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1.
J Drugs Dermatol ; 17(11): 1157 - 1162, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-30481953

RESUMEN

OBJECTIVE: The aim of this study was to evaluate the incidence of adverse effects following laser skin resurfacing with the microablative carbon dioxide (CO2) laser system (SmartXide DOT; DEKA, Calenzano, Italy). METHODS: A retrospective chart review was performed. Data was collected for DOT laser procedures performed at three clinical centers from 2008-2014. Results: Of the 1,081 DOT laser procedures, there were 13 complications (1.3% of all cases), which included eleven cases of prolonged erythema and two cases of post-inflammatory hyperpigmentation. Of note, there were no cases of scarring. LIMITATIONS: This was a retrospective chart review. Data was collected from laser case logs. However, all patients with complications were evaluated clinically by a physician. CONCLUSION: Microablative fractional resurfacing with the DOT laser enables treatment of a diversity of skin conditions with short post-procedure recovery time and an extremely low incidence of adverse side effects. J Drugs Dermatol. 2018;17(11):1157-1162.


Asunto(s)
Dermatosis Facial/cirugía , Láseres de Gas/efectos adversos , Envejecimiento de la Piel , Anciano de 80 o más Años , Eritema/etiología , Femenino , Humanos , Incidencia , Indiana , Cuello , Ciudad de Nueva York , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Ritidoplastia/instrumentación
2.
J Drugs Dermatol ; 15(2): 241-3, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26885795

RESUMEN

We report a unique case of herpes zoster that developed shortly after Varicella Zoster vaccination.


Asunto(s)
Vacuna contra la Varicela/efectos adversos , Herpes Zóster/inducido químicamente , Herpes Zóster/diagnóstico , Vacunación/efectos adversos , Anciano , Humanos , Masculino , Factores de Tiempo
3.
Dermatol Surg ; 41(3): 397-403, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25705954

RESUMEN

BACKGROUND: In Mohs surgery, the histologic verification of tumor removal results in a lower rate of cancer recurrence compared with simple excision. Factors associated with the increased use of Mohs surgery are not well characterized. OBJECTIVE: To investigate trends in the utilization of Mohs surgery. METHODS AND MATERIALS: The authors performed a retrospective analysis of the National Ambulatory Medical Care Survey for patient visits associated with Mohs surgery from 1995 to 2010. The authors assessed percentage of skin cancers managed with Mohs surgery, the most common locations of skin cancer managed with Mohs surgery, and patient demographics associated with Mohs surgery. RESULTS: Although there was an upward trend in the use of Mohs surgery (p = .004), a low percentage of skin cancers (average of 10.0%) were managed with this technique. When the surgical location was specified, Mohs surgery was most commonly used for the head and neck region. Demographic groups receiving Mohs surgery at higher rates included African Americans (44.2%) and patients aged 75 to 84 years (12.4%). CONCLUSION: There has been an upward trend in the use of Mohs surgery, particularly in the head and neck region where tissue preservation is essential.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Cirugía de Mohs/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Persona de Mediana Edad , Cirugía de Mohs/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Adulto Joven
4.
J Drugs Dermatol ; 13(5): 545-52, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24809877

RESUMEN

BACKGROUND: Systemic lupus erythematosus (SLE) and chronic cutaneous lupus (CCLE) therapy has changed little over the past 50 years. In March 2011, the US Food and Drug Administration (FDA) approved belimumab, complementing the three preexisting approved therapies: low dose aspirin, prednisone, and hydroxychloroquine. OBJECTIVE: The objectives for this study were to evaluate trends in the medications prescribed for the management of lupus erythematosus (LE) and to assess how treatment varies among different specialists. METHODS: Outpatient visits for treatment of lupus and its comorbidities were identified in the National Ambulatory Medical Care Survey (NAMCS), a representative survey of visits to physician offices in the United States. Data was evaluated to determine patient demographics, treatments prescribed by each specialty, and comorbidities encountered during the study period of 1993-2010. RESULTS: From 1993-2004, prednisone was the most frequently prescribed medication; however, prednisone became the second most frequently prescribed medication in 2005-2010, as hydroxychloroquine became the leading medication prescribed for LE. In primary care physicians and other non-dermatology specialists, the most frequently prescribed medications for lupus were prednisone and hydroxychloroquine; whereas, hydroxychloroquine and triamcinolone were the top two medications preferred by dermatologists. LIMITATIONS: The NAMCS collects cross-sectional data, such that individual patients cannot be followed over time. Hence, it does not provide data regarding the incidence of disease, patient age at the time of diagnosis, change in individual patient's medication regimens over time, or prognosis related to patient demographics. In addition, it is possible that the physician did not always record nonprescription medication use, such as NSAIDS, since these are typically used first line. CONCLUSION: First-line treatment of LE changed minimally from 1993 to 2010, with prednisone and hydroxychloroquine serving as the primary medications utilized by most physicians for the management of LE.


