Consumption Of Sugar-Sweetened Beverages, Artificially Sweetened Drinks May Be Tied To Male Pattern Hair Loss, Research Suggests

Consumption Of Sugar-Sweetened Beverages, Artificially Sweetened Drinks May Be Tied To Male Pattern Hair Loss, Research Suggests

Healio (6/21, Capaldo) reports, "The consumption of sugar-sweetened beverages and artificially sweetened drinks may be linked to male pattern hair loss," investigators concluded in a study that "included 1,028 men (mean age, 27.8 years) – 42.4% without male pattern hair loss and 57.6% with male pattern hair loss – who completed a self-reported online survey about their hair loss patterns, dietary habits and sociodemographic statuses." The findings were published online in the journal Nutrients.

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Skin Care Physicians of Costa Rica

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Association Between Granuloma Annulare and the Risk of Hematologic Malignancies

TAKE-HOME MESSAGE

• This study involving 48,132 patients with granuloma annulare and 48,132 matched controls found that patients with granuloma annulare had a significantly increased risk of lymphoma, leukemia, and any hematologic malignancy compared with controls. Age-stratified analyses showed comparable findings among patients aged 51 to 70 years and those older than 70 years, and there was no significant increase in the risk for hematologic malignancies in patients younger than 50 years.
• This study suggests that patients diagnosed with granuloma annulare have an increased risk of hematologic malignancies, emphasizing the need for further research and potential screening strategies, particularly in older age groups.

–  Lillian Sun, MD

Written by

 

 

Misha A. Rosenbach MD

Granuloma annulare and its potential association with hematologic malignancies

Granuloma annulare (GA) is an uncommon but not incredibly rare disease that most dermatologists encounter with some frequency. While there are a number of variants, most patients present with localized disease, some pediatric patients may present with harder-to-recognize subcutaneous lesions, and a minority of patients (approximately 20%) present with generalized disease. Recognizing the disease is only the first step — dermatologists should be familiar with both disease associations/comorbidities and emerging literature on potential drug triggers and maintain familiarity with the evolving landscape of treatment options and algorithms.

Our understanding of the epidemiology of GA and potential disease associations has improved significantly over the past 5 years. Two large epidemiological studies suggest that the incidence of GA is approximately 0.04% to 0.1% of the US population, with the highest rates noted in the fifth decade of life and an approximately a 3–4:1 female:male ratio, and occurs more commonly among White individuals.1,2 There appears to be an association of GA with type 2 diabetes and hyperlipidemia and an increased risk of other autoimmune diseases, including thyroid disease.3,4There does not appear to be an association between GA and solid organ malignancy.5 Prior research had suggested a potential increased risk of hematologic malignancies in patients with GA.3

The study by Garate et al (conflict of interest disclosure: I am a co-author of this study) used analysis of ICD-10 codes (which have been previously validated for this work) in the TriNetX research network to explore that link further. The findings suggest an increased risk for lymphoma, leukemia, and any hematologic malignancy in patients with GA compared with matched controls. This lends further evidence to the observation that patients with GA may have an increased risk of hematologic malignancy. There were similar disease associations in patients aged 51 to 70 years and those older than 70 years, and there was no increased risk for younger patients (due to the rarity of hematologic malignancy, the study may lack the power to exclude a small increased risk in that age group). Notably, hematologic malignancies remain rare overall; hence, even with a potential increase in the risk, most patients with GA will not have or develop a hematologic malignancy.

Prior to this work, I would counsel patients who presented with atypical disease (eg, near-erythroderma), recalcitrant disease (eg, failing to respond to initial first- or second-line therapy), or an unusual demographic (eg, age >65 years) about the need to consider the underlying drivers of their GA, including potential hematologic disease. Practically, this would often mean screening with at least a complete blood count, chest x-ray, and evaluation for paraprotein with a serum protein electrophoresis. Based on this new study, I will likely extend that evaluation to patients older than 50 years, and advise them to report concerning symptoms (easy bleeding/bruising, "B symptoms" of fever, chills, weight loss, night sweats, etc), and keep up to date with their primary care doctor and age-appropriate evaluations (as should all patients!). Over time, this disease association may also impact treatment algorithms, as recent publications have proposed the consideration of off-label use of TNF inhibitors as potential second-line agents for recalcitrant generalized GA.6

