Screenshot 2020-01-31 at 09.02.27

Inhibidores de dipeptidil peptidasa 4 y Penfigoide

The association of dipeptidyl peptidase IV inhibitors and other risk factors with bullous pemphigoid in patients with type 2 diabetes mellitus: A retrospective cohort study.

Guo JY, et al. J Diabetes Complications. 2019.

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Abstract

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder with unknown etiology. Evidence revealed that dipeptidyl peptidase IV inhibitors (DPP4i) may increase the associated risk. This study aimed to evaluate the relationship of BP with the administration of DPP4i and other risk factors in patients with type 2 diabetes mellitus (T2DM).

METHODS: Using the Taiwan National Health Insurance Database (NHIRD) from 2009 to 2013, we identified patients with T2DM and the use of DPP4i 12 weeks or greater as a DPP4i cohort and patients with T2DM who never use DPP4i as a control cohort. They were frequency matched on gender and age within 5 years at a ratio of 1:2. The Cox proportional hazard regression model was used to estimate the hazard ratios (HRs) and confidence intervals (CIs) for the cohorts.

RESULTS: A total of 14,187 individuals taking DPP4i and 28,374 matched cohorts without taking DPP4i were included. The incidence rate of BP was higher in DPP4i cohort than in control cohort (1.41 vs. 0.59 per 1000 person-years; adjusted HR 2.14, 95% CI = 1.02-4.50). The cumulative event rate of BP in DPP4i cohort was higher than in control cohort (log-rank test, p = .01). Patients with dementia and taking spironolactone had a higher associated risk to develop BP; lower associated risk in patients taking metformin.

CONCLUSIONS: In patients with T2DM, subjects taking DPP4i, having dementia, and taking spironolactone were associated with an increased risk for the development of BP.

Copyright © 2019. Published by Elsevier Inc.

PMID

 31932172 [ - as supplied by publisher]

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Guias de Psoriasis en Pediatria

New Pediatric Psoriasis Guideline Released

Information sourced from NEJM Journal Watch:

New Pediatric Psoriasis Guideline

Recommendations address disease severity, screening and treatment related to comorbidities, and therapies for psoriatic symptoms.

Sponsoring Organizations: The American Academy of Dermatology and the National Psoriasis Foundation

Background and Objective: An expert group was convened to answer three primary clinical questions and make recommendations for each based on available evidence. The three questions were:

1. What are the available screening tools used to effectively measure psoriasis severity and response to therapy in children with psoriasis? (2 recommendations)

2. What are the available screening and/or therapeutic interventions used to manage comorbidities in children with psoriasis? (23 recommendations)

3. What are the efficacy, effectiveness, and adverse events of treatments for psoriasis (topical, phototherapy and photochemotherapy, nonbiologic systemic treatments, biologic therapy) in pediatric and adolescent patients? (44 recommendations)

Key Points

• Disease severity measurement should include quality of life in addition to traditional measures based on amount of affected body surface area. The Children's Dermatology Life Quality Index (CDLQI) is a 10-question survey that can be used during clinical visits.

• Comorbidities known to affect adults with psoriasis may also affect children. Signs and symptoms of the following should be sought routinely [through] history and physical exam, with specialty referrals made as appropriate: psoriatic arthritis, cardiovascular disease, metabolic syndrome, mental health, and inflammatory bowel disease.

• Although strong evidence for topical treatments was lacking, corticosteroids and vitamin D analogues (alone or in combination), as well as anthralin, received the strongest recommendations.

• Specific photochemotherapeutic, nonbiologic systemic, and biologic treatments received recommendations of varying strengths, but typically would not be used by primary care clinicians.

• Due to the potential impact of psoriasis on child and adolescent psycho-emotional development, there should be close partnership between the dermatologist, the patient/family, and the patient's primary care provider.

• Patient and family education are essential to effective treatment decisions and disease outcomes.

• Substantial gaps in research exist; only 5% of recommendations are based on consistent and good-quality patient-oriented evidence.

COMMENT

While these recommendations will be most relevant to dermatologists, they provide general pediatricians and other child health clinicians with knowledge of current standards and the general lack of strong evidence behind them. Families commonly turn to primary care providers with questions and requests for advice when faced with challenging decisions about their children's chronic illnesses. Staying up to date with current specialty guidelines allows generalists to give informed advice.

