Talco sin asbesto

J&J Baby Powder Doesn't Contain Asbestos, New Testing Finds

By the Editors

Johnson & Johnson says that a bottle of baby powder — in which FDA testing found trace amounts of chrysotile asbestos — did not contain asbestos after all. In mid-October, the company recalled one lot of baby powder, amounting to 33,000 bottles, based on the FDA's results.

Now, Johnson & Johnson says 15 additional tests on the same bottle of powder were negative for the contaminant, and 48 tests on other powder from the same lot confirmed those results. The company noted that three samples did initially test positive for asbestos, but further investigation revealed that an air conditioner in the lab conducting the tests had caused the contamination.

Johnson & Johnson news release (Free)

New York Times story (Registration may be required)

Background: Physician's First Watch coverage of J&J recall (Free)

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Cirugia bariátrica y cancer de piel

Bariatric Surgery Associated with Lower Risk for Skin Cancer

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Obese adults who undergo bariatric surgery may experience an unexpected benefit — a reduced risk for skin cancer — according to a prospective study in JAMA Dermatology.

Researchers in Sweden matched some 2000 obese adults who chose bariatric surgery with 2000 who chose nonsurgical treatment. During a median follow-up of 18 years, there were 11 squamous cell carcinoma (SCC) cases and 12 melanoma cases among surgery patients, versus 16 and 29, respectively, among controls. After multivariable adjustment, surgery patients had a 41% lower risk for skin cancer overall and 57% lower risk for melanoma, while the risk reduction for SCC alone was not significant. (Of note, skin cancer was not a prespecified study outcome.)

The authors propose several possible explanations for the association, including the role of leptin receptors on melanoma cells.

The researchers write, "Bariatric surgery should not be viewed as a public health intervention specific to skin cancer. Instead, these findings give additional support for an association between obesity and skin cancer and for an association between weight loss and reduced cancer incidence."

JAMA Dermatology article (Free abstract)

Background: NEJM Journal Watch Women's Health earlier coverage of cancer outcomes in this study cohort (Free)

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Niños con cancer

Studies Indicate Childhood Cancer Survivors Treated With Chemotherapy, Radiation Face Elevated Risk For Subsequent Malignancies

MedPage Today (10/29) reports two studies examining the same cohort indicate "childhood cancer survivors have a dramatically higher risk for breast cancer and other subsequent malignancies, especially when treated with both chemotherapy and radiation." In one study (10/28) published in JAMA Pediatrics, researchers found "among girls, the likelihood of a breast cancer diagnosis as an adult increased for every 10 Gy of radiation received (odds ratio [OR] 3.9, 95% CI 2.5-6.5) and for every 100 mg/m2 of anthracycline administered (OR 1.23, 95% CI 1.09-1.39)." In the second study published in the Journal of Clinical Oncology, "the increased risk from chemotherapy alone was linked to multiple subsequent cancers," including thyroid cancer and melanoma.

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HPV Oral en mujeres

Oral HPV Fairly Common in Sexually Active Adolescent Girls

By Kelly Young

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Oral human papillomavirus (HPV) is not uncommon among sexually active adolescent females, and the vaccine appears to be protective, suggests a JAMA Network Open study. 

Nearly 1300 sexually active females aged 13 to 21 in New York City had oral samples tested for HPV at baseline. Roughly 6% tested positive for oral HPV. Nearly 2% were positive for oncogenic types, while 0.2% had types included in the quadrivalent vaccine. Risk for oral HPV decreased with increasing time since their first sexual experience, "potentially reflecting the highlight transient nature of HPV infection," the authors write. 

Patients who received at least one dose of the vaccine had an 80% lower risk for oral HPV types included in the quadrivalent vaccine, relative to unvaccinated participants, although the authors note that few patients were unvaccinated. In addition, the presence of cervical HPV was associated with oral HPV.

The authors conclude: "This study's findings suggest that ... HPV vaccination is associated with a significant decrease in detection of HPV types in the oral cavity."

Commentators say the results are similar to what is observed in adult patients.

JAMA Network Open article (Free)

JAMA Network Open commentary (Free)

Background: NEJM Journal Watch Women's Health coverage of evidence of herd immunity against oral HPV (Your NEJM Journal Watch subscription required)

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Dupi en otras cosas

Published in Dermatology

Journal Scan / Review · October 26, 2019

Dupilumab Beyond Atopic Dermatitis

Journal of Drugs in Dermatology

TAKE-HOME MESSAGE

• In this review, the authors found reports of successful treatment of contact dermatitis, hand dermatitis, and chronic spontaneous urticaria (patients also with history of atopic dermatitis) in the published literature. Improvement in alopecia was coincidentally noted in four case reports of patients with AD treated with dupilumab. Eosinophilic annular erythema, anogenital pruritus, and bullous pemphigoid also were reported to improve in isolated case reports.

