2685 articles - 10.09.10
1: Br J Dermatol. 2010 Sep 6; [Epub ahead of print]
Schmitt J, von Kobyletzki L, Svensson A, Apfelbacher C.
Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany.
ABSTRACT Background: Long-term low level topical anti-inflammatory therapy has been suggested as a new paradigm in the treatment of atopic eczema (AE). Objective: To determine the efficacy and tolerability of topical corticosteroids and calcineurin-inhibitors for flare prevention in AE. Methods: Systematic review of randomised controlled trials (RCT) reporting efficacy of topical corticosteroids and/or topical calcineurin-inhibitors for flare prevention of AE. Identification of relevant articles by systematic electronic searches (Cochrane Library, Medline) supplemented by handsearch. Primary efficacy endpoint: proportion of participants experiencing at least one flare during proactive anti-inflammatory treatment. Relative risks (RR) and corresponding 95% confidence intervals (95%CI) were calculated and pooled by pharmaceutical agent using random effects meta-analysis. Sensitivity analysis included meta-regression to explore the influence of study-specific covariates. Results: Nine articles reporting on eight vehicle-controlled trials were included. Three, four, and one trial evaluated proactive therapy with topical tacrolimus, fluticasone propionate, and methyl-prednisolone aceponate, respectively. Each agent under study was more efficacious to prevent flares than vehicle. Meta-analysis suggested that topical fluticasone propionate (RR (95%CI) 0.46 (0.38-0.55)) may be more efficacious to prevent disease flares than topical tacrolimus (RR (95%CI) 0.78 (0.60-1.00). Meta-regression indicated robustness of these findings. Proactive anti-inflammatory therapy was generally well tolerated. The trials identified, however, do not allow firm conclusions about long-term safety. Conclusions: Vehicle-controlled trials indicate efficacy of proactive treatment with tacrolimus, fluticasone propionate, and methyl-prednisolone aceponate to prevent AE flares. Indirect evidence from vehicle-controlled trials suggests that twice weekly application of the potent topical corticosteroid fluticasone propionate may be more efficacious to prevent AE flares than tacrolimus ointment. Head to head trials should be conducted to confirm these results. Future studies are also needed to evaluate the long-term safety of proactive treatment of AE.
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PMID: 20819086 [PubMed - as supplied by publisher]2: Br J Dermatol. 2010 Aug 26; [Epub ahead of print]
Blume-Peytavi U, Blumeyer A, Tosti A, Finner A, Marmol V, Trakatelli M, Reygagne P, Messenger A.
Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charite- Universitatsmedizin, Berlin, Germany.
Abstract Androgenetic alopecia is the most common hair loss disorder, affecting both men and women. Due to the frequency and the often significant impairment of life perceived by the affected patients, competent advice, diagnosis and treatment is particularly important. As evidence-based guidelines on hair disorders are rare, a European consensus group was constituted to develop guidelines for diagnostic evaluation and treatment of androgenetic alopecia. This S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescents review the definition of androgenetic alopecia and presents expert-opinion based recommendations for gender-dependent steps in the diagnostic procedure.
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PMID: 20795997 [PubMed - as supplied by publisher]3: J Am Acad Dermatol. 2010 Aug 17; [Epub ahead of print]
Miller AC, Rashid RM, Falzon L, Elamin EM, Zehtabchi S.
Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
BACKGROUND: For decades silver-containing antibiotics such as silver sulfadiazine (SSD) have been applied as standard topical therapy for patients with partial-thickness burns and venous stasis ulcers. This evidence-based review intends to answer the following research question: in ambulatory patients with partial-thickness burns or stasis dermatitis ulcers, does the use of topical SSD compared with nonantibiotic dressings improve mortality, wound healing, re-epithelialization, or infection rates? METHODS: MEDLINE, EMBASE, Cochrane Library, and other databases were searched. We considered trials that enrolled patients of any age with partial-thickness burns or venous stasis ulcers and randomized them to either topical SSD or placebo, saline-soaked gauze, paraffin gauze, sterile dry dressing, or nonantibiotic moist dressing. Outcomes included mortality, wound healing, speed of re-epithelialization, and infection rates. RESULTS: For burns, our search revealed 400 potential articles. No human studies met the inclusion criteria. Only 7 animal studies (1 mouse, 4 rat, and 2 pig) were relevant to the proposed question. These animal studies provided conflicting results. Whereas some support the use of SSD for treatment of partial-thickness burns, others question its effectiveness. For stasis dermatitis ulcer, the search identified 50 articles for review, of which 20 abstracts were reviewed, and one article met the inclusion criteria. This study did not show any significant improvement in the rate of complete healing in SSD group compared with placebo either at 4 weeks (relative risk 6.2, 95% confidence interval 0.8-48) or at 1 year (relative risk 5.2, 95% confidence interval 0.6-41.6) of follow-up. CONCLUSION: There is insufficient evidence to either support or refute the routine use of SSD for ambulatory patients with either partial-thickness burns or stasis dermatitis ulcers to decrease mortality, prevent infection, or augment wound healing in human beings. Copyright (c) 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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PMID: 20724028 [PubMed - as supplied by publisher]4: Br J Dermatol. 2010 Aug 13; [Epub ahead of print]
Warren RB, Brown BC, Lavery D, Griffiths CE.
Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, UK.
Summary Background There are few reports of the practical use of adalimumab outside of a clinical trial setting and, to our knowledge, none from the U.K. Objectives We assessed the efficacy and safety of adalimumab in a cohort of patients with severe psoriasis attending a tertiary dermatology referral centre in the U.K. Patients/Methods A retrospective case-note review was used to identify all patients initiated on adalimumab for psoriasis. Results Baseline Psoriasis Area and Severity Index (PASI) was 24+/-11 (range 9-54; n=46). After 4 months' treatment with adalimumab 64% (29/45), of patients had achieved PASI 75 (75% decrease from baseline) whilst 80% (36/45) of patients met NICE criteria for continuation of treatment. Therapy was well-tolerated. Importantly, 68% (21/31) of patients who had previously received another tumour necrosis factor alpha inhibitor met NICE criteria for continuation of treatment at 16 weeks. Conclusions In a cohort of U.K. patients with severe psoriasis, adalimumab has proved to be a significant addition to the expanding armamentarium of biologics for psoriasis. Pharmacovigilance, in the form of registries, is essential to assess the long-term safety of such drugs.
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PMID: 20716225 [PubMed - as supplied by publisher]5: Br J Dermatol. 2010 Aug 12; [Epub ahead of print]
Crijns HJ, Straus SM, Gispen-de Wied CH, de Jong-van den Berg LT.
) Medicines Evaluation Board, The Hague, the Netherlands.
Abstract Introduction: The aim of this review is to indentify publications describing the use of isotretinoin in humans and the compliance to the pregnancy prevention programme (PPP) in Europe. Material and Method: Systematic search in Medline and Embase using the terms 'isotretinoin, pregnancy (and Europe)'. Furthermore, manual search in publications was performed. Results: A total of 17 publications were identified. Publications consist of case reports of exposed pregnancies, surveys among dermatologists or pharmacists and database studies evaluating the compliance of the PPP. The studies and surveys deal with groups of patients exposed to isotretinoin before or during pregnancy and/or compliance with the PPP of isotretinoin. If provided, in 6-26% isotretinoin was prescribed in full accordance with the PPP. Pregnancy incidence was seen in 0.2-1.0 per 1000 women of childbearing age using isotretinoin. Between 65-87% of these pregnancies were terminated. Conclusions: Review of studies in Europe performed so far show failures in the implementation of this PPP. Therefore, the isotretinoin PPP has to be scrutinized to identify whether new measures should be taken or whether the failures in the implementation have to corrected. New measures should take into account the definition of the ultimate goal of a PPP and the acceptable burden. In the mean time, stakeholders could make a start with adjustments in the implementation of the PPP by taking their responsibility and enhancing the performance by explicit instructions, monitoring the performance and adjusting, if necessary.
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PMID: 20716214 [PubMed - as supplied by publisher]6: Arch Dermatol. 2010 Aug;146(8):896-902.
Zhao YE, Wu LP, Peng Y, Cheng H.