John D. Cowden, MD, MPH reviewing Menter A et al. J Am Acad Dermatol 2020 Jan

CITATION(S):

Menter A et al. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020 Jan; 82:161.
[PubMed® abstract]

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El riesgo del Vaping... ahora en la piel

GETTING STEAMED OVER VAPING

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By Danielle DeHoratius, MD
January 29, 2020
Vol. 2, No. 4

To call vaping an epidemic is an understatement. As of Oct. 15, 2019, the CDC has confirmed 33 deaths among the 1,479 lung injuries associated with the use of e-cigarettes (1). Every state but Alaska has been affected by the use of these products. There are many vaping products available but those containing tetrahydrocannabinol (THC), the psychoactive component of marijuana, are the deadliest. The typical patient is largely young and male. Four out of five people afflicted are younger than 35 years old. The CDC is actively testing lung biopsies and autopsy specimens searching for other substances that could be etiologic for lung injury. One example is vitamin E acetate which is a chemical found in marijuana. It tends to be cheaper than THC oil and is often added to vape cartridges. The CDC is also testing the vapor emitted by e-cigarettes. At this point specific compounds have not been recognized.

The serious concern has been the unidentified lung disease associated with vaping. Symptoms include difficulty breathing, shortness of breath, or chest pain. Also reported is fever, coughing, vomiting, and diarrhea. As of now there is no specific infectious etiology. To date, the culprit is not defined. Could it be the e-cigarette devices or ingredients, even contaminants inhaled? A variety of substances have been used as ingredients including nicotine and marijuana-based products. The do-it-yourself home products also make finding an etiology difficult. Of note, a majority of the patients with symptoms had used or consumed THC. In a recent report in the NEJM there were 53 cases of vaping-related illnesses between April and August in Illinois and Wisconsin and 84% of those patients reported using THC products in their vaping devices. (2)

JAAD 2019; 81:1001-7.

It is not surprising that vaping can display cutaneous manifestations. While there are documented reports of burn injuries with vaping devices, there are many anecdotal reports of additional reactions to vaping products. Hua et al reviewed online e-cigarette forums searching for health effects and reported symptoms. Almost 14% of users reported dermatologic symptoms including dermatitis, burns, acne, boils, bumps, and blisters. (3)

Based on this conclusion, Visconti and Ashack performed a literature review identifying the dermatologic conditions associated with the use of e-cigarettes. (4) There has been an increase in reports of contact dermatitis associated with e-cigarette use, including reports of itchy erythematous scaly eruptions typically on the hands. These patients were subsequently found to have a nickel allergy; the devices were found to be positive on a dimethylglyoxime (DMG) nickel spot test. Many electronic cigarettes are powered by lithium-containing batteries. Over a two-year period, an estimated 2,035 individuals presented with explosion and burn injuries from e-cigarettes, which was 40 times more than the previous 6 years combined. Tobacco smoking is associated with many different oral mucosal lesions (OML) and research shows that e-cigarettes present similarly. A recent study found that three specific OMLs are more prevalent in e-cigarette users: nicotine stomatitis, hyperplastic candidiasis, and black hairy tongue. (5).

Burns, both thermal and chemical, are the most common reported complication of e-cigarette use. Jones et al performed a comprehensive review of the burns. There were 90 patients in 19 case series/reports in a 3-year period. There was a male predominance and the most common burn was a flame injury, usually related to battery malfunction. (6)

Peterson et al reported the case of discoid lupus erythematosus developing at the site of e-cigarette use in a 34-year-old woman with a history of systemic lupus and Sjogren syndrome. The authors suspected that the heat derived from the e-cigarette may have induced the lesion via a Koebner phenomenon. (7)

E-cigarettes can have a dramatic effect on the skin. Fracol et al reported a case of a 51-year old female who underwent bilateral mastectomy and immediate tissue expander reconstruction for newly diagnosed breast cancer. (8) She reported to be a non-smoker (she had a 25-pack year history) however had significant e-cigarette use. After the surgery she experienced flap necrosis and breast reconstruction failure. We do not know the physiologic effects they have on wound healing and tissue perfusion, but it may be that they are similar to the changes induced by traditional cigarettes.

Although we do not know all the ingredients of vaping liquid, two very prominent components are propylene glycol and vegetable glycerin. At the cytologic level, use of e-cigarettes was found to increase the pro-inflammatory cytokines; subsequent analysis determined that it was additives such as flavoring agents, rather than nicotine or humectants, that were responsible for the in vitro cytotoxicity. (9)

Point to Remember: Dermatologists need to inquire about vaping, especially when patients present with contact dermatitis or burn injuries.

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Our Expert's Viewpoint

Our Editor's Viewpoint
Warren R. Heymann, MD

One of the major medical stories of 2019 were the pulmonary deaths related to vaping, and the sleuthing to find the culprit. There is still so much to learn.

As stated in Nature (Scientists Chase Cause of Mysterious Vaping Illness as Death Toll Rises, Heidi Ledford, Oct. 11, 2019): "Researchers and physicians alike were caught unprepared by the illness, which has now sickened about 1,300 U.S. vapers and killed 26. Scientists are scrambling to find out why, and to save other vapers from the same fate. 'Everything is rapidly evolving,' says Brandon Larsen, a pulmonary pathologist at the Mayo Clinic in Phoenix, Arizona. 'I could tell you something today and next week it could be totally wrong.'"