Asunto(s)
Lupus Eritematoso Discoide/tratamiento farmacológico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Niño , Preescolar , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Estados Unidos , Adulto Joven
5.
J Drugs Dermatol ; 13(2): 135-40, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24509962

RESUMEN

BACKGROUND: The treatment of acne can be difficult, with suboptimal adherence resulting in poor treatment outcomes. PURPOSE: To determine whether demonstrating to patients how to properly apply a topical acne medication through the use of a sample product will improve adherence. METHODS: Subjects with mild to moderate acne were instructed to use adapalene/benzoyl peroxide gel once daily for six weeks. Subjects were randomized into sample or no sample group. Sample group received a demonstration on how to apply the medication using a product sample. The primary outcome was median adherence, recorded using electronic monitoring, and secondary outcomes were efficacy measures including the Acne Global Assessment (AGA) and lesion counts and the Perceived Medical Condition Self-Management Scale (PMCSMS). RESULTS: Data from 17 patients was collected and analyzed. Median adherence rates were 50% in the sample group and 35% in the no sample group (p=0.67). The median percent improvement in non-inflammatory lesions were 46% for the sample group and 33% for the no-sample group (p=0.10). LIMITATIONS: The small size of this pilot study limited the extent of subgroup analyses. CONCLUSIONS: Objective electronic monitoring expanded our previous observations of poor adherence in the treatment of acne. There is a considerable potential effect size on adherence for the use of samples, supporting the need for future, well powered studies to assess the value of using samples in the treatment of acne and other dermatologic skin diseases.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Peróxido de Benzoílo/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Naftalenos/uso terapéutico , Acné Vulgar/patología , Adapaleno , Administración Cutánea , Adolescente , Adulto , Peróxido de Benzoílo/administración & dosificación , Fármacos Dermatológicos/administración & dosificación , Femenino , Geles , Humanos , Masculino , Cumplimiento de la Medicación , Naftalenos/administración & dosificación , Proyectos Piloto , Índice de Severidad de la Enfermedad , Método Simple Ciego , Resultado del Tratamiento , Adulto Joven
6.
J Cutan Med Surg ; 18(1): 49-55, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24377474

RESUMEN

BACKGROUND: Analyzing adherence to treatment and outcomes in atopic dermatitis is limited by methods to assess continual disease severity. Atopic dermatitis significantly impacts sleep quality, and monitoring sleep through actigraphy may capture disease burden. PURPOSE: To assess if actigraphy monitors provide continuous measures of atopic dermatitis disease severity and to preliminarily evaluate the impact of a short-course, high-potency topical corticosteroid regimen on sleep quality. METHODS: Ten patients with mild to moderate atopic dermatitis applied topical fluocinonide 0.1% cream twice daily for 5 days. Sleep data were captured over 14 days using wrist actigraphy monitors. Investigator Global Assessment (IGA) and secondary measures of disease severity were recorded. Changes in quantity of in-bed time sleep were estimated with random effects models. RESULTS: The mean daily in-bed time, total sleep time, and wake after sleep onset (WASO) were 543.7 minutes (SEM 9.4), 466.0 minutes (SEM 7.7), and 75.0 minutes (SEM 3.4), respectively. WASO, a marker of disrupted sleep, correlated with baseline (ρ  =  .75) and end of treatment IGA (ρ  =  .70). Most patients did not have marked changes in sleep. IGA scores declined by a median change of 1 point at days 7 (p  =  .02) and 14 (p  =  .008). CONCLUSIONS: Using actigraphy, atopic dermatitis disease severity positively correlated with sleep disturbances. Actigraphy monitors were well tolerated by this cohort of atopic dermatitis subjects.