References

1. Leasure AC, Damsky W, Cohen JM. Prevalence of Granuloma Annulare in the United States: A Cross-Sectional Study in the All of Us Research Program. Int J Dermatol. 2022;61(8):e301–e302. https://onlinelibrary.wiley.com/doi/10.1111/ijd.15832
2. Barbieri JS, Rodriguez O, Rosenbach M, et al. Incidence and Prevalence of Granuloma Annulare in the United States. JAMA Dermatol. 2021;157(7):824–830. https://jamanetwork.com/journals/jamadermatology/fullarticle/2780648
3. Barbieri JS, Rosenbach M, Rodriguez O, et al. Association of Granuloma Annulare With Type 2 Diabetes, Hyperlipidemia, Autoimmune Disease, and Hematologic Malignant Neoplasms. JAMA Dermatol. 2021;157(7):817–823. https://jamanetwork.com/journals/jamadermatology/fullarticle/2780649
4. Leasure AC, Damsky W, Cohen JM. Comorbities Associated With Granuloma Annulare: A Case–Control Study in the All of Us Research Program. J Am Acad Dermatol. 2022;87(1):197–199. https://www.jaad.org/article/S0190-9622(21)02183-6/fulltext
5. Barbieri JS, Rosenbach M, Rodriguez O, et al. Granuloma Annulare Is Not Associated With Solid-Organ Malignancies: A Cohort Study. J Am Acad Dermatol. 2022;86(6):1352–1354. https://www.jaad.org/article/S0190-9622(21)00986-5/fulltext
6. Berk-Krauss J, Weiner D, Rosenbach M. Results of a Treatment Algorithm for Generalized Granuloma Annulare. J Am Acad Dermatol. 2023 Sep 26. doi: 10.1016/j.jaad.2023.09.050. Online ahead of print. https://www.jaad.org/article/S0190-9622(23)02867-0/fulltext

Abstract

Granuloma annulare (GA) is an inflammatory granulomatous skin condition of unknown etiology that can be a localized or generalized eruption of ringed erythematous plaques, papules, or intertriginous patches. Previous investigations have postulated potential associations between GA and hematological malignancies. However, results from epidemiologic evaluations have been conflicting and have been limited by sample size and imprecision.

Journal of the American Academy of Dermatology

Granuloma annulare is associated with an increased risk of hematologic malignancies: A multicenter cohort study using TriNetX

J Am Acad Dermatol 2023 Dec 24;[EPub Ahead of Print], D Garate, CJ Thang, W Damsky, M Rosenbach, G Golovko, MG Wilkerson, JS Barbieri

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Skin Care Physicians of Costa Rica

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Cuidado con lo que se lee y si es publicado no necesariamente es totalmente solido: Toxic Ingredients in Personal Care Products: A Dermatological Perspective

Lectura critica!

TAKE-HOME MESSAGE

• This review explores data regarding environmental pollutants, including bisphenols, phthalates, parabens, poly-fluoroalkyl substances, p-phenylenediamine, and formaldehyde, found in personal care products. The article delves into the toxicology and pathophysiologic mechanisms of these compounds as well as the potential dermatological manifestations.
• This review examines the various environmental pollutants in personal care products, offering medical professionals insight into their potential effects on dermatological health.

–  Lillian Sun, MD

Written by

 

 

JiaDe Yu MD, MS

Less is more

Personal care products constitute a multibillion-dollar industry that is expected to grow significantly in the ensuing years. Propagated by celebrities and social media influencers, trends in personal care products continue to evolve. One thing that has stayed constant is the dizzying array of unreadable and unpronounceable ingredients that constitute a product. Most ingredients are there for a reason — whether it is a preservative that prevents the harmful growth of bacteria or an emulsifier that prevents the separation of oils in the sunscreen sitting in your cabinet — some may cause more harm than good. Social media and environmental activist groups have promoted "clean" beauty to avoid these potentially harmful ingredients. However, is the evidence truly robust enough to discount these potentially dangerous ingredients?

Lin et al published a comprehensive review of potentially "problematic" ingredients in personal care products, including bisphenols, phthalates, parabens, per-fluoroalkyl and poly-fluoroalkyl substances, p-phenylenediamine, and formaldehyde, identified by the Environmental Working Group. Many of these ingredients, such as bisphenols and phthalates, are labeled as potential endocrine disruptors. Some ingredients, including bisphenols, parabens, and phthalates, have been linked to the development of cancers, while others are listed as potential contact allergens, such as parabens, formaldehyde, and p-phenylenediamine.