• While randomized controlled trials supporting efficacy for dupilumab beyond atopic dermatitis within the field of dermatology are lacking, review of the published literature reveals that it may have potential use in several other dermatologic conditions.

– Caroline Crabtree, MD

Abstract

Dupilumab inhibits the interleukin-4 receptor subunit α and is FDA approved for treatment of moderate-to-severe atopic dermatitis. It is a relatively new drug, and whether it is efficacious for other diseases in dermatology is an area of increasing interest. We searched the literature and ClinicalTrials.gov database for uses of dupilumab beyond atopic dermatitis in dermatology and for ongoing studies on new uses for dupilumab. Off-label reports identified described use of dupilumab for several different dermatologic conditions, including allergic contact dermatitis, hand dermatitis, chronic spontaneous urticaria, prurigo nodularis, and alopecia areata. Overall, there is limited but promising data for dupilumab use beyond atopic dermatitis in dermatology. The relatively safe adverse effect profile of dupilumab may make it an option for certain recalcitrant diseases in dermatology, but further studies will be needed to assess its efficacy and determine its best possible use.

Journal of Drugs in Dermatology

Dupilumab in Dermatology: Potential for Uses Beyond Atopic Dermatitis

J Drugs Dermatol 2019 Oct 01;18(10)1053-1055, NJ Maloney, K Tegtmeyer, J Zhao, S Worswick 

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Estres e infección

PTSD, Other Stress Disorders Linked to Serious Infection Risk

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Stress-related disorders are associated with increased risk for life-threatening infections, suggests a case-control study in The BMJ.

Using Swedish registries, researchers compared over 100,000 people diagnosed with a stress-related disorder — including post-traumatic stress disorder (PTSD), acute stress reaction, and adjustment disorder — with unaffected siblings.

During roughly 8 years' follow-up, the incidence of life-threatening infections (e.g., sepsis, endocarditis meningitis) was significantly higher in those with diagnosed stress disorders than in their siblings (2.7 vs. 1.7 per 1000 person-years). Results were confirmed with a community-based cohort.

Long-term risk for these infections was lower when selective serotonin reuptake inhibitors were used during the year after stress-disorder diagnosis. 

The researchers and an editorialist say that an overproduction of inflammatory cytokines in stress disorders could play a role in the observed infections. 

The authors conclude: "Despite a relatively low absolute risk, the high mortality from life threatening infections calls for increased clinical awareness among health professionals caring for patients with stress related disorders."

The BMJ article (Free)

The BMJ editorial (Subscription required)

Background: NEJM Journal Watch Dermatology coverage of stress and infections (Free)

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Paracoccidiodomicosis en Población menor a 15 años...

ORIGINAL ARTICLE

Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

Mariana Tresoldi das Neves Romaneli 

 

Natália Rocha Tardelli 

… See all authors 

First published: 13 August 2019

 

https://doi.org/10.1111/myc.1298

Read the full text

Summary

The acute‐subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute‐subacute PCM, to determine a mortality risk factor and to propose a test for non‐survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute‐subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole‐trimethoprim (SMX‐TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut‐off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute‐subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

Hongos estudiados hasta la saciedad.

ORIGINAL ARTICLE

Trichophyton mentagrophytes and T interdigitale genotypes are associated with particular geographic areas and clinical manifestations

Simin Taghipour 

 

Ivan M. Pchelin 

 

Ali Zarei Mahmoudabadi 

 

Saham Ansari 

… See all authors 

First published: 24 August 2019

 