Department of Immunology and Pathogen Biology, Medical School of Xi'an Jiaotong University, No. 76 Yanta W. Road, Xi'an, China. zhaoyae@sina.com
OBJECTIVES: To explore the association between Demodex infestation and rosacea and the pathogenesis of demodicosis rosacea by means of a meta-analysis. DATA SOURCES: Electronic searches of the ISI Web of Knowledge (Science Citation Index, ISTP [Index to Scientific & Technical Proceedings], Journal Citation Reports, BP [BIOSIS Preview], INSPEC [Ination Service in Physics, Electronics Technology, and Computer and Control], and DII [Derwent Innovation Index]), MEDLINE, and CNKI (China National Knowledge Infrastructure) databases (January 1, 1950, to December 31, 2009). We also performed hand searches of reference lists and conference proceedings. STUDY SELECTION: Predefined selection criteria were applied to all published case-control studies that analyzed the association between Demodex infestation and rosacea. DATA EXTRACTION: Two of us independently extracted data from the included studies. For disputed articles, a third party mediated whether to include the study. DATA SYNTHESIS: Forty-eight English- and Chinese-language articles, which covered 10 different countries and 28 527 participants, were eligible. The pooled odds ratio in random-effects models is 7.57 (95% confidence interval, 5.39-10.62). Stability is good according to sensitivity analysis. The fail-safe number is 18 456 in the quantitative analysis of publication bias. CONCLUSIONS: A significant association exists between Demodex infestation and the development of rosacea. Demodex infestation is a vital risk factor for rosacea according to the time-to-event relationship, and the degree of infestation played a more important role than did the mite infestation rate in the development of rosacea.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20713824&dopt=ExternalLink
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PMID: 20713824 [PubMed - in process]7: Arch Dermatol. 2010 Aug;146(8):865-9.
Smidt AC, Lai JS, Cella D, Patel S, Mancini AJ, Chamlin SL.
University of New Mexico School of Medicine, Departments of Dermatology and Pediatrics, 1021 Medical Arts Ave. NE, Albuquerque, NM 87131, USA. asmidt@salud.unm.edu
OBJECTIVE: To develop and validate a quality-of-life index for adolescents with skin disease. DESIGN: Prospective, longitudinal cohort study taking place from July 15, 2005, through February 29, 2008. SETTING: Academic pediatric dermatology practice. PATIENTS: A total of 205 patients between the ages of 12 and 17 years with a skin condition. MAIN OUTCOME MEASURES: Participants completed the Skindex-Teen questionnaire, reported sociodemographic data, and answered clinical questions at enrollment. Four weeks later, they completed Skindex-Teen and responded to clinical questions again. Forty patients also completed Skindex-Teen 48 hours after baseline. RESULTS: Of 205 patients, 200 (97.6%) completed all enrollment materials; 125 (62.5%) of these returned follow-up materials, of which 115 (57.5%) were complete. Twenty-three of 40 participants (57.5%) completed the 48-hour-after-initial-answers materials. The mean (SD) age of the patients was 15.3 (1.4) years (range, 12.9-18.0 years). Approximately half reported their skin condition as poor (26 [13.0%]) or fair (67 [33.5%]); most rated their general health as very good (62 [31.0%]) or excellent (80 [40.0%]). The dimensionality of the items was evaluated using factor analysis; results suggested 2 factors, termed physical symptoms (5 items) and psychosocial functioning (16 items). Both scales demonstrated excellent internal consistency. All item-scale reliabilities were greater than 0.4. Fit of items to the measurement model was supported by Rasch analysis. Test-retest reliability was supported by intraclass correlation coefficients (0.82-0.94) for total scores, physical symptoms, and psychosocial functioning scales. At 4 weeks, 16 (13.9%) reported worsening of their skin condition, 57 (19.6%) reported it had remained unchanged, and 42 (36.5%) reported improvement. Significant mean differences were present between the improved and worsened groups for the psychosocial functioning scale and total scores. CONCLUSIONS: These data provide evidence of construct, content, and face validity for Skindex-Teen, a new quality-of-life instrument for adolescents with skin disease. Test-retest reliability was verified, and responsiveness at 4 weeks was shown for total scores and the psychosocial functioning scale scores.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20713817&dopt=ExternalLink
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PMID: 20713817 [PubMed - in process]8: Arch Dermatol. 2010 Jul;146(7):775-8.
Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA.
Department of Dermatology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226, USA. kholland@mcw.edu
BACKGROUND: Propranolol hydrochloride has been prescribed for decades in the pediatric population for a variety of disorders, but its effectiveness in the treatment of infantile hemangiomas (IHs) was only recently discovered. Since then, the use of propranolol for IHs has exploded because it is viewed as a safer alternative to traditional therapy. OBSERVATIONS: We report the cases of 3 patients who developed symptomatic hypoglycemia during treatment with propranolol for their IHs and review the literature to identify other reports of propranolol-associated hypoglycemia in children to highlight this rare adverse effect. CONCLUSIONS: Although propranolol has a long history of safe and effective use in infants and children, understanding and recognition of deleterious adverse effects is critical for physicians and caregivers. This is especially important when new medical indications evolve as physicians who may not be as familiar with propranolol and its adverse effects begin to recommend it as therapy.