As editor of DWI&I, I asked Dr. DeHoratius to explore the dermatologic manifestations of vaping. She has done a yeoman's job in reviewing the panoply of findings that have been reported. Unsurprisingly, the etiologies of cutaneous findings are more obvious than pulmonary toxins — burns, contact dermatitis, and oral lesions are more easily explained. Where dermatologists can save lives is considering vaping when seeing (mostly) younger patients with the features described in Dr. DeHoratius' commentary. Patients (and their parents) must be reminded that they literally may be playing with fire, and every effort must be made to encourage patients to cease vaping. 

1. Knowles, H. As vaping-linked deaths rise to 33, officials are still seeking answers. The Washington Post Oct 2019.

2. Laydem JE, Ghinai I, Pray I et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Preliminary Report. N Engl J Med Sept 6th 2019.

3. Hua M, Alfi M, Talbot P. Health-related effects reported by electronic cigarette users in online forums. J Med Internet Res. 2013;15:e59.

4. Visconti MJ and Ashack AK. Dermatologic manifestations associated with electronic cigarette use. J Am Acad Dermatol 2019; 81:1001-7.

5. Bardellini E, Amadori F, Conti G, Majorana A. Oral mucosal lesions in electronic cigarette consumers versus former smokers. Acta Odontol Scand 2018;76:226-228.

6. Jones CD, Ho W, Gunn E, Widdowson D, Bahia H. E-cigarette burn injuries: Comprehensive review and management guidelines proposal. Burns 2019;45(4):763-771.

7. Peterson E, Ugonabo N, Franks AG, LoSicco K. Case report of discoid lupus erythematosus in association with electronic cigarette use. JAAD Case Rep 2019; 12: 1030-1032.

8. Fracol M, Dorfman R, Janes L, Kulharni S, Bethke K, Hansen N, Kim J. The Surgical Impact of E-Cigarettes: A Case Report and Review of the Current Literature. Arch Plast Surg. 2017 Nov;44(6):477-481.

9. Cervellati F, Muresan X, Sticozzi C, Gambari R, Montagner G, Forman H, Torricelli C, Maioli E, Valacchi G. Comparative effects between electronic and cigarette smoke in human keratinocytes and epithelial lung cells. Toxicol in Vitro. 2014;28(5):999-1005.



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All content found on Dermatology World Insights and Inquiries, including: text, images, video, audio, or other formats, were created for informational purposes only. The content represents the opinions of the authors and should not be interpreted as the official AAD position on any topic addressed. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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IV drug succeeds in 50% of patients with unresectable SCC

Cemiplimab may be an option for people with high-risk squamous cell carcinoma that has persisted after surgery and radiotherapy, says Chrysalyne Schmults, a vice chair of surgical oncology at Brigham and Women's Hospital. The intravenous monoclonal antibody drug has about a 50% efficacy rate in patients with unresectable SCC, but the treatment is not appropriate for patients who have had an organ transplant or who have an immune-mediated disease, Schmults says.

Dermatology Times online (1/20) 

Como destruir fomites?

Published in Dermatology

Journal Scan / Research · January 02, 2020

Eliminating Scabies Parasites From Fomites

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• Over 5500 adult mites and 2300 eggs of S. scabiei were obtained from a porcine model (which is indistinguishable from human scabies) and used in an ex vivo experiment to determine ways to eliminate scabies. Thermal killing (ie, 100% of scabies mites and eggs dead) at ≥50°C (for at least 10 minutes) and freezing below −10°C (for at least 5 hours) was effective. Washing or heat-drying beyond the heat threshold in conventional machines killed parasites quickly. Detergent or ozone laundry disinfection had minimal effect on mite and egg mortality. If there is no access to washer/dryer or freezer, scabies-contaminated fomites may be isolated in plastic bags until all parasites are dead, which may take up to 3 days in temperate–dry and 8 days in warm–humid conditions.

• In this labor-intensive experiment, the authors for the first time validated "real-life" decontamination modalities for scabies, which may be applicable in settings with and without electricity. Environmental decontamination should always be integrated with pharmaceutical therapy.

– InYoung Kim, MD, PhD

 Dermatology

Written by

 

 

Scott A Norton MD, MPH, MSc

The word, scabies, refers to both the mites, scientifically known as Sarcoptes scabiei, and the skin condition that it causes. Scabies, in both senses of the word, is associated with discomfort, fear, anxiety, revulsion, and myth. Many of the myths center on how infectious an individual who has scabies is—and how one actually acquires the infestation. A lingering issue is whether scabies is reliably transmitted via fomites (inanimate objects such as clothing and bed linens). A corollary question is: How can one decontaminate clothing and bed linens that have been used by scabies-infested people?