https://doi.org/10.1111/myc.12993

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Summary

The fungi Trichophyton mentagrophytes and T interdigitale account for significant amount of dermatophytosis cases worldwide. These two dermatophytes form a species complex and have a number of ribosomal internal transcribed spacer (ITS) region genotypes, allowing simultaneous species identification and strain typing. Our aim was to describe the geographic distribution of T mentagrophytes/T interdigitale ITS region genotypes and find an association between the genotypes and clinical presentations of respective infections. We performed rDNA ITS region sequencing in 397 Iranian T mentagrophytes/T interdigitale isolates and analysed all available in GenBank entries with sequences of this kind. For the study, 515 clinical annotations were available. Statistical analysis was performed by chi‐squared test and Spearman rank correlation analysis. A total of 971 sequences belonged to genotypes with at least 10 geographic annotations and were classified on the basis of exclusive occurrence in a particular region or high relative contribution to a regional sample. We discerned Asian and Oceanian ("KU496915" Type V, "KT192500" Type VIII, "KU315316"), European ("FM986750" Type III, "MF926358" Type III*, "KT285210" Type VI) and cosmopolitan ("FM986691" Type I, "JX122216" Type II, "KP132819" Type II* and "AF170453" Type XXIV) genotypes. There was statistically significant difference in the ITS genotype distribution between different affected body sites. Trichophyton mentagrophytes "KT192500" Type VIII correlated with tinea cruris, T mentagrophytes "KU496915" Type V correlated with tinea corporis, T interdigitale"JX122216" Type II correlated with tinea pedis and onychomycosis. Trichophyton mentagrophytes and T interdigitale genotypes can be associated with distinct geographic locations and particular clinical presentations.

Oh y demencia

October 17, 2019

Relation Between Alcohol Use and Cognitive Impairment

Thomas L. Schwenk, MD reviewing Koch M et al. JAMA Netw Open2019 Sep 27

Among people in their 70s and 80s, associations between alcohol consumption and incident dementia depended on the baseline presence of mild cognitive impairment.

Researchers explored previous conflicting findings about a relation between alcohol intake and development of dementia by performing secondary analyses of a prior large prospective dementia clinical trial (JAMA 2008; 300:2253). Alcohol consumption patterns and baseline cognition of 3021 participants (median age, 78; mostly white) were assessed at baseline. Cognitive function was assessed every 6 months during a median follow-up of 6 years.

Analyses were adjusted for a wide range of clinical and demographic factors. The association of alcohol intake with incident dementia depended on baseline cognition, as follows:

• For patients without baseline mild cognitive impairment (MCI), no level of alcohol consumption was associated with any excess risk for incident dementia.

• For patients with baseline MCI, alcohol intake of >14 drinks weekly, compared with ≤1 drink weekly, was associated with slightly higher risk for developing dementia (hazard ratio, 1.72; P=0.13) and a significantly greater decrease in the Modified Mini-Mental State Examination score (P=0.02).

• Dementia risk with any alcohol consumption was not associated with the presence or absence of the apolipoprotein E e4 allele (a genetic risk factor for Alzheimer disease).

COMMENT

This study suggests that, in older patients with MCI, consuming 14 or more alcoholic drinks weekly probably promotes further cognitive decline — and eventually might hasten progression to dementia. Clinicians should not overlook detailed alcohol-consumption assessment in such patients.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Thomas L. Schwenk, MD at time of publication

Editorial boards

UpToDate

CITATION(S):

Koch M et al. Alcohol consumption and risk of dementia and cognitive decline among older adults with or without mild cognitive impairment. JAMA Netw Open 2019 Sep 27; 2:e1910319. (https://doi.org/10.1001/jamanetworkopen.2019.10319)

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Five-point checklist for skin cancer detection in primary care - Giornale Italiano di Dermatologia e Venereologia 2019 October;154(5):523-8 - Minerva Medica - Journals

ORIGINAL ARTICLE   

Giornale Italiano di Dermatologia e Venereologia 2019 October;154(5):523-8

DOI: 10.23736/S0392-0488.17.05565-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Five-point checklist for skin cancer detection in primary care

Elvira MOSCARELLA 1 ✉, Aimilios LALLAS 2, Caterina LONGO 1, Roberto ALFANO 3, Giuseppe ARGENZIANO 4

1 Unit of Dermatology and Skin Cancer, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy; 2 First Department of Dermatology, Aristotle University, Thessaloniki, Greece; 3Department of Anesthesiology, Surgery and Emergency, Luigi Vanvitelli University of Campania, Naples, Italy; 4 Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy

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BACKGROUND: Skin cancer screening interventions often relay on the involvement of general practitioners (GPs). Many interventions up to now have been directed to training approaches focusing on the clinical features of skin malignancies to increase GPs skill in skin cancer recognition.
METHODS: Based on the available current knowledge about skin cancer epidemiology and risk factors, we built up a 5-point checklist to help GPs in triaging patients to be referred to a dermatologist.
RESULTS: Five-point check-list: 

1) visible sun damaged skin on exposed areas (red and brown to black macules and crusts on visible skin); 

2) more than 20 nevi on the arms; 

3) one or more ABCD positive lesions (flat, large and asymmetric macules); 

4) one or more EFG positive lesions (elevated, firm and growing skin lesions); 

5) a pigmented lesion larger than 1.5 cm in diameter.