Although the article cites numerous sources for its claims (137 sources!), this is a perfect example of an instance where just because the article is published in a journal, does not mean it is clinically relevant. Most studies on endocrine disruption have been conducted in animal models or ex-vivo cells and not at physiologic doses of the chemical. Similar to the aluminum and breast cancer scare, there are no high-quality studies that support this relationship. While the jury is still out for these chemicals, I would suggest reading this review with a critical lens. The American Contact Dermatitis Society named parabens as the non-allergen of the year to dispel the myth that parabens are common causes of allergic contact dermatitis and to support its use in personal care products in lieu of potentially more sensitizing allergens such as methylisothiazolinone. The American Cancer Society states that there is no good evidence to suggest that aluminum or parabens increase the risk of breast cancer, citing poor-quality studies.

At the end of the day, less is probably more. Patients often ask me about my skin care routine, and I say "soap and water" because I don't need more than that. Is there evidence that an eight-step nighttime routine is better than my 8-second one? The jury is out for that.

Abstract

Environmental dermatology is the study of how environmental factors affect the integumentary system. The environment includes natural and built habitats, encompassing ambient exposure, occupational exposures, and lifestyle exposures secondary to dietary and personal care choices. This review explores common toxins found in personal care products and packaging, such as bisphenols, parabens, phthalates, per- and poly-fluoroalkyl substances, p-phenylenediamine, and formaldehyde. Exposure to these toxins has been associated with carcinogenic, obesogenic, or proinflammatory effects that can potentiate disease. In addition, these compounds have been implicated as endocrine-disrupting chemicals that can worsen dermatological conditions such as acne vulgaris, or dermatitis. Certain pollutants found in personal care products are not biodegradable and have the potential to bioaccumulate in humans. Therefore, even short-term exposure can cause long-lasting issues for communities. The skin is often the first point of contact for environmental exposures and serves as the conduit between environmental toxins and the human body. Therefore, it is important for dermatologists to understand common pollutants and their acute, subacute, and chronic impact on dermatological conditions to better diagnose and manage disease.

"Lin RR, Lin DA, Maderal AD. Toxic Ingredients in Personal Care Products: A Dermatological Perspective. Dermatitis. 2023 Dec 18. doi: 10.1089/derm.2023.0215. Epub ahead of print. PMID: 38109205."

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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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Acitretina mas itraconazol en onicomicosis

Skin care en jovenes…

Young People Increasingly Seeking Out Cosmetic Botox Treatments, Skincare Products As Part Of "Anti-Aging" Craze

CNN (1/16, Musa) reports, "Although most Botox recipients are middle-age, dermatologists and plastic surgeons say they're now catering to a new group of patients: Gen Z." And "the anti-aging craze is not unique to young adults. Preteens dubbed 'Sephora kids' can be found racing down cosmetic store aisles in search of trendy skin-care products they've seen online." However, "tweens who are desperate to fit in can unintentionally harm their skin barrier by using skincare products that are not meant for them." That barrier "is meant to protect from irritants such as pollution, dust mites and fragrances in skin care products, according to the American Academy of Dermatology," and "at 9 or 10 years old, the skin barrier is not fully formed and is easily damaged by products with active ingredients like vitamins A and C."

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Skin Care Physicians of Costa Rica

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Early signs of dementia

Early Warning Signs of Dementia

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Everyone experiences forgetfulness from time to time. You might misplace your wallet, forget to call a loved one on their birthday, or have trouble recalling why you walked into a room—all of which can happen if you're feeling stressed or not getting enough sleep.1

But as you get older, your brain also ages, which increases your risk of having lapses in your memory. If changes in memory are starting to affect your quality of life, you might be experiencing an early warning sign of dementia. Dementia is an umbrella term for neurological (brain-related) conditions that affect memory, thinking, judgment, and the ability to carry out daily tasks.2

Types of Dementia

Alzheimer's disease is the most common type of dementia. In fact, up to 80% of all dementia cases are due to Alzheimer's disease.3 Other primary types of dementia include frontotemporal dementia, Lewy body dementia, and vascular dementia.4

It's worth noting that dementia is not a normal part of aging. While it's normal to forget some details as you age, dementia leads to a much greater loss of memory. To help differentiate between normal memory changes and dementia, researchers have developed a list of several warning signs of dementia you can spot. Learning how to recognize these symptoms early can help you or your loved one seek a diagnosis from a healthcare provider and receive treatment sooner.56

Memory Loss That Affects Daily Life 

With normal memory changes, you may forget a date or a person's name and then remember that information at a later time. But one of the hallmark warning signs of dementia is forgetting information that you just learned and then not remembering the details at all.5 For example, if a loved one is telling you a story about their day, you might forget that you had a conversation with them altogether.

