Dermatología en Costa Rica

Sunday, February 27, 2022

Association Between Isotretinoin and Adverse Neuropsychiatric Outcomes

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Abstract 


BACKGROUND

Severe neuropsychiatric outcomes have been reported in individuals exposed to isotretinoin, but the evidence is inconclusive and complicated by several methodological limitations.

OBJECTIVES

To establish and quantify the association between isotretinoin and one-year incident neuropsychiatric adverse outcomes.

METHODS

Propensity score matched cohort study of electronic medical records between years 2013 and 2019 with patients followed up for one year after their index dispensed prescription. Over 12 million patients aged 12 to 27 years from 56 healthcare organizations. Patients aged 12 to 27 years with a dispensed prescription for isotretinoin or control prescription. International Classification of Diseases Clinical Modification 10threvision diagnoses of any incident sleep or mental health disorder, or non-fatal self-harm within one year of the index prescription. Odds ratios (OR) with 95% confidence intervals (95%CI).

RESULTS

We included 30866 acne patients in the isotretinoin cohort, 44748 patients in the oral antibiotics cohort, 108367 in the topical anti-acne agents cohort, and 78666 in the cohort of acne patients without anti-acne prescription medicines. After propensity score-matching for baseline confounders, the OR for any incident neuropsychiatric outcomes in acne patients exposed to isotretinoin was 0.80 (95%CI: 0.74 to 0.87) compared to acne patients with oral antibiotics, 0.94 (95%CI: 0.87 to 1.02) compared to acne patients with topical anti-acne medicines, and 1.06 (95%CI: 0.97 to 1.16) compared to acne patients without prescription anti-acne medicines. Patients exposed to isotretinoin experienced significantly more incident physical symptoms than patients in any of the three comparison cohorts.

CONCLUSIONS

Isotretinoin was not independently associated with excess adverse neuropsychiatric outcomes at the population level. In monitoring potential adverse outcomes during isotretinoin treatment, clinicians should also consider the high mental health burden associated with treatment-resistant acne and the potential contribution of physical side effects of the prescribed medication on mental health.


The British Journal of Dermatology

Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data

Br J Dermatol 2022 Feb 10;[EPub Ahead of Print], T Paljarvi, T McPherson, S Luciano, K Herttua, S Fazel 





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Skin Care Physicians of Costa Rica

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Twenty-Nine Novel Loci Identified for Acne Susceptibility

Meta-analysis of genome-wide association studies adds to knowledge of genetic contribution to acne susceptibility

WEDNESDAY, Feb. 9, 2022 (HealthDay News) -- Twenty-nine novel significant loci for acne have been identified, according to a study published online Feb. 7 in Nature Communications.

Brittany L. Mitchell, Ph.D., from the QIMR Berghofer Medical Research Institute in Brisbane, Australia, and colleagues performed the largest meta-analysis of genome-wide association studies to date, which included 20,165 individuals with acne from nine cohorts.

The researchers identified 29 novel genome-wide significant loci and replicated 14 of 17 previously identified risk loci. At several acne susceptibility loci, which have previously been implicated in Mendelian hair and skin disorders such as pustular psoriasis, putative causal genes were identified. Shared genetic etiology was identified between acne, hormone levels, hormone-sensitive cancers, and psychiatric traits. In an independent cohort, up to 5.6 percent of the variance in acne liability was explained by a polygenic risk score calculated from these results.

"Our results highlight the substantial influence on genetic risk harbored by other, as yet undiscovered loci and motivate future studies to both identify additional risk loci and establish the biological processes through which genetic risk is mediated," the authors write.




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Friday, February 25, 2022

Impact of Immunological Tests to Predict Relapse of Bullous Pemphigoid After Treatment Cessation Journal of the American Academy of Dermatology

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Abstract


BACKGROUND

A high level of anti-BP180 antibodies on ELISA and a persistent positive direct immunofluorescence at the end of treatment (immunological tests, ITs) are predictors of relapse after treatment cessation (TC) in patients with bullous pemphigoid.