Asunto(s)
Dermatitis Atópica/diagnóstico , Dermatitis Atópica/fisiopatología , Actigrafía , Administración Tópica , Adolescente , Adulto , Anciano , Antialérgicos/administración & dosificación , Dermatitis Atópica/tratamiento farmacológico , Femenino , Fluocinonida/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
7.
Int J Dermatol ; 53(9): 1091-7, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23675774

RESUMEN

BACKGROUND: Skin conditions are common among Latino migrant farm workers. Although many skin conditions are related to occupational exposures, poor housing conditions may also contribute to skin ailments in migrant farm workers. OBJECTIVES: To evaluate the association between housing conditions and skin conditions among Latino migrant farm workers. MATERIALS AND METHODS: A cross-sectional study design using interview questionnaires, home inspections, and environmental sampling was implemented to document housing quality of farm worker camps/homes and the prevalence of self-reported skin conditions in Latino migrant farm workers. Interviews were completed with 371 farm workers residing in 186 of the 226 camps (camp response rate 82.3%). RESULTS: Self-reported pruritus (31%), rash (25%), scaling (12%), blisters (11%), and ingrown nails (10%) were common among the participants. Pruritus was more likely to be reported by farm workers living in dwellings without air-conditioning (P < 0.05). Rash was associated with dwellings reported to have a low humidity (P < 0.05). Scaling was more likely to be reported by farm workers living in dwellings with indoor temperatures in the thermal discomfort range (P < 0.05). No statistically significant associations were detected for indoor allergens and self-reported skin ailments among migrant farm workers. CONCLUSIONS: Skin conditions are common among migrant farm workers in North Carolina. The quality of housing conditions, particularly hot, dry indoor thermal environment, demonstrated significant associations with pruritus, rash, and scaling. The impact of housing characteristics on pruritus and blisters was greatest in new migrant farm workers. Further research is needed to delineate additional housing factors that could cause or exacerbate skin diseases in farm workers.


Asunto(s)
Agricultura , Vivienda , Enfermedades de la Piel/epidemiología , Migrantes/estadística & datos numéricos , Adolescente , Adulto , Aire Acondicionado , Estudios Transversales , Hispánicos o Latinos , Calor , Humanos , Humedad , Masculino , North Carolina/epidemiología , Adulto Joven
8.
Cutis ; 94(6): 285-92, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25566569

RESUMEN

The dermatologic conditions that are most commonly encountered by nondermatologists are not well characterized, which can hamper efforts to train them in skin disease management. The purpose of this study was to identify the 20 most common dermatologic conditions encountered by nondermatologic specialties (ie, emergency medicine, family practice, general surgery, internal medicine, otolaryngology, pediatrics). Data from the National Ambulatory Medical Care Survey from 2001 to 2010 were analyzed to evaluate the dermatologic diagnoses made by each specialty during this time period. The most common skin conditions reported by dermatologists were compared to those reported by nondermatologists. Nondermatologists evaluated 52.9% of cutaneous diseases that presented in the outpatient setting. Among each nondermatologic specialty included in the study, only 6 to 10 of the top 20 conditions overlapped with the top 20 conditions reported by dermatologists. This study is a retrospective review of a large database and only included skin conditions that were diagnosed in an outpatient setting. The skin conditions that most frequently presented to nondermatologists differed considerably from those most commonly seen by dermatologists. Because dermatologists often are responsible for training nondermatologists in the diagnosis and management of skin disease, curriculum content should reflect these differences to enhance the efficacy of such training opportunities.