Protocols that address community-level detection, treatment, control, prevention, and decontamination appear in infection-control manuals for hospitals, nursing homes, prisons and other confined facilities, daycare centers, and school systems. Most protocols assume access to simple resources, such as electricity, water, and replacement items. However, many places with scabies hyperinfestation lack the necessary resources (ie, water, power, laundry appliances, heat source) to follow such guidelines.

Thus, the investigation reported in this study was prompted, in part, by an inquiry from indigenous Australian communities in remote Queensland. There, scabies infestation is hyperendemic and health consequences are far more serious than mere incessant, unremitting, intractable, generalized pruritus.

Bernigaud and colleagues from France, Australia, and Sri Lanka conducted simple studies using thousands of mites and eggs collected from porcine models (ie, scabies-infested pigs maintained in laboratory conditions). The studies were conducted on ex vivo mites and eggs (those that were no longer on the living host).

Their study is unique in that they looked at viability of scabies eggs, something that is important in a discussion of fomite-based transmission but has never been done before. They tested dozens of ways to decontaminate fomite-laden fabrics, and they provide us an evidence-based algorithm for conducting chemical-free decontamination based on physical factors such as temperature and humidity.

One of their references is the classic paper by Kenneth Mellanby, an entomologist in the United Kingdom during World War II.1 As Allied military forces gathered in close quarters, crowded conditions prompted great concern for outbreaks of scabies. One should read Mellanby's 1941 paper, "The transmission of Scabies," published in the British Medical Journal. The paper describes that "the volunteers were all pacifists who had offered to co-operate in this work and…agreed to submit themselves to infection [with scabies] and to allow the course of the disease to be followed on their person…. Uninfected volunteers slept together in the same beds as these men suffering from scabies…for seven nights…. The men were stripped and inspected daily for a period of about a month (sometimes longer)…." Mellanby examined thousands of patients during the course of his experiments—and his various papers are the basis of much of our knowledge of this nearly universal affliction.

Reference

1. Mellanby K. Transmission of scabies. Br Med J. 1941 Sep 20;2(4211):405-406. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2284263/pdf/brmedj03939-0015.pdf

Abstract

Scabies is one of the most prevalent infectious dermatological diseases worldwide. Overcrowding, high population movement and suboptimal health care are major risk factors for outbreaks, particularly in disadvantaged populations and institutional settings. In the tropics scabies often causes secondary bacterial infections and potentially life threatening sequelae including sepsis, glomerulonephritis, rheumatic fever and heart disease. Direct skin-to-skin contact is the main transmission pathway, however, as mites survive short-term outside their host, contaminated fomites can also spread the disease, especially in the cases of profuse or crusted scabies. Parasites within skin squames shed into beddings have been reported to infect laundry workers, and have been responsible for therapeutic failure. Consequently, environmental decontamination should be integrated with individual medication. To date, no field studies have been performed to validate decontamination measures. As there is no in vitro culture, previous experimental research was limited in parasite numbers and never considered the egg stage. Accordingly, the existing decontamination protocols are based on poor statistical power and vary significantly, resulting in confusion of patients and medical workers. We aimed to generate statistically valid experimental data as a basis to develop standardized guidelines with clear and simple directions for scabies outbreaks.

Journal of the American Academy of Dermatology

How to Eliminate Scabies Parasites From Fomites — A High Throughput Ex Vivo Experimental Study

J Am Acad Dermatol 2019 Dec 16;[EPub Ahead of Print], C Bernigaud, DD Fernando, H Lu, S Taylor, G Hartel, O Chosidow, K Fischer 

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Porcentaje de Células T en un Melanoma predice quien progresa o no...

Researchers Identify T-Cell Fraction As Predictor Of Melanoma Progression

Health IT Analytics (1/21, Kent) reports "researchers used high-throughput DNA sequencing to analyze the T cell repertoire of" melanoma tumors and "found that of all the variables identified, the T-cell fraction (TCFr, the proportion of cells in the lesion that were T cells) was a powerful predictor of which patients would progress. Even for patients whose lesion thickness was the same, TCFr was able to predict which patients were more likely to have metastatic disease." The findings were published in Nature Cancer.

Nadie hace caso... adherencia, adherencia, adherencia!

Many People Do Not Use Sunscreen As Frequently As Recommended, German Study Suggests

Dermatology Advisor (1/21, Peckel) reports researchers found that "the majority of people who use sunscreen do not follow recommendations for frequency of application and reapplication." The researchers conducted "a cross-sectional review of 3000 German residents aged 14 to 45 years" and published their findings in the Journal of the European Academy of Dermatology and Venereology.

Ya no hay que raspar para detectar Tinea Capitis en niños, con un hisopeo se puede...