OBJECTIVE

To evaluate the real-life impact of the immunological-based decision of TC on the 3 and 6-month relapse rate after TC in bullous pemphigoid.

METHODS

Retrospective multicentric study included patients followed almost 6 months after TC. Patients were classified according to whether the TC decision was in accordance with the results of ITs performed during the 3 months before TC, despite the results of ITs or without ITs performed.

RESULTS

We included 238 patients. Three months after TC, 36 patients showed relapse: 14/95 of patients with TC in accordance with IT results (14.7%), 5/21 with TC despite ITs (23.8%) and 17/122 with TC without ITs (13.9%, p=0.5). Six months after TC, the relapse rate was 18.9%, 28.6%, and 18.9% (p=0.56), respectively, in the 3 groups.

LIMITATIONS

The retrospective design and the limited follow-up.

CONCLUSION

In real-life practice, in bullous pemphigoid, 3 and 6-month relapse rate was not significantly reduced with TC decision based on results of ITs as compared with a classical clinical-based decision.


Journal of the American Academy of Dermatology
Real-life impact of the immunological tests to predict relapse after treatment cessation in patients with bullous pemphigoid: a French multicenter retrospective study
J Am Acad Dermatol 2022 Jan 25;[EPub Ahead of Print], G Battesti, C Garcia, M Viguier, V Marchal, M Castel, P Joly, AP Ledard, MP Konstantinou, V Seta, N Cordel, S Duvert-Lehembre, E Tancrède-Bohin, T Belmondo, S Ingen-Housz-Oro, M d'Incan 



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Awareness of Alpha-Gal Allergy Among Dermatologic Surgeons

Awareness of Alpha-Gal Allergy Among Dermatologic Surgeons

Dermatologic Surgery


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Abstract

Alpha-gal syndrome, also known as mammalian meat allergy (MMA), was first described by Commins and colleagues in 2009. They presented 24 patients with anaphylaxis or urticaria after eating beef, pork, or lamb who demonstrated the presence of Immunoglobulin E (IgE) antibodies to galactose-a-1,3-galactose (a-gal), an oligo- saccharide. This carbohydrate is not inherently present in humans or primates, and exposure and sensitization have been linked to species-specific ticks in the United States and Australia. Higher incidences of alpha-gal syndrome were reported in a similar geographic distribution as Amblyomma Americanum, also known as the lone star tick, the southeastern United States. Therefore, geographic implications for this allergen exist with about 20% of the population of TN, NC, and Virginia, demonstrating serum IgE antibodies to alpha-gal.

Dermatologic Surgery
Alpha-Gal (Mammalian Meat) Allergy: Implications for Dermatologic Surgeons
Dermatol Surg 2022 Feb 08;[EPub Ahead of Print], K Raji, M Baucom 


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Espironolactona no se asocia a Cancer…

Association of Spironolactone Use With Risk of Cancer

JAMA Dermatology


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Abstract


IMPORTANCE

While originally approved for the management of heart failure, hypertension, and edema, spironolactone is commonly used off label in the management of acne, hidradenitis, androgenetic alopecia, and hirsutism. However, spironolactone carries an official warning from the US Food and Drug Administration regarding potential for tumorigenicity.

OBJECTIVE

To determine the pooled occurrence of cancers, in particular breast and prostate cancers, among those who were ever treated with spironolactone.

DATA SOURCES

PubMed, Cochrane Library, Embase, and Web of Science were searched from inception through June 11, 2021. The search was restricted to studies in the English language.

STUDY SELECTION

Included studies reported the occurrence of cancers in men and women 18 years and older who were exposed to spironolactone.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers (K.B. and H.H.) selected studies, extracted data, and appraised the risk of bias using the Newcastle-Ottawa Scale. Studies were synthesized using random effects meta-analysis.

