?
This splitting of eczema into two broad categories—atopic dermatitis (AD) and allergic contact dermatitis (ACD)— is most useful in cases where a patient's dermatitis is strictly due to a delayed-type hypersensitivity reaction to one or more contact allergens. In such cases of "pure" ACD, allergen avoidance can be curative. Clues pointing to ACD include delayed onset (teenage years or adulthood) and a patterned distribution (eg, eyelids for cosmetic dermatitis; periumbilical, ear lobes, or neck for nickel dermatitis).
In contrast, classic AD presents during infancy with recurrent facial dermatitis, morphing during childhood into chronic inflammatory flexural patches and lichenified plaques. It is a T-cell*mdash;driven, chronic inflammatory skin disease with impaired cutaneous barrier function and a prevalence of up to 10% in adults and 25% in children.[1,2]
In many cases, the "AD versus ACD" distinction is an oversimplification. Patients with AD are more likely to develop contact allergies due to immune dysregulation and skin barrier disruption,[3] with one study showing ACD in 25% of AD patients.[4] Furthermore, contact dermatitis can masquerade as AD, as illustrated by a recent case series of children misdiagnosed with AD who had developed chronic ACD to methylisothiazolinone-a biocide and preservative found in baby wipes, paint, and "homemade slime."[5]
Add to this picture the concept of systemic contact dermatitis (SCD): eczema triggered by inhaled or ingested allergens. SCD occurs when skin-sensitized patients are reexposed to a triggering allergen such as Compositae, balsam of Peru, or nickel through the respiratory or gastrointestinal tracts. Flares tend to be severe, widespread, and chronic.
Risk Factors for SCD
What are the risk factors for developing SCD? To address this important question, Scott and colleagues[6] first identified 23 allergens known to cause SCD via a type IV (delayed) hypersensitivity reaction. They divided these into four broad groups: plant derivatives, metals, steroids, and miscellaneous (dibucaine, ethylenediamine, parabens, propylene glycol).
Next, they performed a retrospective cohort review of 2416 patients who were patch tested for suspected ACD over a 15-year period. Of this group, 457 patients (18.9%) had AD (defined as a history of childhood flexural dermatitis). Patients with AD were further stratified by age (younger or older than 18 years), presence or absence of respiratory atopy, and occupation (wet or dry work).[7]
The study's patch test cohort had the following main characteristics:

278 out of 457 patients with AD also had respiratory atopy (60.8%)
Patients with AD were more likely to have positive patch tests to SCD-linked allergens if they also had respiratory atopy (odds ratio [OR], 1.28)
Patients without AD had similar patch test results whether or not they had respiratory atopy
In younger patients with AD (< age 18 years), those with concurrent respiratory atopy were most likely to have positive patch tests to SCD-linked allergens (OR, 2.33)
In patients with both AD and respiratory atopy, an occupational history of wet work (eg, hairdresser) versus dry work increased the likelihood of a positive patch test result (OR, 1.47)
Viewpoint
Because of its widespread distribution, severity, and chronicity, SCD can mimic an atopic flare. Patients with treatment-resistant AD should be patch tested for contact allergen triggers, remembering that allergen exposure can occur through inhalation or ingestion.
Based on the observations of Scott and colleagues, younger patients with both AD and respiratory atopy are most likely to have positive patch test results to at least one of the 23 allergens identified in this study as being associated with SCD. Occupational wet work also increases the likelihood of being sensitized to these allergens.[8]
Do positive patch test results predict the true risk of developing SCD? Not necessarily, as this study was limited by a retrospective design. A prospective study linking positive patch tests to clinically confirmed eczema flares that improve upon allergen avoidance would be far more informative. Nevertheless, these results offer a tantalizing first step. If we can identify those atopic patients who are most likely to develop SCD, then we'll be in a better position to offer targeted patch testing in the future.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube References
1. Silverberg JI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017;35:283-289.
Source
2. Hanifin JM, Reed ML, Eczema Working Group. A population-based survey of eczema prevalence in the United States. Dermatitis. 2007;18:82-91. Source
3. Borok J, Matiz C, Goldenberg A, Jacob SE. Contact dermatitis in atopic dermatitis children: past, present, and future. Clin Rev Allergy Immunol. 2019;56:86-98. Source
4. Lee S, Wang HY, Kim E, et al. Clinical characteristics and genetic variation in atopic dermatitis patients with and without allergic contact dermatitis. Eur J Dermatol. 2018;28:637-643.
5. Deschamps T, Nosbaum A, Delcroix F, Vocanson M, Berard F, Nicolas JF. Long-lasting allergic contact dermatitis to methylisothiazolinone misdiagnosed as atopic dermatitis. Eur J Dermatol. 2018 Dec 10. [Epub ahead of print]
6. Scott JF, Conic RR, Kim I, Rowland DY, Nedorost ST. Atopy and sensitization to allergens known to cause systemic contact dermatitis. Dermatitis. 2019;30:62-66.
7. Kohli N, Nedorost S. Inflamed skin predisposes to sensitization to less potent allergens. J Am Acad Dermatol. 2016;75:312-317.
8. Caroe TK, Ebbehoj NE, Bonde JP, et al. Hand eczema and wet work: dose-response relationship and effect