Dementia-related memory loss may cause you to:27

• Have difficulty creating new memories
• Forget important information, such as your home address, phone number, or the name of your spouse
• Lose track of medications you need to take or appointments you need to go to
• Depend on memory aids like phone reminders or handwritten notes
• Ask the same question over and over
• Get lost in familiar places

Difficulty With Planning and Problem-Solving 

Making plans, following instructions, and solving daily problems can become more challenging with dementia. These changes are sometimes known as executive dysfunction—a term that describes challenges with cognitive (thinking-related) abilities like planning and organizing.8

This warning sign can manifest in the following ways:5

• Forgetting to pay bills
• Difficulty concentrating on activities like reading or playing games
• Not being able to follow directions on a map or recipe instructions in a cookbook
  

Trouble Completing Familiar Tasks 

Dementia can often make it difficult to stick to your daily routine and finish tasks you're already familiar with. This change can make you forget how to:9

• Use your phone or a remote control
• Prepare a meal
• Drive to a store that you frequently visit
• Get dressed or brush your teeth
• Engage in your favorite hobby
  

Losing Track of Times, Dates, and Places 

With dementia, time starts to feel blurry. It can be easy to forget which day it is, what season you're in, or where you are. Keep in mind: most people lose track of time once in a while, especially if you've been busy at work or engaged in a fun activity. But dementia can cause disorientation that can affect your life in these ways:5

• Not remembering how you arrived somewhere
• Trying to walk into someone else's home thinking it's your own
• Thinking it's the winter when it's actually the summer
• Feeling like you've time-traveled to a previous period of your life
  

Changes in Vision and Spatial Abilities 

As you get older, it's normal to have some vision changes—like not being able to see things up close or having cataracts.10 But dementia-related vision problems can be more severe. That's because your brain tissue is directly connected to your eyes. Because dementia damages your brain cells, your vision and spatial orientation can also become compromised.11 As a result, you may notice these changes:9

• Trouble reading words
• Losing balance or having trouble walking
• Difficulty judging distance or how far one thing is from another
• Not being able to tell the difference between two colors
• Dropping things or tripping over items frequently
  

Forgetting Words While Speaking or Writing 

Communication can become difficult if you have dementia. People with dementia may start losing the ability to understand conversations or express themselves verbally or in writing.12Problems with communication may cause you to:5

• Forget what you were saying
• Stop talking in the middle of your sentence
• Repeat yourself multiple times
  
• Have trouble understanding what someone else is saying to you
• Misremember the name of a word
• Say words that don't make sense

Frequently Misplacing Items 

It's common to forget where you left your keys or put your glasses. Eventually, you'll find these items and go about your day. But dementia-related memory loss can make it easy to lose items and not find them again. Consider the following examples:13149

• Leaving your phone or book in a room and not being able to retrace your steps
• Putting your watch or jewelry in the refrigerator
• Hiding items for safekeeping and then forgetting where the hiding spot is located
• Collecting or hoarding unnecessary or broken items
• Searching for items you think are missing but are actually not

Poor Judgment or Decision-Making 

The ability to pay attention to yourself or your surroundings and make decisions often decreases with dementia. A loss of judgment can also lead to questionable actions and inappropriate choices.15 Here's what that can look like:9

• Not washing your hands after using the bathroom
• Forgetting to take care of a pet
• Walking across the road on a busy street
• Falling for scams or being a victim of fraud
• Wearing shorts or a tank top during stormy weather

Withdrawing From Relationships and Activities 

Because dementia affects the health of your brain cells, it's common to lose your ability to complete tasks and activities you've done for a long time.16 For example, if dementia is causing communication troubles, you may stop trying to start a conversation with others. If you notice that you're frequently getting lost or having trouble following directions, you might avoid driving.