Efficacy Of Cotton Swab-Culture Method For Diagnosing Tinea Capitis In Pediatric Patients Appears To Be Indistinguishable To The Scrape-Culture Method, Study Indicates

Healio (1/21, Welsh) reports, "Efficacy of the cotton swab-culture method for diagnosing tinea capitis in pediatric patients is indistinguishable to the scrape-culture method," research indicated in a study that included "25 pediatric patients...suspected of tinea capitis diagnosis." Because of "the numerous benefits to the swab technique, the researchers recommend and support adopting this technique in pediatric medicine to obtain samples to diagnose tinea capitis." The findings of the "prospective study" were published online in the Journal of the American Academy of Dermatology.

Reportaje ampliado de químicos en sangre de filtros solares... usar ropa protectora.

Sunscreen Chemicals May Be Absorbed Into The Bloodstream, Study Suggests

Reuters (1/21, Steenhuysen) reports scientists at the FDA found "that active chemicals in sunscreens can readily soak into the bloodstream, confirming the need for more testing on whether these products are safe." The findings were published in JAMA replicating the "findings of a pilot study by FDA scientists in May."

        On its website, CNN (1/21, Lamotte) reports Dr. Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research, said that just because an ingredient is absorbed into the bloodstream does not mean it is unsafe, "Rather, this finding calls for further industry testing to determine the safety and effect of systemic exposure of sunscreen ingredients, especially with chronic use." Experts agree that "the sun's link to cancer and aging is real, so don't abandon sun protection." The article adds that the American Academy of Dermatology "recommends applying at least 1 ounce of sunscreen to all exposed skin every two hours or after swimming, including 'back, neck, face, ears, tops of your feet and legs.'" The Academy also "recommends talking to a board-certified dermatologist if you are concerned about the safety of the sunscreen's ingredients."

        Healio (1/21) reports that in the latest study, the researchers at the FDA tested six active ingredients and found that all of them were absorbed through the skin into the bloodstream. The six ingredients tested in the study were: avobenzone, homosalate, octinoxate, octisalate, octocrylene, and oxybenzone.

        HealthDay (1/21, Norton) reports Dr. Adam Friedman, a member of the Academy and a professor at George Washington University School of Medicine, said, "All this study shows is that it's possible to detect very tiny amounts of sunscreen ingredients in the blood. It was not designed to say anything about safety." Dr. George Hruza, the president of the Academy, said that it's still clear sunscreen can reduce the risk of skin cancer, "The AAD recommends that everyone seek shade, wear protective clothing – including a lightweight and long-sleeved shirt, pants, a wide-brimmed hat and sunglasses – and apply a broad-spectrum sunscreen with an SPF of 30 or higher to all exposed skin."

        MedPage Today (1/21, Bankhead) and Medscape (1/21, Goodman, Subscription Publication) also cover the FDA study.

Otro estudio sobre absorción de Filtros Químicos en la Sangre, pero sin saber que implica...

Sunscreen Absorbed into the Blood, Consequences Unknown

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Chemical sunscreen ingredients are systemically absorbed after one application, and some ingredients can stay in the blood for at least 3 weeks, according to an FDA study published in JAMA. 

In a lab setting, 48 adults were randomized to receive one of four formulations of chemical sunscreens containing avobenzone, oxybenzone, octocrylene, homosalate, octisalate, or octinoxate. Sunscreen was applied once on the first day and four times on days 2 through 4. Participants had 34 blood samples collected over 21 days.

The maximum plasma concentration of avobenzone over days 1 through 21 — the primary outcome — was 7.1 ng/mL for lotion, 3.5 ng/mL for aerosol and nonaerosol spray, and 3.3 ng/mL for pump spray. For all six active ingredients, most participants had maximum plasma concentrations that were at or above the FDA's 0.5 ng/mL threshold (for possibly waiving additional safety studies) for as long as 23 hours after a single application. For homosalate and oxybenzone, over half of participants had above-threshold plasma levels 21 days after application. 

The authors say their findings reinforce the need for further studies on sunscreen safety. Editorialists conclude: "In the absence of clear data demonstrating harm, the use of chemical sunscreen may still be considered appropriate; the use of mineral-based sunscreen is a well-established safe alternative."

JAMA article (Free abstract)

JAMA editorial (Subscription required)

Background: Physician's First Watch coverage of earlier study on sunscreen absorption (Free)

La estupidez es contagiosa...

Support for Vaccines Continues Downward Trend in US, Poll Shows

Megan Brooks

January 16, 2020

A new Gallup survey shows that support for vaccination in the United States is declining, particularly among parents of young children.

The survey, conducted in December 2019, shows that 84% of Americans feel it's extremely or very important that parents vaccinate their children. That matches Gallup's prior reading in 2015, but is down 10% from 2001, when 94% of Americans felt this way.