CONCLUSIONS: 

Our aim was to provide a short list of practical rules, easy to adopt into a routine practice, in order to achieve a more effective triage of patients requiring a dermatology consultation for skin cancer examination. The novelty of the proposed method relies on the approach. The proposed method does not require the GP to diagnose skin cancer. The aim is to involve GPs in the selection of patients to be referred to the specialist, in order to reduce the waiting time while avoiding the risk to leave cancers untreated.

KEY WORDS: Skin neoplasms; Melanoma; General practitioners

https://www.minervamedica.it/en/journals/dermatologia-venereologia/article.php?cod=R23Y2019N05A0523

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Correlation of changes in HIF-1α and p53 expressions with vitamin B3 deficiency in skin cancer patients - Giornale Italiano di Dermatologia e Venereologia 2019 October;154(5):513-8 - Minerva Medica - Journals

ORIGINAL ARTICLE   

Giornale Italiano di Dermatologia e Venereologia 2019 October;154(5):513-8

DOI: 10.23736/S0392-0488.17.05775-3

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Correlation of changes in HIF-1α and p53 expressions with vitamin B3 deficiency in skin cancer patients

Ting LIU ✉, Hao YANG, Yunzhu MOU, Hao ZHANG

Department of Dermatovenereology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China

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BACKGROUND: To investigate the correlation of changes in hypoxia-inducible factor-1α (HIF-1α) and p53 expressions with vitamin B3 deficiency in skin cancer patients.
METHODS: Twenty non-melanoma skin cancer patients with positive HIF-1α and p53 expressions were selected and randomly divided into two groups, the placebo group and the experimental group. After an appropriate number of cancer tissues were taken, the experimental group was treated with oral administration of 500 mg vitamin B3 every day, while the placebo group was treated with oral administration of the same amount of placebo; after 1 week, the skin cancer tissues in the same part were taken, and the skin tissues of healthy people were taken as the control group; the mRNA and protein expression levels of HIF-1α and p53 in tissues were detected.
RESULTS: HIF-1α and p53 were mainly expressed in the nucleus in non-melanoma skin cancer. The protein and mRNA expression levels of HIF-1α and p53 in tissues of skin cancer patients were significantly increased compared with those in skin tissues of healthy people (P<0.05). The protein and mRNA expression levels of HIF-1α and p53 in tissues of skin cancer patients were significantly decreased at 1 week after the oral administration of vitamin B3 compared with those before the oral administration of vitamin B3 (P<0.05), but the protein and mRNA expression levels of HIF-1α and p53 in tissues of skin cancer patients in placebo group had no significant changes (P>0.05). The vitamin B3 deficiency in skin cancer patients was positively correlated with the expressions of HIF-1α and p53.
CONCLUSIONS: The expression levels of HIF-1α and p53 in tissues of skin cancer patients are significantly increased compared with those in skin tissues of healthy people, and the changes in their expressions are positively correlated with the vitamin B3 deficiency. Supplementing vitamin B3 has a certain protective effect on skin cancer patients.

KEY WORDS: Skin neoplasms; Hypoxia-inducible factor 1; alpha Subunit; Genes; p53

https://www.minervamedica.it/en/journals/dermatologia-venereologia/article.php?cod=R23Y2019N05A0513

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Pruebas de parche y dupilumab

Published in Dermatology

Journal Scan / Research · October 14, 2019

The Impact of Dupilumab on Patch Testing and the Prevalence of Co-Morbid ACD in Recalcitrant Atopic Dermatitis

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• This retrospective chart review included patients with moderate to severe atopic dermatitis (AD) who had been patch tested prior to starting dupilumab. Of the 125 patch test pairs (those tested both before starting dupilumab and while on dupilumab), only 13 patch test reactions were considered lost (10.4%). These patch tests spanned a wide range of allergen groups. Of the 35 patients patch tested while on dupilumab, 32 had comorbid allergic contact dermatitis and 92.3% of these patients experienced further clinical improvement with allergen avoidance.

• Based on this study, the Th-2–specific immunosuppressive action of dupilumab does not appear to interfere with patch testing. Patch testing should be considered for patients who have dermatitis refractory to dupilumab as comorbid allergic contact dermatitis is highly prevalent in this population and allergen avoidance leads to further clinical improvement.