MAIN OUTCOMES AND MEASURES

Cancer occurrence, with a focus on breast and prostate cancers.

RESULTS

Seven studies met eligibility criteria, with sample sizes ranging from 18 035 to 2.3 million and a total population of 4 528 332 individuals (mean age, 62.6-72.0 years; in the studies without stratification by sex, women accounted for 17.2%-54.4%). All studies were considered to be of low risk of bias. No statistically significant association was observed between spironolactone use and risk of breast cancer (risk ratio [RR], 1.04; 95% CI, 0.86-1.22; certainty of evidence very low). There was an association between spironolactone use and decreased risk of prostate cancer (RR, 0.79; 95% CI, 0.68-0.90; certainty of evidence very low). There was no statistically significant association between spironolactone use and risk of ovarian cancer (RR, 1.52; 95% CI, 0.84-2.20; certainty of evidence very low), bladder cancer (RR, 0.89; 95% CI, 0.71-1.07; certainty of evidence very low), kidney cancer (RR, 0.96; 95% CI, 0.85-1.07; certainty of evidence low), gastric cancer (RR, 1.02; 95% CI, 0.80-1.24; certainty of evidence low), or esophageal cancer (RR, 1.09; 95% CI, 0.91-1.27; certainty of evidence low).

CONCLUSIONS AND RELEVANCE

In this systematic review and meta-analysis, spironolactone use was not associated with a substantial increased risk of cancer and was associated with a decreased risk of prostate cancer. However, the certainty of the evidence was low and future studies are needed, including among diverse populations such as younger individuals and those with acne or hirsutism.


JAMA Dermatology
Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-analysis
JAMA Dermatol 2022 Feb 09;[EPub Ahead of Print], K Bommareddy, H Hamade, MA Lopez-Olivo, M Wehner, T Tosh, JS Barbieri 


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Skin Care Physicians of Costa Rica

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Wednesday, February 09, 2022

LIGHTENING THE CUTANEOUS AND EMOTIONAL BURDEN OF MELASMA: CYSTEAMINE’S ROLE



By Warren R. Heymann, MD, FAAD
February 9, 2022
Vol. 4, No. 6

Melasma is a frustrating disorder for patients and practitioners alike. Facial gray-brown patches may cause psychosocial distress and embarrassment, thereby diminishing quality of life. (1) Melasma most frequently occurs in women with Fitzpatrick skin types III-VI with an average onset between 20-30 years of age. Exacerbating factors of melasma include pregnancy, hormonal contraceptives, ultraviolet light exposure, and autoimmune thyroid disorders. (2,3) The pathogenesis is enigmatic, but increased stem cell factor, which binds the tyrosine kinase receptor c-kit, alterations in the Wnt signaling pathway, α-melanocyte-stimulating hormone, barrier dysfunction, increased oxidative stress, increased mast cells, fatty acid abnormalities, and increased vascularity related to VEGF have all been implicated. (1)

Although triple combination therapy (hydroquinone/fluocinolone/tretinoin) is considered the premier topical treatment for melasma, the controversy regarding potential carcinogenicity of hydroquinones (an increased skin tumor incidence has been reported in mice treated dermally, however, there is no information available on the carcinogenic effects of hydroquinone in humans), (4) and the risk of exogenous ochronosis, have propelled the search for alternative treatments. 

The number of therapeutic options is dizzying — Austin et al identified 35 original randomized clinical trials using azelaic acid, cysteamine, epidermal growth factor, hydroquinone (liposomal-delivered), lignin peroxidase, mulberry extract, niacinamide, Rumex occidentalis, triple combination therapy, tranexamic acid, 4-n-butylresorcinol, glycolic acid, kojic acid, aloe vera, ascorbic acid, dioic acid, ellagic acid and arbutin, flutamide, parsley, or zinc sulfate for melasma. The authors concluded that cysteamine, triple combination therapy, and tranexamic acid received strong clinical recommendations for the treatment of melasma. (5)


This commentary focuses on cysteamine for the treatment of melasma.