Changes in your normal abilities can make you feel isolated, lonely, or disengaged.16 These feelings can be extremely hard to deal with. In some cases, you might not even realize you're withdrawing until a loved one notices or says something. Some examples of withdrawal may include:9

• Avoiding social gatherings with your family and friends
• Losing interest in your hobbies
• Skipping regular activities like going for a walk or a restaurant you enjoy
• Not being able to follow the news or keep up-to-date with your favorite sports team

Emotional and Behavioral Changes 

Dementia affects more than just your thinking. It's common to also experience changes in how you feel or act. These changes might be difficult for you to notice on your own. A loved one of someone with early signs of dementia typically recognizes personality shifts first. Personality changes may include:1741819

• Having rapid mood swings
• Feeling easily upset, annoyed, or agitated, especially when you're out of your comfort zone
• Experiencing symptoms of anxiety or depression
• Becoming paranoid, fearful, or suspicious of others
• Losing sleep at night or being extremely tired during the day
• Imaging things that aren't there or having visual hallucinations
• Physically hurting yourself or others
• Making inappropriate comments or sexual advances
• Sundowning, or feeling confused or disoriented when it's dark outside

A Quick Review 

Dementia is a group of neurological diseases that cause significant changes in memory, thinking, and judgment. Contrary to normal changes in memory, dementia can severely affect one's quality of life. Some of the primary early warning signs of dementia include memory decline, poor decision-making, and social withdrawal. These changes may also lead to emotional and behavioral concerns, like anxiety, confusion, and fear.

Keep in mind: early signs of dementia are not the same as normal age-related memory decline. If you're noticing memory changes in a loved one, it's important to seek an evaluation from a healthcare provider as soon as possible.

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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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5 year safety on jaks

Choose a Specialty
5-Year Safety Data Leaves Clinicians Optimistic in Upadacitinib for AD Management
Dec 11, 2023
By Lauren Buchanan, MA, Managing Editor
News
Article





Christopher Bunick, MD, PhD, presented the research during a late-breaking research session during the 2023 Revolutionizing Atopic Dermatitis Virtual Conference.

Results from the largest safety study for upadacitinib (Rinvoq) to manage atopic dermatitis (AD) shows promising long-term data and was presented during a late breaking research session during the 2023 Revolutionizing Atopic Dermatitis Virtual Conference on December 10, 2023.Christopher Bunick, MD, PhD, associate professor of dermatology and physician-scientist at the Yale School of Medicine in New Haven, Connecticut, showed 5-year safety data on upadacitinib in 15mg and 30mg doses totreat moderate to severe AD.


Seventyfour/Adobe Stock
Seventyfour/Adobe Stock

The data integrates 3 global Phase 3 studies: Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318). The unique aspect of this presentation is the extended follow-up period of260 weeks, making it the longest safety study for any systemic agent in AD. The study included around 2700 patients, and notable findings included the representation of a diverse patient population with cardiovascular risk factors and the durability of upadacitinib, as evidenced by low discontinuation rates due to adverse events.

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Atopic Dermatitis
In terms of adverse events, the presentation highlighted exposure-adjusted rates per 100 patient years. Notably, there were low discontinuation rates (about 4 events per 100 patient years) and minimal events leading to death (<0.1), indicating the drug's safety and durability. Specific adverse events or special interests, such as serious infections, active tuberculosis, herpes zoster, non melanoma skin cancer, malignancy, gastrointestinal perforations, and venous thromboembolic events (VTE), were analyzed. Key points include stable rates across the 1 to 5-year time frame, with no new safety signals and very low event rates.

The trials demonstrated consistent event rates over 1, 3, and 5 years, reinforcing the drug's stability and safety. The presentation also contextualized adverse event rates of malignancy, major adverse cardiovascular events (MACE), and VTE in comparison to background rates in the general population and AD patients.

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In summary, this presentation signifies the largest safety study for an AD systemic therapy, with upadacitinib showing a favorable safety profile over a 5-year period. The highest signal was herpes zoster, emphasizing the importance of considering shingles vaccine. MACE, VTE, and malignancy exhibited rock-bottom rates, comparable to or even lower than background rates, suggesting potential anti-inflammatory and cardiovascular protective effects. The conclusion is that prescribing upadacitinib for patients with AD can be considered with confidence.

Reference

Bunick, C. Long-term 5-year safety of upadacitinib in moderate-to-severe atopic dermatitis: An integrated analysis including over 7000 patient-years of exposure. Presented at: 2023 Revolutionizing Vitiligo Virtual Conference; December 10, 2023.

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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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