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PMID: 20644039 [PubMed - in process]9: Arch Dermatol. 2010 Jul 19; [Epub ahead of print]
Defazio JL, Marghoob AA, Pan Y, Dusza SW, Khokhar A, Halpern A.
Department of Medicine (Dr DeFazio), Memorial Sloan-Kettering Cancer Center, Hauppauge, New York; Victorian Melanoma Service, The Alfred, Melbourne, Victoria, Australia (Dr Pan); and Dermatology Service (Drs Dusza and Halpern), Department of Medicine (Dr Halpern), Memorial Sloan-Kettering Cancer Center, New York, New York. Ms Khokhar reports no institutional affiliations.
OBJECTIVE: To assess current practices and recommendations of US physicians regarding depth of excision for melanomas of varying histologic thicknesses. DESIGN: A 2-page, 13-question survey of depth of excision practices for the treatment of melanoma was developed and distributed. SETTING: Both private and academic settings. PARTICIPANTS: A total of 1184 US physicians (1000 dermatologists and 184 melanoma specialists) were sent the survey. The 184 melanoma specialists included dermatologists, oncologists, and surgeons working in pigmented lesion clinics. MAIN OUTCOME MEASURES: Depth of excision practices reported for melanomas of varying histologic thicknesses and comparison of treating physician groups. Results were tabulated, and descriptive frequencies were used to describe demographics and survey responses. RESULTS: The final study analysis included 498 completed surveys. The overall response rate was 45% (498 of 1097 [1184 total respondents - 87 ineligibles]). The response rate for the specialists was 63% (115 of 183 [184 total respondents - 1 ineligible]), and for nonspecialist dermatologists it was 43% (383 of 892 [1000 total respondents - 108 ineligibles]). Specialists were more likely to practice in an urban setting than were nonspecialist dermatologists (78% vs 46%) (P < .001). Fifty-eight percent of nonspecialist dermatologists reported more than 400 patient visits per month compared with only 16% of specialists (P < .001). While specialists reported fewer patient visits per month, 51% reported diagnosing over 20 invasive melanomas in the previous year compared with 11% of nonspecialist dermatologists. There was no significant difference in excision depth reported among the specialties for melanoma in situ (P = .15). For invasive melanoma, significant differences were observed among treating groups, with the greatest incongruence reported for thin invasive melanoma (<0.50 mm, P = .02; 0.50-0.75 mm, P < .001; and 0.76-1.00 mm, P < .001). Specialist nondermatologists consistently reported excising more deeply than specialist dermatologists and nonspecialist dermatologists. More specialist nondermatologists report excising to the fascia for thin invasive melanoma than do both specialist and nonspecialist dermatologists. For thicker melanomas (>1.00 mm), differences in excision depths among treating physician groups decreased: most physicians in each group reported excising to the fascia. CONCLUSIONS: There is considerable variation among physician groups with regard to depth of excision practices for the treatment of melanoma. Given the current lack of clinical data available, studies assessing depth of excision and patient outcomes are needed to better define our surgical management of melanoma.Published online July 19, 2010 (doi:10.1001/archdermatol.2010.156).
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PMID: 20644028 [PubMed - as supplied by publisher]10: J Am Acad Dermatol. 2010 Aug;63(2):274-83.
Manuskiatti W, Triwongwaranat D, Varothai S, Eimpunth S, Wanitphakdeedecha R.
Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. siwmn@mahidol.ac.th
BACKGROUND: Treatment of atrophic scars with a fractional laser resurfacing technique has demonstrated favorable outcomes, although data on the efficacy and adverse effects of this procedure in persons with dark-skinned phototypes are limited. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of carbon-dioxide ablative fractional resurfacing on atrophic acne scars in Asian individuals. METHODS: Thirteen subjects (8 female and 5 male, aged 25-52 years) with skin phototype IV and atrophic acne scars were treated with 3 sessions of carbon-dioxide ablative fractional resurfacing laser on an average of 7-week interval. Objective (ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment. RESULTS: At the 6-month follow-up, 85% of the subjects were rated as having at least 25% to 50% improvement of scars. Improvement significantly progressed from the 1-month follow-up to the 6-month follow-up (P = .002). At 1 month after 3 treatments, surface smoothness (P = .03) and scar volume (P < .001) significantly improved, compared with baseline measurements. Of the subjects, 62% rated themselves as having at least 50% improvement in their scars. Mild postinflammatory hyperpigmentation was the most common adverse effect observed in 92% of the subjects or 51% of treatment sessions, and was completely resolved in an average of 5 weeks. LIMITATION: The small sample size was a study limitation. CONCLUSIONS: Carbon-dioxide ablative fractional resurfacing appears to be effective and well tolerated for the treatment of atrophic acne scars in Asians. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Publication Types: Clinical Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20633798&dopt=ExternalLink
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PMID: 20633798 [PubMed - indexed for MEDLINE]11: J Am Acad Dermatol. 2010 Aug;63(2):195-211; quiz 211-2.
Sakamoto FH, Torezan L, Anderson RR.
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Photodynamic therapy requires a photosensitizer, oxygen, and activating light. For acne, pilosebaceous units are "target" structures. Porphyrins are synthesized in vivo from 5-aminolevulinic acid (ALA), particularly in pilosebaceous units. Different photosensitizers and drug delivery methods have been reported for acne treatment. There are a variety of porphyrin precursors with different pharmacokinetic properties. Among them, ALA and methyl-ester of ALA (MAL) are available for possible off-label treatment of acne vulgaris. In addition, various light sources, light dosimetry, drug incubation time, and pre- and posttreatment care also change efficacy and side effects. None of these variables has been optimized for acne treatment, but a number of clinical trials provide helpful guidance. In this paper, we critically analyze clinical trials, case reports, and series of cases published through 2009. LEARNING OBJECTIVES: After completing this learning activity, participants should be able to analyze photodynamic therapy using 5-aminolevulinic acid and its derivates for acne treatment, predict the effectiveness and outcomes of photodynamic therapy using different parameters and/or different porphyrin-related photosensitizers, and assess and manage the side effects of porphyrin-based photodynamic therapy for acne. Copyright 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Publication Types: Review
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PMID: 20633797 [PubMed - indexed for MEDLINE]12: J Am Acad Dermatol. 2010 Aug;63(2):252-8. Epub 2010 Jun 3.
Eun HC, Kwon OS, Yeon JH, Shin HS, Kim BY, Ro BI, Cho HK, Sim WY, Lew BL, Lee WS, Park HY, Hong SP, Ji JH.
Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. hceun@snu.ac.kr
BACKGROUND: Dutasteride (Avodart) is a dual inhibitor of both type I and type II 5 alpha reductases, and thus inhibits conversion of testosterone to dihydrotestosterone, a key mediator of male pattern hair loss. OBJECTIVES: The aim of this randomized double-blind phase III study was to compare the efficacy, safety, and tolerability of dutasteride (0.5 mg) and placebo for 6 months of treatment in male patients with male pattern hair loss. METHODS: A total of 153 men, 18 to 49 years old, were randomized to receive 0.5 mg of dutasteride or placebo daily for 6 months. Efficacy was evaluated by the change of hair counts, subject assessment, and photographic assessment by investigators and panels. RESULTS: Mean change of hair counts from baseline to 6 months after treatment start was an increase of 12.2/cm(2) in dutasteride group and 4.7/cm(2) in placebo group and this difference was statistically significant (P = .0319). Dutasteride showed significantly higher efficacy than placebo group by subject self-assessment and by investigator and panel photographic assessment. There was no major difference in adverse events between two groups. LIMITATIONS: The study was limited to 6 months. CONCLUSIONS: This study clearly showed that 0.5 mg of dutasteride improved hair growth and was relatively well tolerated for the treatment of male pattern hair loss. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Publication Types: Clinical Trial, Phase III Randomized Controlled Trial Research Support, Non-U.S. Gov't
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PMID: 20605255 [PubMed - indexed for MEDLINE]13: Arch Dermatol. 2010 Jun;146(6):607-13.
Lehman JS, Cook-Norris RH, Weed BR, Weenig RH, Gibson LE, Weaver AL, Pittelkow MR.
Department of Dermatology, MayoClinic, Rochester, Minnesota, USA.