Cysteamine (2-mercaptoeth-ylamine) hydrochloride has been known as a potent depigmenting agent for more than 40 years. It is a product of cysteine metabolism, acting as an intrinsic antioxidant, protecting against ionizing radiation and serving as an antimutagenic agent (compared to hydroquinones, which are cytoxic and mutagenic in some animal models). Cysteamine is a thiol compound, inhibiting tyrosinase and peroxidase involved in melanogenesis. The molecule also scavenges dopaquinone in the melanin pathway, chelates iron and copper, and increases intracellular levels of glutathione (which is associated with the shift of eumelanogenesis to pheomelanin synthesis). Being a thiol compound, cysteamine is associated with an offensive odor, which obviated its cosmetic use; only recently has new technology combated this odor, allowing a cream to be developed for clinical application. Mansouri et al, in a randomized, placebo-controlled double-blind study, demonstrated that cysteamine showed significantly greater efficacy than placebo in the treatment of melasma at 2 and 4 months as determined by investigator's global assessment and patients' viewpoints. (6)

Studies comparing cysteamine to hydroquinone have been performed. Lima et al performed a quasi-randomized, multicenter, evaluator-blinded clinical trial on 40 women with facial melasma utilizing 5% cysteamine or 4% hydroquinone (HQ) on hyperpigmented areas for 120 days. Patients were assessed at the inclusion and after 60 and 120 days of treatment for mMASI (modified melasma area severity index), MELASQoL (melasma quality of life scale), and the difference in colorimetric luminosity between melasma and the adjacent unaffected skin. The Global Aesthetic Improvement Scale was used to assess the difference in the appearance of the skin through standardized photographs. The mean reduction of the mMASI scores was 24% for cysteamine and 41% for HQ (P = 0.015) at 60 days, and 38% for CYS and 53% for HQ (P = 0.017) at 120 days. The photographic evaluation revealed up to 74% improvement for both groups, without statistically significant difference between them. The MELASQoL score showed a progressive decrease for both groups over time, despite the greater reduction for HQ after 120 days. Colorimetric assessment disclosed progressive depigmenting in both groups, without statistically significant difference between them. No severe adverse effects were identified in either group. Erythema and burning were the most important local adverse effects with cysteamine, although their frequency did not differ between groups (P > 0.170). The authors concluded that cysteamine is safe, well-tolerated, and effective, despite its inferior performance to hydroquinone in decreasing mMASI and MELASQoL in the treatment of melasma. (7)

Nguyen et al performed a randomized, double-blinded, single-center trial with 20 recruited participants who were given either cysteamine cream or hydroquinone cream for 16 weeks. The primary outcome measure was a change in the mMASI. Quality of life at baseline and week 16 as well as standard digital photography at each follow-up visit was assessed as secondary outcome measures. At week 16, 14 participants completed the study with 5 participants in the cysteamine group and 9 patients in the hydroquinone group. In the intention to treat analysis there was a 21.3% reduction in mMASI for the cysteamine group compared to a 32% reduction in the hydroquinone group. The difference between groups was not statistically significant (P = 0.3). Hydroquinone cream was generally better tolerated that cysteamine cream. The authors suggest that topical cysteamine may have comparable efficacy to topical hydroquinone, thereby providing a possible alternative to patients and clinicians who wish to avoid or rotate off topical hydroquinone. (8)

Cysteamine is readily available on the internet. In an unscientific survey, there is a range of reviews from 5 star ("This product delivers exactly what is promises. In just 3 weeks the results are obvious and amazing. I thought I was going to have to live with discoloration for the rest of my life. I am confident with my skin for the first time in 3 years."); 3 stars ("I was very disappointed in this cream at first. I was frustrated because I wasn't seeing any results. AND IT SMELLS AWFUL. I used up a whole tube and saw no difference. I sucked it up and bought another tube because their case study pictures were so impressive. I'm in my 12 or 13th week using this cream and I am pretty impressed. My melasma is lightening up nicely. It took about 12 weeks for me to notice a change. Takes a while to see results, but this cream does work. Stinks...but it works...LOL"); to 1 star ("No change to age spots. Still there. :-( Might work for others — It just didn't work for me"). The tally of 25 Amazon reviews for this brand (accessed March 16, 2021) was 5 stars [8], 4 stars [4], 3 stars [1], 2 stars [2], and 1 star [8].