"Widespread public support for childhood vaccines creates a wall preventing contagious diseases like measles and polio from spreading in the US, but a breach in that wall appeared in 2015 and it has not been repaired," Gallup said in a news release.

Among parents of children younger than 18 years old, 77% feel vaccination is important in 2019, down from 92% in 2001.

The decline in Americans' belief in the importance of vaccinating children between 2001 and 2015 occurred among almost all subgroups of the public.

Highly educated Americans with postgraduate degrees is the only group that has maintained its 2001 level of support for vaccines; 90% of this subgroup continues to believe vaccination is important, essentially unchanged from the 92% in 2015 and 2001. Perceptions of the importance of vaccination declined by at least 5 percentage points among all other education subgroups, Gallup reported.

Public Awareness Campaigns Working?

Most Americans say they are aware of the advantages and disadvantages of vaccines. In the latest survey, nearly 9 in 10 (89%) say they have heard "a great deal" or "a fair amount" about the advantages of vaccinations, up from 83% in 2015 and 73% in 2001.

More than three quarters (79%) say they have heard a great deal or a fair amount about the possible disadvantages of vaccines — up modestly from 73% in 2015 but a substantial increase from 39% in 2001.

"Pro-vaccine public awareness campaigns appear to be working to the extent that more Americans — now a majority for the first time — report having heard a lot about the medical advantages of vaccines for children," Gallup reports.

"However, more have also heard about the disadvantages. While they are not as pervasive and are being exposed as untrue, these counterarguments are still getting through, perhaps explaining why public support for vaccines remains lower than at the start of this century," they point out.

Uncertainty on Vaccine-Autism Link Persists

Although many Americans who oppose vaccinations argue that they are more dangerous than the diseases they prevent, the vast majority of Americans (86%) continue to disagree. This is unchanged from the 87% who felt that vaccines were less dangerous in 2015 and only modestly lower than the 90% in 2001.

Currently, 11% of US adults think vaccines are more dangerous than the diseases they prevent.

Although the vast majority of Americans see vaccines as less dangerous than the diseases they prevent, only 62% feel the federal government should make all parents get their children vaccinated. In a 1991 Princeton survey, 81% felt the government should require vaccination.

Despite the well-publicized and debunked claim that vaccines cause autism, 10% of US adults still believe that vaccines cause autism in children, marking a modest increase from 6% in 2015. Nearly half (45%) do not think vaccines cause autism, up modestly from 41% who said the same almost 5 years ago, whereas 46% still aren't sure. In 2001, 94% of Gallup survey respondents were unsure whether vaccines cause autism.

Americans with more formal education were more apt to say vaccines do not cause autism. The figure is 73% among those with postgraduate education, falling to 61% among those with a college degree only, 42% of those with some college, and 28% of those with no college experience.

Lesser-educated Americans were much more likely to have no opinion than to say they believe vaccines do cause autism. The percentage making the causal connection tops out at 12% among Americans with no college education vs 5% of postgraduates.

There was also a partisan split in opinions, with 55% of Democrats saying vaccines do not cause autism, compared with 37% of Republicans, according to Gallup.

The results are based on telephone interviews with a random sample of 1025 adults, aged 18 and older, from all 50 US states and the District of Columbia, with the margin of sampling error of ±4 percentage points.

More information on the survey is available online.

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Cite this: Support for Vaccines Continues Downward Trend in US, Poll Shows - Medscape - Jan 16, 2020.

Nuevos marcadores sericos para detectar Lupus.

Serum Biomarker Panels for Lupus May Aid Diagnosis

By Reuters Staff

January 13, 2020

NEW YORK (Reuters Health) - New serum biomarker panels show promise for diagnosing systemic lupus erythematosus (SLE) and for the differential diagnosis of other major rheumatic immune diseases, report researchers from China.

"Clinical diagnosis of SLE is currently challenging due to its heterogeneity. Many autoantibodies are associated with SLE and are considered potential diagnostic markers, but systematic screening and validation of such autoantibodies is lacking," Dr. Dong-Qing Ye of Anhui Medical University and colleagues note in Rheumatology.

To identify candidate SLE-related autoantibodies, they analyzed sera from 15 patients with SLE and five healthy volunteers using human proteome microarrays. They validated their results in 107 SLE patients, 94 healthy volunteers and 60 disease controls using focused arrays made up of autoantigens corresponding to the identified candidate antibodies.

The researchers identified 31 autoantibodies that were expressed at significantly higher levels in the SLE group than in healthy volunteers; 11 autoantibodies with significantly higher expression in the SLE group than in disease controls; and 18 when the healthy volunteers plus disease controls were combined and compared with the SLE group.

Many of these differentially expressed autoantibodies were previously unreported.