OBJECTIVES: To clarify clinicopathologic features and reconcile discrepancies in previous studies of folliculotropic mycosis fungoides (FMF). DESIGN: A single-center retrospective clinicopathologic study and a systematic review of FMF. SETTING: Tertiary referral center in the midwestern United States. PATIENTS: Patients with clinical and histopathologic evidence of FMF seen at the tertiary referral center during a 12(1/2)-year period. MAIN OUTCOME MEASURES: Clinicopathologic features of FMF. RESULTS: Fifty patients (32 male [64%] and 18 female [36%]) met study criteria for the clinicopathologic review. Pruritic patches, plaques, and folliculocentric lesions (milia, cysts, and alopecia) on the head, neck, and trunk were common clinical findings. The mean time to diagnosis of FMF was 5.0 years. Diagnostic latency did not affect risk of death. One-year and 5-year overall survival rates were 96% and 62%, respectively. Frequent microscopic features were follicular mucinosis (74%) and epidermotropism (54%). Systematic review of 186 additional patients confirmed male predominance (ratio of men to women, 3.2:1.0), prevalent pruritus (73%), frequent follicular mucinosis (69%) and epidermotropism (37%) microscopically, and common head, neck, and trunk involvement. Combined data demonstrated that 6% of patients with FMF had concurrent non-mycosis fungoides hematologic malignant neoplasms and that the 5-year overall survival rate was 62% to 64%. CONCLUSION: Folliculotropic mycosis fungoides has distinct clinical and microscopic features and is associated with a poor 5-year overall survival rate.
Publication Types: Comparative Study
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PMID: 20566923 [PubMed - indexed for MEDLINE]14: J Invest Dermatol. 2010 Jun 17; [Epub ahead of print]
Tan JK, Wolfe BJ, Bulatovic R, Jones EB, Lo AY.
Department of Medicine, University of Western Ontario, London, Ontario, Canada.
Numerous international clinical guidelines for management of psoriasis have recently been published. We evaluated the quality of guidelines published between 2006 and December 2009 using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Eight guidelines from five separate working groups fulfilled inclusion criteria and were evaluated. Four used the standards established by the AGREE instrument in the process of development of their guidelines. Each of the guidelines uniformly received high domain scores (i.e., >90%) for scope and purpose (range of 94-100%), and clarity and presentation (range of 92-100%). Nevertheless, each of the eight guidelines had important shortcomings (item scores </=2/4, in which 4 indicates strongly agree and 1 indicates strongly disagree that specific items have been adequately addressed) in at least one item including: stakeholder involvement (by lack of piloting and inadequate determination of patient views), development rigor (inadequate procedure for updating), applicability (by lack of discussion on organizational barriers), and editorial independence (from funding body). Despite the use of predefined standards in their development, important deficiencies exist in the most recent clinical treatment guidelines for psoriasis.Journal of Investigative Dermatology advance online publication, 17 June 2010; doi:10.1038/jid.2010.164.
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PMID: 20555354 [PubMed - as supplied by publisher]15: J Invest Dermatol. 2010 Aug;130(8):1971-87. Epub 2010 Jun 17.
Gould Rothberg BE, Rimm DL.
Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Among individuals with localized (Stage I-II) melanoma, stratifying patients by a number of phenotypic variables (e.g., depth of invasion, ulceration) yields a wide range of 10-year melanoma-specific survival rates. With the possible exception of Ki-67, no molecular assessment is routinely used. However, there have been a tremendous number of studies assessing protein expression by immunohistochemistry toward the goal of better prediction of recurrence. In a previous systematic review, which required publication of multivariable prognostic models as a strict inclusion criterion, we identified 37 manuscripts that collectively reported on 62 proteins. Data for 324 proteins extracted from 418 manuscripts did not meet our inclusion criteria for that study, but are revisited here, emphasizing trends of protein expression across either melanocytic lesion progression or gradations of tumor thickness. These identified 101 additional proteins that stratify melanoma, organized according to the Hanahan and Weinberg functional capabilities of cancer.
Publication Types: Research Support, N.I.H., Extramural
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PMID: 20555347 [PubMed - indexed for MEDLINE]16: J Am Acad Dermatol. 2010 Aug;63(2):228-34. Epub 2010 May 21.
Bissonnette R, Bolduc C, Poulin Y, Guenther L, Lynde CW, Maari C.