It is difficult to reach any conclusions on something I have never prescribed yet, other than the realization that cysteamine may offer some benefit for selected patients who do not wish to be treated with hydroquinone products. Inevitably there will be more studies forthcoming with combination products with cysteamine as part of the mix. For now, at least there is another option that at least has the potential to lighten the skin and spirit of those afflicted with melasma. 

Point to Remember: Cysteamine may be an alternative for some patients with melasma where the use of hydroquinone is either contraindicated or not desired. 

Our expert's viewpoint 

Seemal R. Desai, MD, FAAD
Founder & Medical Director
Innovative Dermatology
Clinical Assistant of Professor
Department of Dermatology
The University of Texas Southwestern

Melasma is a chronic vexing disorder of hyperpigmentation that can affect both females and males. It is critically important that patients understand that melasma is something that is not necessarily curable, but rather a skin disease that is controllable using a variety of therapeutic options. In fact, in my practice, which focuses on disorders of pigmentation and skin of color, melasma is never a condition that I treat with simply one therapeutic tool. This can often represent a challenge, since topical skin lightening, for example, is still dominated by prescription-based therapies centered around hydroquinone. So, you have a perfect storm — a chronic relapsing condition requiring multiple tools in your toolbox including a workhorse (i.e., hydroquinone) that has its own limitations preventing long-term use. Repeatedly, the question comes up both from colleagues, patients and even rhetorically — what else can one do?

That is where non-hydroquinone based topicals come into play. Off-label use of other tyrosinase enzyme acting agents, like azelaic acid, kojic acid, and others is a very significant part of my melasma algorithm. Oral polypodium leucotomas, with its antioxidant and UV benefits, plays a role. Topical cosmeceuticals like Vitamin C, topical tranexamic acid, topical cysteamine therapy, and other botanicals have become important alongside off-label oral tranexamic acid for recalcitrant cases. As discussed in this DWI&I commentary, cysteamine is an ingredient that has been around for a long time, but only now are we starting to incorporate it into our pigmentary disease discussions. All of this goes without saying, that broad-spectrum UV sunscreen topically is the number-one therapeutic recommendation no matter what other ingredients of the recipe you decide to use.

As we continue to research more and more about the pathogenesis of melasma, we find that the layers of the onion continue to peel. A disease which was once thought to be singularly linked to increased melanin, is now a disorder that has an increased vascular component due to VEGF and other factors. These include increased dermal mast cells, basement membrane alterations, UV-induced epidermal changes, and more. This is an exciting time for pigmentary diseases, and skin of color dermatology in particular.

  1. Jusuf NK, Putra IB, Mahdalena M. Is There a Correlation between Severity of Melasma and Quality of Life? Open Access Maced J Med Sci. 2019 Aug 25;7(16):2615-2618. doi: 10.3889/oamjms.2019.407. PMID: 31777617; PMCID: PMC6876811.

  2. Kagha K, Fabi S, Goldman MP. Melasma's Impact on Quality of Life. J Drugs Dermatol. 2020 Feb 1;19(2):184-187. doi: 10.36849/JDD.2020.4663. PMID: 32129968.

  3. Kheradmand M, Afshari M, Damiani G, Abediankenari S, Moosazadeh M. Melasma and thyroid disorders: a systematic review and meta-analysis. Int J Dermatol. 2019 Nov;58(11):1231-1238. doi: 10.1111/ijd.14497. Epub 2019 May 31. PMID: 31149743.