The researchers say an optimized panel of three autoantibodies (anti-RPLP2, anti-SNRPC and anti-PARP1) had an area under the curve (AUC) of 0.973 for SLE diagnosis, while a panel of four biomarkers (anti-RPLP2, anti-PARP1, anti-MAK16 and anti- RPL7A) had an AUC of 0.911 for the differential diagnosis of SLE.

The researchers also observed some correlations between the autoantibodies identified and clinical characteristics of SLE patients, such as disease activity with the level of anti-PARP1 and rash with the level of anti-RPLP2, anti-MAK16 and anti- RPL7A.

"Further validation and application of the combined biomarker panels in clinical practice is expected," they conclude.

The study had no commercial funding and the authors made no relevant disclosures.

Dr. Ye did not respond to a request for comment by press time.

SOURCE: http://bit.ly/2N4tDQ4 Rheumatology, online January 3, 2020.

Reuters Health Information © 2020 

Cite this: Serum Biomarker Panels for Lupus May Aid Diagnosis - Medscape - Jan 10, 2020.

Cocamidopropyl Betaine en Pediatria

Published in Dermatology

Journal Scan / Research · January 20, 2020

Cocamidopropyl Betaine Is Commonly Found in Hypoallergenic Personal Care Products for Children

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• Of the top 6 online retailers for baby shampoo and baby soap, 52% (39/75) of unique shampoo and 43.9% (29/66) of unique soap products contained cocamidopropyl betaine (CAPB). Among those found in more than one query of the product databases of these retailers, 61.9% (13/21) of shampoo and 78.6% (11/14) of soap products contained CAPB. The term "hypoallergenic" was present on either the label of the product itself or in the product's description.

• Based on previous studies demonstrating a strong association of CAPB contact sensitivity with atopic dermatitis (AD), CAPB is thought to be a prevalent sensitizer that should be avoided in AD patients. Unfortunately, CABP was frequently found in pediatric shampoo and soap products that were marketed as "hypoallergenic." Given that CAPB is prevalent in pediatric products but not included on the TRUE test, the authors recommend expanded or custom patch testing to include CAPB when contact sensitivity is suspected in children with AD.

– InYoung Kim, MD, PhD

Atopic dermatitis (AD), found in approximately 15% of pediatric patients in the United States, is an inflammatory skin condition associated with poor skin barrier function, resulting in significantly higher rates of cutaneous delayed-type hypersensitivity and allergic contact dermatitis (ACD) compared to nonatopic populations1 particularly to weaker allergens.2 In 2014, Shaughnessy et al. analyzed 1674 patients with and without AD who underwent patch testing with the North American Contact Dermatitis Group patch series for reactivity to surfactants, products known to worsen skin barrier dysfunction and aggravate skin inflammation in patients with ACD and AD.1 Their study determined an association between cocamidopropyl betaine (CAPB) contact sensitivity and a history of AD, and concluded that children with AD should not be exposed to CAPB;1 these results are supported by our recent study of a pediatric cohort wherein all CAPB reactions came exclusively from patients with AD.3 Despite being the allergen with the 8th 18 most frequent reactions in a recent 10-year retrospective chart review of pediatric patients, CAPB is commonly found in products branded as "hypoallergenic" which are recommended for children with ACD or AD.4 This study aims to assess the frequency of CAPB inclusion in commonly purchased pediatric hypoallergenic personal care products.

Journal of the American Academy of Dermatology

Cocamidopropyl Betaine Is Commonly Found in Hypoallergenic Personal Care Products for Children

J Am Acad Dermatol 2019 Dec 21;[EPub Ahead of Print], RW Collis, DM Sheinbein 

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Jak y herpes

Patients With IBD And Other Immune-Mediated Diseases Who Receive JAK Inhibitors May Be At Greater Risk For Herpes Zoster Infection, Review Study Indicates

Healio (1/15, Young) reports, "Patients with inflammatory bowel disease [IBD] and other immune-mediated diseases who receive Janus kinase [JAK] inhibitors may be at increased risk for herpes zoster infection," researchers concluded after studying data from "82 studies comprising 66,159 patients." The findings of the meta-analysis were published online in Gastroenterology.

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

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

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Guselku vs Ixe...

Ixekizumab May Be More Effective At Improving Signs, Symptoms Of Moderate To Severe Plaque Psoriasis Than Guselkumab, Phase 4 Study Indicates

Healio (1/15, Welsh) reports research indicates that ixekizumab appears "to be more effective at improving signs and symptoms among patients with moderate to severe plaque psoriasis than" guselkumab, investigators concluded in a "multicenter, randomized, double-blind, parallel-group, phase 4 study" that included 1,027 patients. The findings were published online in the British Journal of Dermatology.

        Guselkumab May Be More Effective Than Ustekinumab For Achieving, Maintaining Treatment Responses In Moderate To Severe Plaque Arthritis, Research Suggests. Dermatology Advisor (1/15, May) reports researchers compared individual patient data from clinical trials for guselkumab and ustekinumab and concluded that guselkumab "may be more effective than ustekinumab for helping patients with moderate to severe plaque psoriasis achieve and maintain treatment response through 40 weeks." The findings were published online in the British Journal of Dermatology.