Innovaderm Research Inc, Montreal, Quebec, Canada. rbissonnette@innovaderm.ca
BACKGROUND: The safety and efficacy of adalimumab in patients who have shown an unsatisfactory response to etanercept are unknown. OBJECTIVE: We sought to evaluate the safety and efficacy of adalimumab in patients who failed to show a satisfactory response or lost their satisfactory response to etanercept. METHODS: This multicenter study enrolled patients who either failed to reach a physician global assessment (PGA) score of 0 or 1 after 12 weeks of etanercept (group A; 50 patients) or who lost their PGA score of 0 or 1 at any time after etanercept dose decrease from 50 mg twice a week to 50 mg every week (group B; 35 patients). Patients received adalimumab 40 mg every other week without loading dose for 12 weeks followed by 40 mg every week for an additional 12 weeks if they did not reach a PGA score of 0 or 1. RESULTS: After 12 weeks of adalimumab, 34.0% (n = 17; 95% confidence interval [CI] 20.4-47.6) and 31.4% (n = 11; 95% CI 15.2-47.6) of patients from groups A and B, respectively, reached a PGA score of 0 or 1. A total of 46.0% (n = 23; 95% CI 31.7-60.3) and 45.7% (n = 16; 95% CI 28.4-63.1) of patients from group A and B, respectively, achieved a PGA score of 0 or 1 after 24 weeks of adalimumab. Adalimumab was well tolerated and no serious adverse events were reported. LIMITATIONS: This was an open-label uncontrolled study. CONCLUSIONS: Adalimumab should be considered as an alternative in patients with psoriasis who have not shown an adequate response or who lost their response to etanercept after a dose decrease. Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Publication Types: Clinical Trial Multicenter Study Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20494479&dopt=ExternalLink
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PMID: 20494479 [PubMed - indexed for MEDLINE]17: J Am Acad Dermatol. 2010 Jul;63(1):52-62. Epub 2010 May 21.
Seidler EM, Kimball AB.
Clinical Unit for Research Trials in Skin, Massachusetts General Hospital, Boston, Massachusetts 02139, USA.
BACKGROUND: Comparative efficacy of the multiple treatments containing benzoyl peroxide (BPO) and clindamycin (CL) is not established. OBJECTIVE: We compared the efficacy of topical 5% BPO, 1% to 1.2% CL, 5% BPO with salicylic acid (SA) preparation, and combination BPO/CL in acne lesion reduction. METHODS: A meta-analysis was conducted using the Cochrane collaboration guidelines in accordance with the PRISMA statement. RESULTS: A total of 23 studies including 7309 patients were used in the meta-analysis. At 2 to 4 weeks, 5% BPO + SA had statistically greater percent lesion reductions over other groups (weighted mean inflammatory lesion reduction: BPO = 33.4%, CL = 21.5%, BPO + SA = 55.2%, BPO/CL = 40.7%, placebo = 7.3%; weighted mean noninflammatory lesion reduction: BPO = 19.1%, CL = 10.0%, BPO + SA = 42.7%, BPO/CL = 26.2%, placebo = 6.7%). At 10- to 12-week end points, 5% BPO + SA and BPO/CL were similar, with overlapping confidence intervals (weighted mean inflammatory lesion reduction: BPO = 43.7%, CL = 45.9%, BPO + SA = 51.8%, BPO/CL = 55.6%, placebo = 26.8%; weighted mean noninflammatory lesion reduction: BPO = 30.9%, CL = 32.6%, BPO + SA = 47.8%, BPO/CL = 40.3%, placebo = 17.0%). LIMITATIONS: Trial heterogeneity, publication bias, and deficits in the reporting of individual primary studies may affect results. CONCLUSION: At early time points, 5% BPO + SA had the best profile. BPO/CL was only incrementally better than BPO alone but was superior to CL alone. At later time points, 5% BPO + SA was similar to BPO/CL. Copyright (c) 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Publication Types: Comparative Study Meta-Analysis Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20488582&dopt=ExternalLink
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PMID: 20488582 [PubMed - indexed for MEDLINE]18: Arch Dermatol. 2010 May;146(5):534-41.
Langan S, Schmitt J, Coenraads PJ, Svensson A, von Elm E, Williams H; European Dermato-Epidemiology Network (EDEN).