of leaving the profession. Contact Dermatitis. 2018;78:341-347. Source Medscape Dermatology © 2019 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this article: Graeme M. Lipper. The Triggers of Systemic Contact Dermatitis - Medscape - Feb 07, 2019.

https://www.medscape.com/viewarticle/908497_print


Sent from my iPad
Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 2224-0654
Momentum Escazu: 2101-9574
Please excuse the shortness of this message, as it has been sent from
a mobile device.

AVC y sodas

Artificially Sweetened Drinks Linked to Stroke, Heart Disease

By Kelly Young

Edited by Richard Saitz, MD, MPH, FACP, DFASAM

Consumption of artificially sweetened beverages like diet soda is associated with elevated risk for cardiovascular disease, suggests an observational study in Stroke.

As part of the Women's Health Initiative, researchers asked 80,000 women aged 50 to 79 about their consumption of artificially sweetened beverages over the past 3 months and followed them for a mean of 12 years.

After multivariable adjustment, consumption of two or more artificially sweetened beverages a day was associated with higher risks for ischemic stroke (hazard ratio, 1.31), coronary heart disease (HR, 1.29), and all-cause mortality (HR, 1.16), compared with drinking less than one a week. The findings remained significant when women with cardiovascular disease or diabetes were excluded.

Editorialists emphasize that water is the best substitute for sugar-sweetened beverages. However, if artificially sweetened beverages are used to help patients limit sugary beverages, they "should be viewed as a time-limited intermediate in the transition to water and other healthier beverages."

Stroke article (Free abstract)

Stroke editorial (Subscription required)

Background: Physician's First Watch coverage of diet beverages and stroke risk (Free)


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Wednesday, February 13, 2019

Postpeeling

 

Efficacy of Silver-Based gel Compared With Fusidic Acid Cream in Topical Treatment Following Trichloroacetic Acid Facial Skin Peeling

A Pilot Study

Geva Landau, MD; Sami Gabario, MD; Shaked Menashe, MD; Hodaya Saadon, BSc; Lior Heller, MD

Wounds. 2018;30(12):363-366. 

Abstract and Introduction 

Abstract

Background: Trichloroacetic acid (TCA) is a nontoxic chemical that has been used for more than 20 years in skin rejuvenation treatments for various skin conditions. Currently, there is no single accepted protocol for local burn care following TCA peeling.

Objective: This pilot study assesses the efficacy and tolerability of a silver-based gel compared with fusidic acid cream as a complementary topical treatment for burns following TCA peeling.

Materials and Methods: The authors conducted a comparative study on healthy female patients in the Department of Plastic and Reconstructive Surgery at Assaf Harofe Medical Center (Zerifin, Israel). Patients were treated with TCA 15% for superficial facial skin peeling, followed by applications of both the silver-based gel and fusidic acid cream on opposite sides of their face. Patient evaluation included high-resolution photographic evaluation pre- and post-peeling; physician assessment for the presence of complications such as infection, edema, and allergic reactions; and a self-completed questionnaire in reference to the outcomes and side effects (eg, burning, itching) experienced.