Asunto(s)
Dermatología/educación , Manejo de la Enfermedad , Enfermedades de la Piel/diagnóstico , Atención Ambulatoria/estadística & datos numéricos , Competencia Clínica , Medicina Familiar y Comunitaria/educación , Medicina Familiar y Comunitaria/normas , Cirugía General/educación , Cirugía General/normas , Encuestas de Atención de la Salud , Humanos , Evaluación de Necesidades , Pediatría/educación , Pediatría/normas , Mejoramiento de la Calidad
9.
JAMA Dermatol ; 150(1): 51-5, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24005847

RESUMEN

IMPORTANCE: Sunscreen is an important part of sun protection to prevent skin cancer but may not be recommended as often as guidelines dictate. OBJECTIVE: To evaluate trends in sunscreen recommendation among physicians to determine whether they are following suggested patient-education guidelines regarding sun protection, and to assess data regarding physician sunscreen recommendations to determine the association with patient demographics, physician specialty, and physician diagnosis. DESIGN, SETTING, AND PARTICIPANTS: The National Ambulatory Medical Care Survey was queried to identify patient visits to nonfederal outpatient physician offices at US ambulatory care practices (January 1, 1989-December 26, 2010) during which sunscreen was recommended. MAIN OUTCOMES AND MEASURES: Frequency of sunscreen recommendation. RESULTS: According to the National Ambulatory Medical Care Survey, there were an estimated 18.30 billion patient visits nationwide. Physicians mentioned sunscreen at approximately 12.83 million visits (0.07%). Mention of sunscreen was reported by physicians at 0.9% of patient visits associated with a diagnosis of skin disease. Dermatologists recorded the mention of sunscreen the most (86.4% of all visits associated with sunscreen). However, dermatologists reported mentioning sunscreen at only 1.6% of all dermatology visits. Sunscreen was mentioned most frequently to white patients, particularly those in their eighth decade of life, and least frequently to children. Actinic keratosis was the most common diagnosis associated with sunscreen recommendation. CONCLUSIONS AND RELEVANCE: Despite encouragement to provide patient education regarding sunscreen use and sun-protective behaviors, the rate at which physicians are mentioning sunscreen at patient visits is quite low, even for patients with a history of skin cancer. The high incidence and morbidity of skin cancer can be greatly reduced with the implementation of sun-protective behaviors, which patients should be counseled about at outpatient visits.


Asunto(s)
Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/prevención & control , Protectores Solares/administración & dosificación , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Grupos Raciales/estadística & datos numéricos , Factores Sexuales , Estados Unidos , Adulto Joven
10.
J Drugs Dermatol ; 12(12): 1411-5, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24301243

RESUMEN

BACKGROUND: Verrucae (warts) are a very common dermatologic disease. They can be of cosmetic concern, cause physical discomfort, and predispose patients to certain malignancies. Management of warts has traditionally been based on anatomic location, clinical appearance, and patient preference. PURPOSE: To investigate trends in the treatment of warts, as well as patient demographics associated with the diagnosis of warts. METHODS: The National Ambulatory Medical Care Survey (NAMCS) was queried for data regarding patient visits associated with the diagnosis of warts from 1990 to 2009. RESULTS: There was a significant increase in the use of topical imiquimod during the study period, such that it became the most frequently used medication for warts. No statistically significant trends were detected regarding the frequency of treatment with medication only, procedure only, or combination treatment. In terms of patient demographics, there was an upward trend in regards to increasing patient age and the diagnosis of warts. However, there were no significant trends with respect to patient gender or race and the diagnosis of warts. LIMITATIONS: Warts not otherwise specified (NOS) was the reported diagnosis for more than eighty percent of patient visits for warts. Trends in the treatment of plantar warts could not be evaluated as the ICD-9 code designating this diagnosis was recently instituted in 2009. Data from NAMCS are cross-sectional in nature. CONCLUSIONS: The advent of a new therapy and shifts in population patterns have modified the epidemiologic profile and treatment of warts.


Asunto(s)
Adyuvantes Inmunológicos/uso terapéutico , Aminoquinolinas/uso terapéutico , Verrugas/epidemiología , Adyuvantes Inmunológicos/administración & dosificación , Administración Tópica , Adulto , Distribución por Edad , Aminoquinolinas/administración & dosificación , Femenino , Encuestas de Atención de la Salud , Humanos , Imiquimod , Masculino , Estados Unidos/epidemiología , Verrugas/diagnóstico , Verrugas/tratamiento farmacológico , Adulto Joven
11.
Dermatol Online J ; 19(10): 20029, 2013 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-24139369