Centre of Evidence-Based Dermatology, C Floor, South Block, Queen's Medical Centre, Nottingham NG 2UH, England. sinead.langan@nottingham.ac.uk
OBJECTIVE: To assess the quality of reporting in observational studies in dermatology. DATA SOURCES: Five dermatology journals-the Archives of Dermatology, the British Journal of Dermatology, the Journal of the American Academy of Dermatology, the Journal of Investigative Dermatology, and Acta Dermato-Venereologica. STUDY SELECTION: Cohort, case-control, and cross-sectional studies published as original articles during the period January 2005 through December 2007. Studies were identified with a literature search of PubMed combining the journal title and the term epidemiological studies (free text) and by hand searching all of the issues of each journal to identify relevant articles. DATA EXTRACTION: All articles were extracted by 2 reviewers independently using standardized checklists based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations. DATA SYNTHESIS: The number and proportion of reported STROBE items were analyzed for each article. The proportion of studies with good reporting for each item was also assessed. RESULTS: A total of 138 articles were included and analyzed. Reporting quality was very mixed. Key areas that were infrequently reported included sample size calculations (n = 10 [7%]), missing data (n = 8 [6%]), losses to follow-up (n = 17 [12%]), and statistical methods (n = 19 [14%]). Only 13 studies (9%) explained the role of funders in the research. The quality of reporting was similar across study designs for "critical" questions with the exception of reporting of participant details, which was better reported in cohort studies (96%) compared with cross-sectional (80%) and case-control (70%) studies. CONCLUSIONS: It is difficult to judge the quality of dermatological research unless it is reported well. This study has identified a clear need to improve the quality of reporting of observational studies in dermatology. We recommend that dermatology journals adopt the STROBE criteria.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20479302&dopt=ExternalLink
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PMID: 20479302 [PubMed - indexed for MEDLINE]19: Arch Dermatol. 2010 May;146(5):485-91.
Hillhouse J, Turrisi R, Stapleton J, Robinson J.
Department of Community Health, East Tennessee State University, Campus Box 70674, Johnson City, TN 37614, USA. hillhous@etsu.edu
OBJECTIVE: To evaluate the robustness of an appearance-focused intervention to prevent skin cancer in individuals reporting seasonal affective disorder (SAD) symptoms and pathological tanning motives. DESIGN: Randomized, controlled clinical trial. SETTING: College campus. PARTICIPANTS: Four hundred thirty adult female indoor tanners (200 in the intervention group and 230 control participants). INTERVENTION: A booklet discussing the history of tanning, current tanning norms, UV radiation's effects on skin, recommendations for indoor tanning use focusing on abstinence and harm reduction recommendations, and information on healthier, appearance-enhancing alternatives to tanning. MAIN OUTCOME MEASURES: Self-reported attitudes, intentions, and tanning behaviors; pathological tanning motives assessed by a questionnaire developed for this study; and SAD symptoms assessed by the Seasonal Pattern Assessment Questionnaire. RESULTS: Two of the 4 pathological tanning scales, opiatelike reactions to tanning and dissatisfaction with natural skin tone, were significant moderators demonstrating stronger treatment effects for individuals scoring higher on these scales. Treatment effects were equivalently positive (ie, no significant moderator effects) for all levels of SAD symptoms and all levels of the other 2 pathological tanning motive scales (ie, perceiving tanning as a problem and tolerance to the effects of tanning). CONCLUSIONS: The appearance-focused skin cancer prevention intervention is robust enough to reduce indoor tanning among tanners who exhibit SAD symptoms or pathological tanning motives. Tailored interventions may address individuals' motivations for tanning and their relation to maladaptive behavior, such as dissatisfaction with appearance or the need for relaxation because of anxiety.
Publication Types: Randomized Controlled Trial Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20479295&dopt=ExternalLink
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PMID: 20479295 [PubMed - indexed for MEDLINE]20: J Am Acad Dermatol. 2010 May 12; [Epub ahead of print]
Carter MJ, Tingley-Kelley K, Warriner RA 3rd.
Strategic Solutions Inc, Cody, Wyoming.
Previous systematic reviews of silver-impregnated dressings have been contradictory regarding the healing of leg wounds/ulcers. Our systematic review was restricted to randomized controlled trials. Cochrane Library, Scopus, and MEDLINE databases were searched using the term "silver" in combination with "wound" or "ulcer" (and plural versions) without date/language restriction. Study quality was assessed and meta-analysis conducted for complete wound healing, wound size reduction, and healing rates. Overall study quality was fair with most studies having some bias. Evidence for wound healing using individual studies was poor. Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates. Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers, long-term effects remain unclear. Clinical trial data with longer follow-up times are needed to address these issues. Copyright (c) 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20471135&dopt=ExternalLink
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PMID: 20471135 [PubMed - as supplied by publisher]