  4. https://www.epa.gov/sites/production/files/2016-09/documents/hydroquinone.pdf (accessed March 15, 2021)

  5. Austin E, Nguyen JK, Jagdeo J. Topical Treatments for Melasma: A Systematic Review of Randomized Controlled Trials. J Drugs Dermatol. 2019 Nov 1;18(11):S1545961619P1156X. PMID: 31741361.

  6. Mansouri P, Farshi S, Hashemi Z, Kasraee B. Evaluation of the efficacy of cysteamine 5% cream in the treatment of epidermal melasma: a randomized double-blind placebo-controlled trial. Br J Dermatol. 2015 Jul;173(1):209-17. doi: 10.1111/bjd.13424. Epub 2015 May 29. PMID: 25251767.

  7. Lima PB, Dias JAF, Cassiano D, Esposito ACC, Bagatin E, Miot LDB, Miot HA. A comparative study of topical 5% cysteamine versus 4% hydroquinone in the treatment of facial melasma in women. Int J Dermatol. 2020 Dec;59(12):1531-1536. doi: 10.1111/ijd.15146. Epub 2020 Aug 31. PMID: 32864760.

  8. Nguyen J, Remyn L, Chung IY, Honigman A, Gourani-Tehrani S, Wutami I, Wong C, Paul E, Rodrigues M. Evaluation of the efficacy of cysteamine cream compared to hydroquinone in the treatment of melasma: A randomised, double-blinded trial. Australas J Dermatol. 2021 Feb;62(1):e41-e46. doi: 10.1111/ajd.13432. Epub 2020 Sep 27. PMID: 32981068.


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Tuesday, February 08, 2022

Skin Cancer Risk Factors and Screening

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This abstract is available on the publisher's site.

Importance

Asian American individuals are the fastest growing racial group in the US but remain underrepresented in health disparities research, including research on skin cancer risk factors and screening. Improved understanding of preventable skin cancer risk factors and screening may demonstrate unmet needs among Asian American individuals.

Objective

To examine sunburns, sun-protective behaviors, indoor tanning, and total body skin examinations (TBSEs) for skin cancer screening among Asian American subgroups compared with non-Hispanic White individuals.

Design, Setting, and Participants

The National Health Interview Survey is a nationally representative cross-sectional survey in the US that assesses health behaviors. Self-identified Asian Indian, Chinese, Filipino, non-Hispanic White, and other Asian respondents from survey years 2000, 2005, 2010, and 2015 were included. Data were analyzed from July to November 2021.

Main Outcomes and Measures

Any sunburn within the last year; sun-protective behaviors included applying sunscreen, staying under shade, wearing long-sleeved shirts, wearing long clothing to the ankles, wearing hats, and wearing caps most of the time or always when out in the sun; any indoor tanning within the last year; any TBSE ever.

Results

Of 84 030 participants, 5694 were Asian American (6.8%) and 78 336 (93.2%) were Non-Hispanic White; of these individuals, 1073 (weighted prevalence, 21.0%) were Asian Indian, 1165 (19.4%) Chinese, 1312 (23.5%) Filipino, and 2144 (36.1%) Other Asian. All Asian American subgroups were more likely to seek shade, wear long clothing to the ankles, and wear long-sleeved shirts but less likely to sunburn, apply sunscreen, tan indoors, and receive TBSE than Non-Hispanic White individuals. Asian Indian individuals were less likely than Chinese participants to apply sunscreen (adjusted odds ratio [aOR], 0.55; 95% CI, 0.41-0.74) or wear a hat (aOR, 0.53; 95% CI, 0.37-0.76) and more likely to wear long-sleeved shirts (aOR, 1.89; 95% CI, 1.52-2.33) or long clothing to the ankles (aOR, 1.56; 95% CI, 1.28-1.90).