RESUMEN

BACKGROUND: Adherence in the treatment of chronic inflammatory skin diseases such as atopic dermatitis is poor. Methods to improve adherence have proven difficult. PURPOSE: To determine whether a short course of treatment with a high-potency corticosteroid will improve adherence compared to longer treatment studies and if improvement in disease and itch continues after treatment. METHODS: 10 patients with mild to moderate atopic dermatitis were instructed to apply fluocinonide 0.1% cream twice daily for 5 days. Adherence was self-reported and electronically monitored. Treatment outcomes were assessed in terms of Visual Analog Scale of Itch (VAS), Eczema Area and Severity Index (EASI), and Investigator Global Assessment (IGA) scores. RESULTS: The median adherence rate was 40% (range of 0-100). The median percent change in VAS from baseline measures on days 7 and 14 were 90% (range -13, 100, p=0.02) and 52% (range 0, 100, p=0.004). On days 7 and 14, 20% and 70% patients achieved an EASI-75 and 40% and 60% an IGA of 0 or 1. LIMITATIONS: Small sample size limited subgroup analyses. CONCLUSIONS: Adherence rates with short-term treatment were similar to previously reported rates in longer term treatment studies. However, even non-adherent patients had significant improvement in itch and disease severity.


Asunto(s)
Corticoesteroides/administración & dosificación , Dermatitis Atópica/tratamiento farmacológico , Fluocinonida/administración & dosificación , Cumplimiento de la Medicación , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
12.
Ear Nose Throat J ; 92(10-11): E1, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24170467

RESUMEN

Inverted papilloma is a benign epithelial tumor of the nasal cavity. It is known to coexist with malignancy in 5 to 13% of cases, with squamous cell carcinoma being the most common malignancy. Another associated malignancy, one that is extremely rare, is verrucous carcinoma. To the best of our knowledge, no case of verrucous carcinoma occurring alone or in association with another neoplasm has been described in the nasolacrimal system. We report a case of synchronous verrucous carcinoma and inverted papilloma of the lacrimal sac in a 47-year-old man. The patient presented with epiphora, nasal obstruction, swelling of the left medial canthus, and drainage of a foul-smelling fluid from the left nostril. Computed tomography and magnetic resonance imaging detected the presence of a large mass occupying the left nasal cavity and sinuses with extension into the nasopharynx. In addition, bony invasion of the anteroinferomedial wall of the left orbit was noted with extension of the tumor into the orbit itself, which resulted in lateral displacement of the left medial rectus muscle. The patient underwent endoscopic debulking of the left sinonasal lesion. Of note, the surgery had to be completed in stages because of excessive blood loss. Histopathologic examination of the intranasal component of the tumor identified it as an inverted papilloma. One month after the intranasal resection, a left dacryocystectomy was performed; histopathologic examination revealed that an invasive verrucous squamous cell carcinoma had arisen within the inverted papilloma.


Asunto(s)
Carcinoma Verrugoso/patología , Neoplasias del Ojo/patología , Aparato Lagrimal , Neoplasias Primarias Múltiples/patología , Papiloma Invertido/patología , Neoplasias de los Senos Paranasales/patología , Carcinoma Verrugoso/cirugía , Neoplasias del Ojo/cirugía , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Primarias Múltiples/cirugía , Papiloma Invertido/cirugía , Neoplasias de los Senos Paranasales/cirugía
14.
Dermatol Online J ; 19(6): 18563, 2013 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-24011313

RESUMEN

BACKGROUND: Whereas phototherapy is a safe and cost-effective treatment modality for psoriasis, economic disincentives discourage its use, including both direct and indirect costs to the patient. PURPOSE: To determine when it may be cost-effective for patients to purchase a home light unit versus driving to clinic for outpatient phototherapy sessions. METHODS: Estimates of expenses associated with 3 months of outpatient phototherapy were determined and compared to the price of a home phototherapy unit. Factors examined included the cost of gasoline (based on the national average), fuel efficiency of the vehicle, cost of owning and operating a motor vehicle, lost wages, and copayments. RESULTS: The cost for a standard 6-bulb narrowband UVB home unit is approximately $2600. Direct and indirect expenses imposed on patients increase with distance travelled to the dermatologist. If a patient lives 20 or more miles away from the dermatologist, the expenses associated with travel can total more than the out of pocket expense of purchasing a home phototherapy unit. LIMITATIONS: This small analysis only accounted for the first 3 months of treatment and likely underestimates the total costs that patients would experience over a lifetime of treatment. CONCLUSIONS: It may be beneficial for physicians to educate patients on the cost-burden of in-office versus home phototherapy because patients can use these parameters to determine which option would be more cost-effective for them.