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Cafe y otro beneficio

Consuming caffeine may offset some unhealthful consequences of an obesity-inducing diet, according to a new study in rats.

Scientists at the University of Illinois at Urbana-Champaign fed rats a high-fat, high-sugar diet. They then gave some of the rodents caffeine extracted from mate tea and others decaffeinated mate tea.

The rats that consumed the caffeine extract gained 16% less weight and 22% less body fat than those that consumed decaffeinated mate.

The anti-obesity effects were similar among rats that consumed synthetic caffeine or caffeine extracted from coffee.

By studying the rats' cells, the scientists found that caffeine exerts some of its effects by altering the expression of certain genes.

They report their results in a recent Journal of Functional Foods study paper.

"Considering the findings," says corresponding study author Prof. Elvira Gonzalez de Mejia, Director of Nutritional Sciences at the university, "mate tea and caffeine can be considered anti-obesity agents."

Caffeine reduced body fat accumulation

The team fed six groups of rats a high-fat, high-sugar diet for 28 days. In addition, they supplemented the diet of five of the groups with one of the following: synthetic caffeine, mate tea containing caffeine, caffeine extracted from mate tea, caffeine extracted from coffee, and decaffeinated mate tea.

The amount of caffeine was equivalent to the amount that humans ingest from drinking 4 cups of coffee per day.

After 28 days, there was a marked difference in lean body mass among the six groups of rats. The rats that had consumed caffeine from any source had gained less body fat than their counterparts in the noncaffeine group.

There was a close link between the storage of lipids in fat cells, the gain in body weight, and the increase in body fat.

The findings add to increasing knowledge about the potential for mate tea to help combat obesity. This is in addition to other health benefits conferred by the vitamins, flavonoids, and phenolic compounds in the herbal tea.

Mate, or yerba mate, is a beverage made from the leaves of the tree Ilex paraguariensis St. Hilaire. It is a popular drink in South America, where consumption in countries such as Brazil, Chile, Argentina, Paraguay, and Uruguay can reach 3–10 kilograms per capita.

The drink has become a popular alternative to black tea and coffee because of its reputation as protective against infection, obesity, diabetes, and cardiovascular conditions.

A typical serving of mate contains between 65 and 130 milligrams (mg) of caffeine. A cup of brewed coffee, in contrast, can contain 30–300 mg of caffeine.

Caffeine altered gene expression

In addition to studying the effects of the various forms of caffeine in live rats, the researchers investigated the effects in cell cultures.

They exposed fat cells from mice to all three types of caffeine: synthetic, coffee extracted, and mate extracted.

These tests revealed that lipid buildup in fat cells decreased by 20–41%, regardless of the type of caffeine.

Examination of genes relevant to lipid metabolism and obesity also revealed that caffeine reduced the expression of certain genes.

Caffeine downregulated the expression of genes that code for fatty acid synthase (FASN), an enzyme that helps producelong-chain fatty acids, and lipoprotein lipase (LPL), an enzyme with a key role in breaking down triglycerides.

All three types of caffeine — synthetic, mate extracted, and coffee extracted — reduced the expression of both genes by a considerable amount.

The cell culture tests revealed that FASNexpression decreased by 31–39% and LPLexpression decreased by 51–69%.

In the rats, the consumption of caffeine extracted from mate reduced FASNexpression in fat tissues by 39% and in their livers by 37%.

The researchers found that downregulation of FASN and two other genes in the rats' livers reduced the production of triglycerides and low-density lipoprotein cholesterol in those organs.

Need for affordable, accessible interventionsThe imbalance between the intake and use of energy by the body triggers storage of excessive triglycerides in fat tissues.

The World Health Organization (WHO) defines overweight and obesity as "excessive fat accumulation that may impair health."

Obesity is a major health challenge worldwide. Once confined to higher-income nations, it is now also a growing health problem in middle- and low-income countries. At least 2.8 million deaths per year result from obesity and overweight.

Overweight and obesity are major risk factors for many chronic health conditions, including type 2 diabetes, fatty liver disease, and cardiometabolic diseases.

While various interventions — including lifestyle changes, drugs, and surgery —can help people with obesity lose weight, keeping it off remains a major challenge. 

The pressing need for widely available and affordable strategies is encouraging scientists to search for solutions in plants and herbs.

"The results of this research could be scaled to humans to understand the roles of mate tea and caffeine as potential strategies to prevent overweight and obesity, as well as the subsequent metabolic disorders associated with these conditions."

Prof. Elvira Gonzalez de Mejia

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Skin Care Physicians of Costa Rica

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

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