Conclusions and Relevance

The results of this cross-sectional study found that disaggregated comparisons among Asian American individuals demonstrated differences in skin cancer risk factors that may be used to identify high-risk subgroups and inform culturally aware counseling when indicated. Future studies should further sample Asian American individuals to evaluate for potential masked health disparities through disaggregated analysis.


JAMA Dermatology
Skin Cancer Risk Factors and Screening Among Asian American Individuals
JAMA Dermatol 2022 Jan 26;[EPub Ahead of Print], KJ Supapannachart, SC Chen, Y Wang, H Yeung 

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Safety of Tacrolimus Ointments in Young Children With Atopic Dermatitis

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This abstract is available on the publisher's site.

BACKGROUND

Topical tacrolimus is used off-label in young children, but data are limited on its use in children under 2 years of age and for long-term treatment.

AIM

To compare safety differences between topical tacrolimus (0.03% and 0.1% ointments) and topical corticosteroids (mild and moderate potency) in young children with atopic dermatitis (AD).

METHODS

We conducted a 36-month follow-up study with 152 young children aged 1-3 years with moderate to severe AD. The children were followed up prospectively, and data were collected on infections, disease severity, growth parameters, vaccination responses and other relevant laboratory tests were gathered.

RESULTS

There were no significant differences between the treatment groups for skin-related infections (SRIs) (P = 0.20), non-SRIs (P = 0.20), growth parameters height (P = 0.60), body weight (P = 0.81), Eczema Area and Severity Index (EASI) (P = 0.19), vaccination responses (P = 0.62), serum cortisone levels (P = 0.23) or serum levels of interleukin (IL)-4, IL-10, IL-12, IL-31 and interferon-γ. EASI decreased significantly in both groups (P < 0.001). In the tacrolimus group, nine patients (11.68%) had detectable tacrolimus blood concentrations at the 1-week visit. There were no malignancies or severe infections during the study, and blood eosinophil counts were similar in both groups.

CONCLUSIONS

Topical tacrolimus (0.03% and 0.1%) and topical corticosteroids (mild and moderate potency) are safe to use in young children with moderate to severe AD, and have comparable efficacy and safety profiles.


Clinical and Experimental Dermatology

Safety of tacrolimus 0.03% and 0.1% ointments in young children with atopic dermatitis: a 36-month follow-up study

Clin Exp Dermatol 2021 Nov 19;[EPub Ahead of Print], A Salava, M Perälä, A Pelkonen, M Mäkelä, A Remitz 


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Thursday, February 03, 2022

Better presentations

Seven Tips for Creating Powerful Oral Presentations

African American Man Presenting at Medical Seminar

The next time you set out to develop a professional presentation, you might want to look to the theatrical world for inspiration. This advice comes from Erika Bailey, a professional dialect coach and the Head of Voice and Speech at American Repertory Theater. She recently shared her expertise with scholars in Harvard Medical School's Effective Writing for Health Care certificate program.

Bailey explains that using a theatrical lens can provide a valuable framework through which to organize information for your presentation. In fact, she thinks about preparing her own presentations in two steps: first she crafts as a playwright, and then she presents as a performer. Mastering both roles can be essential to achieving success. 

Here are some of her favorite tips to create powerful presentations:

Tip #1: Craft a good story to engage your audience.

Whether you are sharing research findings or talking about a new service or need, it's always a good idea to think about the story you want to tell. "The story is a powerful way to share ideas and bring people and communities together," Bailey says. You can think about the plotline, the characters involved and their needs, the setting and the back story.

The story could be a mystery (a problem occurs, and you need to solve it), a romance (you have two problematic ideas that come together in a marriage), a revolution (fighting against an established idea) or a crisis (tragedy may occur if you don't act now).

Once you have your story, you might memorize the full script, or use a teleprompter, or have cards with an outline and speak in more free form. Regardless of how you present your information, just remember that the story should be at the center of your efforts to engage your reader in the experience.