– Margaret Hammond, MD

Written by

 

 

Stephen E Helms MD

Written by

 

 

Thy N Huynh MD

Since Jadassohn described contact allergy to mercury in 1895, dermatologists have been working hard to determine the exact mechanisms of sensitization and elicitation of allergic contact dermatitis.1 Mosmann and colleagues defined two subtypes of CD4T cells (Th1 and Th2) that secrete distinctive cytokines.2 Heightened interest has occurred with the development of dupilumab, which specifically targets Th2 cells and their cytokines. Discussion has focused on allergic contact dermatitis, which is generally considered to be a Th1-related disease, whereas atopic dermatitis is a Th2-related disease. However, evidence has been building that Th2 may play a greater role in allergic dermatitis and may be improved with dupilumab therapy. Interestingly, this brings up another question: does dupilumab interfere with patch testing results? This article was designed to evaluate this exact question.

The authors feel that dupilumab does not "significantly" alter final patch testing results: the "lost positive rate" is only 10.4%. If this is correct, the consequence of 1 in 10 false-negative results would be persistent eczema of unknown cause in patients where a relevant antigen would otherwise have been identified. This could be compared with the statistics related to delayed patch test readings. One study demonstrated that 12.8% (7%–14%) of positives may be missed if only 3- or 5-day readings are performed.3 Other studies have shown that up to 30% of corticosteroid allergies may be missed.4,5 Moreover, we considered that some lost allergens could be due to potent induction of Th2 pathway, which is blocked by dupilumab in patients with lost reaction to fragrances.6

Overall, this is a very well–done and interesting manuscript. It shows the necessity of further studies to determine if false-negative patch testing does, in fact, occur in patients treated with dupilumab and whether certain specific antigens are more likely to be associated with false-negative results. Further work is also required to elucidate whether suppression of the immune response to common allergens suggests a role of dupilumab and other Th2 biologics in treating allergic contact dermatitis and other inflammatory skin disorders.

References

1. Jadassohn J. Zure Kenntnis der medikanmentosen Deratosen. Verh Dtsch Derm Gesellschaft V Kongress. 1895;103.
2. Li L, Sad S, Kagi D, Mosmann TR. CD8 Tc1 and Tc2 cells secrete distinct cytokine patterns in vitro and in vivo but induce similar inflammatory reactions. J Immunol. 1997;158(9):4152-4161. https://www.jimmunol.org/content/158/9/4152.long
3. Higgins E, Collins P. The relevance of 7 day patch test reading. Dermatitis. 2013;24(5):237-240. https://journals.lww.com/dermatitis/Abstract/2013/09000/The Relevance of 7 Day Patch Test Reading.6.aspx
4. Isaksson M, Andersen KE, Brandao FM, et al. Patch testing with corticosteroid mixes in Europe. A multicenter study of the EECDRG. Contact Dermatitis. 2000;42(1):27-35. https://onlinelibrary.wiley.com/doi/abs/10.1034/j.1600-0536.2000.042001027.x
5. Isaksson M. Corticosteroids. Dermatol Ther. 2004;17(4):314-320. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1396-0296.2004.04036.x
6. Owen J, Vakharia P, Silverberg J. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018;19(3):293-302. https://link.springer.com/article/10.1007%2Fs40257-017-0340-7

Abstract

BACKGROUND

It is unclear whether the Th2-specific immunosuppressive action of dupilumab interferes with patch testing.

OBJECTIVES

Evaluate the reliability of patch testing on dupilumab and the contribution of allergic contact dermatitis (ACD) to complex dermatitis in patients with residual dermatitis on dupilumab.

METHODS

This is a retrospective chart review of 48 patients with atopic dermatitis (AD) treated with dupilumab. We compare results of patch tests performed before and after initiation of dupilumab and the prevalence of comorbid ACD in patch tested individuals.

RESULTS

A minority of patch test reactions were "lost" on dupilumab (13/125 or 10.4%). 5 of 13 lost reaction occurred in individuals with documented immunodeficiency. 32 of 35 patch tested patients (91.4%) had comorbid ACD; 92.3% of individuals patch tested on dupilumab experienced further clinical improvement with allergen avoidance.

LIMITATIONS

This is a non-randomized study in a small cohort of patients. Clearance of dupilumab was assessed by subjective patient reports.

CONCLUSIONS

Dupilumab does not appear to exert a dampening effect on patch test results. AD with comorbid ACD was highly prevalent and allergen avoidance resulted in significant improvement in residual dermatitis that had not resolved with not dupilumab therapy.

Journal of the American Academy of Dermatology

The Impact of Dupilumab on Patch Testing and the Prevalence of Co-Morbid ACD in Recalcitrant Atopic Dermatitis: A Retrospective Chart Review

J Am Acad Dermatol 2019 Sep 25;[EPub Ahead of Print], J Raffi, R Suresh, N Botto, JE Murase 

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