Results: Seventeen women were included in the study. None of the patients experienced an infection or allergic reaction. Photographic analysis found no significant differences in the outcomes between topical treatments, with a trend for better results with the silver-based gel. Pain, edema, and burning sensations were not significantly different between the topical treatments. Itching was less prevalent in the silver-based gel group (P = .046).

Conclusions: Comparing between the groups treated with silver-based gel and fusidic acid cream, the authors found no inferiority in the outcomes or the prevalence of any complaints, and a superior effect on the prevention of wound itch using a silver-based gel.

Tuesday, February 12, 2019

Ultraprocesados aumentan mortalidad

Higher Intake of Ultraprocessed Foods Tied to Increased Mortality Risk

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD


Among adults, the risk for death increases as the intake of ultraprocessed foods increases, according to a prospective study in JAMA Internal Medicine. Ultraprocessed foods (e.g., packaged breads and snacks) are manufactured from numerous ingredients and generally include additives. 

Researchers in France studied nearly 45,000 adults aged 45 and older who completed multiple 24-hour dietary recall assessments over a 2-year period. During a median follow-up of 7 years, 1.4% of the cohort died. After adjustment for body-mass index, smoking status, and other confounders, the mortality risk was 14% higher with each 10% increase in the amount of ultraprocessed foods consumed.

The researchers propose several reasons for the association — for example, when foods are processed under high temperatures, potentially carcinogenic contaminants form.


JAMA Internal Medicine article (Free abstract)

Background: Physician's First Watch coverage of ultraprocessed foods and cancer risk (Free)

Thursday, February 07, 2019

Uso humano de crema veterinaria


Some Patients With Rosacea Using Veterinary Medicine With Ivermectin To Treat Their Condition.

Business Insider (2/6, Trotter) reports some people with rosacea are using "horse paste" to treat their condition. The veterinary medicine contains the same active ingredient as the FDA-approved Soolantra (ivermectin). The article notes that this is part of a broader trend of patients turning to veterinary drugs to save money.


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Tuesday, February 05, 2019

[Full text] Herpes zoster in psoriasis patients undergoing treatment with biologic | PTT

Conclusion and recommendations

Concerning HZ in psoriasis patients receiving biologicals, the following statements are proposed:

  • Psoriasis does not confer a specific higher risk of HZ compared to the other inflammatory joint and intestinal diseases.
  • The administration of biologicals in these patient groups increases the incidence of HZ by twofold to threefold.
  • In patients treated with biologicals, one may expect HZ in younger age groups compared to common HZ.
  • One should be more vigilant for a possible diagnosis of HZ in the first year after the instauration of a biological therapy.
  • HZ is usually not different from common HZ in the immunocompetent population.
  • Very severe and extensive cases of HZ are rare in these patient groups.
  • In the case of HZ, look for risk factors for severe HZ, especially satellite lesions and severe prodromal pains.
  • Antiviral treatment and management of HZ in psoriasis patients under biologicals are not different compared to their nonimmuncompromised counterparts.
  • Intravenous ACV treatment is recommended for severe cases of HZ.
  • If possible, the HZ LAVV vaccine should be administered before starting biologicals in patients never having experienced HZ previously.
  • When commercially available, the new subunit HZ vaccine should be provided before or during biological treatments in patients never having experienced HZ previously.
https://www.dovepress.com/herpes-zoster-in-psoriasis-patients-undergoing-treatment-with-biologic-peer-reviewed-fulltext-article-PTT


Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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

Cremas topicas para el dolor iguales a placebo...

Compounded Pain Creams No Better Than Placebo

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

Compounded topical creams are no better than placebo creams for treating chronic pain, according to a study in the Annals of Internal Medicine.

Roughly 400 adults with localized chronic pain (neuropathic, nociceptive, or mixed) were randomized to use a compounded cream (containing, for example, ketamine, gabapentin, lidocaine, and clonidine) or a placebo cream three times daily. At 1 month, participants in both the active-treatment and placebo groups had improved pain scores, but there were no significant differences between the groups, regardless of the type of pain. At 3 months, there still were no significant differences between active treatment and placebo.

The researchers conclude that given the lack of benefit — and high cost — of these creams, their routine use should be discouraged.

Annals of Internal Medicine article (Free abstract)

Background: NEJM Journal Watch Psychiatry coverage of alternatives to opioids for chronic pain (Your NEJM Journal Watch subscription required)



Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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