Tip #2: Use simple language that is easy for people to follow.

The words you select, and how you use them, will make a big difference in how well people hear—and remember—what you tell them. This is especially true in oral presentations. "When we write sentences for people to read, we can add more complexities. But when writing for presentations, we need to simplify, since the listener has only one time to hear what you are saying," Bailey explains. This makes it important to craft ideas and sentences that are short and succinct (preferably with more periods and fewer commas for ease of listening).

For example, Bailey works with Harvard faculty who are filming on-demand courses and often must help them adapt their well-crafted essays to work for an oral presentation. 

She helps them to make sentences shorter and more active, add pauses, slow down the pace, and insert gestures to make the material more engaging. She says that these same tweaks can also translate to many types of presentations and settings.  

Tip #3: Use cues to guide your readers through your speech.

In writing, people can go back and read something twice. But in a presentation, they only listen once. Therefore, you need to guide them with strategic cues, so they don't have to work so hard to follow you. This can be adding simple language, such as, "This is what I am going to talk about today," so they will know what to expect and what you want them to take away from your presentation.

You can also use repetition to make sure they will hear—and remember—your main points. For instance, she suggests saying: "I am going to talk about public speaking. You can look at yourself as a playwright and a performer." Then repeat these ideas three times throughout your presentation to make sure people grasp the idea and will be able to recall it later.  

 Finally, you can give a signal of where you are in your speech to grab people's attention as you wind down your presentation. "For example, I suggest saying, 'In conclusion,' to let your audience know when you are finishing up." This signals them to listen carefully because you will be summarizing the takeaways again and you don't want them to miss it.  

Tip #4: Use non-verbal clues strategically.

"Make sure you use your body for inflections and gestures and think about how to move your body in space," Bailey says. "Think about standing tall, lengthening your spine and stretching your tailbone and you will be perceived by your audience as more energized."

 She also recommends using non-verbal clues to punctuate (literally) your words.

"You can use pauses in your speech, and use gestures to act out periods, commas and semi-colons when you talk," she points out.

"Gesture fully. I encourage as much use of movement as possible," she says. With many presentations taking place over Zoom these days, she says that thinking of using your space more fully (extending your movements beyond the small box you show up in on the screen) can help you be perceived as more confident and more engaging, too.  

Tip #5: Develop stage presence to be more memorable.

Some presenters stick with you longer after the presentation ends.

"In my role at American Repertory Theater, I would go across the country and see 50 people a day audition. Then I would look at their headshots later and I could not even remember seeing some of them. But others, I can still remember now exactly what they did in that room. They were able to come alive in the moment," she says, crediting their stage presence to making their performances so memorable.

While stage presence comes more easily to some people than others, Bailey says there are three things you can do to increase your presence:

  1. Be really connected to your subject matter—be interested, curious and want to share what you know.
  2. Connect to your audience in the moment.
  3. See the audience and let them see you.

This commitment to connect with the audience and awareness of self can be especially essential to making that lasting impression, she stresses, and can truly set you apart from everyone else in the room.  

Tip #6: Prepare for success.

"When we write or edit, we edit until 5 minutes before a paper is due. But as a performer, you first need to write and edit your script days before the presentation so you can rehearse it," she says.

Before any presentation, Bailey says she reads her script out loud at home and plays around with vocal variety, including the volume, the pacing and the pitch. This helps her feel more comfortable and allows her to determine the right mix for her presentation in advance.

If you want to increase your comfort level, she recommends joining an organization like Toast Masters to get more practice.  

Tip #7: Cut yourself some slack.

"If you find public speaking nerve-racking, it's okay. It does not have to be perfect. Just find a way to be as expressive as possible (within your comfort zone) to engage your audience," Bailey says.

Also, remember that you don't have to suddenly become a performer. It is okay to start off small by adopting some of these tips and continuing to build on them over time as your confidence grows.

Written by Lisa D. Ellis



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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

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