Asunto(s)
Atención Ambulatoria/economía , Gastos en Salud/estadística & datos numéricos , Transportes/economía , Terapia Ultravioleta/economía , Absentismo , Automóviles/economía , Ahorro de Costo/estadística & datos numéricos , Análisis Costo-Beneficio , Gasolina/economía , Servicios de Atención de Salud a Domicilio/economía , Humanos , Iluminación/economía , North Carolina , Visita a Consultorio Médico/economía , Educación del Paciente como Asunto , Terapia Ultravioleta/instrumentación
15.
J Drugs Dermatol ; 12(8): 855-9, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23986157

RESUMEN

BACKGROUND: Salicylic acid is a topical keratolytic agent used to reduce scaling and hyperkeratosis associated with psoriasis vulgaris. However, its use is limited due to potential systemic toxicity. Hydroxyacids also modulate keratinization and desquamation. Therefore, they may serve a beneficial role in the treatment of hyperkeratotic conditions. To date, there are no clinical studies in the literature regarding the efficacy of hydroxyacids for psoriasis treatment. PURPOSE: To evaluate the therapeutic efficacy of topical 20% alpha-hydroxy/polyhydroxy acid versus standard salicylic acid to reduce scaling in patients with moderate, chronic psoriasis. METHODS: Twenty-five subjects with moderate, chronic psoriasis were enrolled in a 2-week, double-blind, left-right, randomized, bilateral comparison clinical trial to compare the efficacy of 20% alpha-hydroxy/polyhydroxy acid emollient versus 6% salicylic acid cream and 24 were randomized/completed. Clinical evaluations to assess the severity of psoriasis and scaling were performed using a 6-point scale prior to treatment, as well as following 1 and 2 weeks of therapy. RESULTS: Twenty-four participants completed the study. Both 20% alpha-hydroxy/polyhydroxy acid emollient and 6% salicylic acid cream were efficacious in reducing scale of psoriatic lesions. The topical 20% alpha-hydroxy/polyhydroxyacid reduced scaling at a faster rate; however, following 2 weeks of treatment the efficacy of both products were relatively the same. CONCLUSION: 20% alpha-hydroxy/polyhydroxyacid is as efficacious as salicylic acid in regards to the de-scaling of psoriatic plaques. Additionally, 20% alpha-hydroxy/polyhydroxyacid cream may yield quicker results and less toxicity than salicylic acid.


Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Hidroxiácidos/uso terapéutico , Psoriasis/tratamiento farmacológico , Ácido Salicílico/uso terapéutico , Administración Cutánea , Enfermedad Crónica , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/efectos adversos , Método Doble Ciego , Estudios de Seguimiento , Humanos , Hidroxiácidos/administración & dosificación , Hidroxiácidos/química , Psoriasis/patología , Ácido Salicílico/administración & dosificación , Ácido Salicílico/efectos adversos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
16.
J Cutan Med Surg ; 17(4): 269-75, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23815960

RESUMEN

BACKGROUND: Cutaneous reactions to drugs are among the most common clinical manifestations of adverse drug events (ADEs); however, data on outpatient cutaneous adverse drug events (CADEs) are limited. PURPOSE: To provide national estimates of outpatient CADEs and determine their most frequent causes. METHODS: Outpatient CADEs recorded in the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1995 and 2005 were analyzed. The national incidence of outpatient CADEs in those seeking medical attention in the United States was estimated, and the common medication classes implicated with CADEs were identified. RESULTS: There were a mean annual total of 635,982 CADE-related visits, resulting in an annual incidence of 2.26 CADEs per 1,000 persons. Patients took an average of 2.2 medications in addition to the one causing the CADE. The incidence of CADEs increased with age, with a peak in the age group from 70 to 79 years. The medications most frequently causing a CADE were antimicrobial agents. Dermatitis and urticaria were the two main types of skin reactions reported. CONCLUSIONS: CADEs occur less frequently in outpatients than in inpatients and result in few hospital admissions. Physicians must be particularly cognizant of the occurrence of CADEs when prescribing antimicrobial agents.


Asunto(s)
Erupciones por Medicamentos/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Estados Unidos , Adulto Joven
17.
Pediatr Dermatol ; 30(6): 689-94, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23876222

RESUMEN

The prevalence of acne in younger children is increasing. Of the acne treatments that the U.S. Food and Drug Administration (FDA) has approved for ages 12 years and older, it is unclear which medications are being prescribed off-label for this younger patient population. The purpose of this study is to compare the therapies being prescribed to preadolescent patients with acne (defined in this study as ages 7 to 11 years) with those being prescribed to adolescent patients (ages 12 to 18 years) and to determine whether prescribing patterns differ between dermatologists and pediatricians. Leading therapies for the treatment of children with a diagnosis of acne were collected from the National Ambulatory Medical Care Survey (NAMCS) from 1993 to 2009. Data were stratified according to age group and physician specialty. Physicians prescribed a wide variety of FDA-approved and off-label medications to preadolescent patients with acne. The leading medications were topical treatments, including adapalene (14.4%), benzoyl peroxide (12.8%), and tretinoin (12.5%). Treatment of this age group differed substantially between specialties, with dermatologists frequently prescribing topical retinoids and primary care physicians preferring antibiotics, particularly oral antibiotics. Limitations included a lack of data on acne severity and morphology through NAMCS, as well as the absence of longitudinal data. With the limited number of FDA-approved treatment options, off-label prescribing for acne in preadolescent patients is common. Furthermore, this study identified a potential knowledge gap between pediatricians based on their prescribing patterns in this patient population.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Acné Vulgar/epidemiología , Peróxido de Benzoílo/uso terapéutico , Naftalenos/uso terapéutico , Tretinoina/uso terapéutico , Adapaleno , Adolescente , Distribución por Edad , Edad de Inicio , Antibacterianos/uso terapéutico , Niño , Fármacos Dermatológicos/uso terapéutico , Dermatología/estadística & datos numéricos , Encuestas de Atención de la Salud , Humanos , Queratolíticos/uso terapéutico , Uso Fuera de lo Indicado/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prevalencia , Estados Unidos/epidemiología
18.
Am J Clin Dermatol ; 14(4): 315-26, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23696234

RESUMEN

BACKGROUND: During the last decade, the implementation of biologic agents has changed the therapeutic management of severe psoriasis. Biologic agents have clinically proven efficacy, but their use is associated with a much higher cost compared with traditional treatment options. Therefore, when assessing the use of these drugs for the treatment of psoriasis, it is important to consider their cost effectiveness. OBJECTIVE: The objective of this study was to determine and compare the cost effectiveness of biologic agents with regard to the cost per patient achieving a minimally important difference (MID) in the Dermatology Life Quality Index (DLQI) and the cost per patient achieving a 75% improvement in the Psoriasis Area Severity Index (PASI-75). METHODS: A PubMed literature search was conducted to identify studies describing the efficacy of all currently US FDA-approved biologic therapies. The cost effectiveness of each agent over a 12-week period was determined and a sensitivity analysis was performed. Based on clinical efficacy at 12 weeks, treatment paradigms were extrapolated to estimate cost-effectiveness ratios after 1 year of treatment. Pooled data on each biologic agent at different doses were compared in a one-way sensitivity analysis and in an extreme case scenario analysis. RESULTS: Twenty-seven studies were included in the analysis. Intravenous (IV) infliximab 3 mg/kg was the most cost-effective biologic agent with respect to both the cost per patient achieving PASI-75 and the cost per patient achieving a DLQI MID. The next most cost-effective agents in terms of cost per patient achieving PASI-75 were subcutaneous (SQ) adalimumab 40 mg administered every other week (eow) after an 80-mg loading dose, SQ adalimumab 40 mg eow, and IV infliximab 5 mg/kg. In terms of cost per patient achieving DLQI MID, IV infliximab 5 mg/kg, SQ etanercept 25 mg once weekly, SQ etanercept 50 mg once weekly, and SQ adalimumab 50 mg eow after an 80-mg loading dose were the next most cost-effective agents behind IV infliximab 3 mg/kg. For both costs per patient achieving DLQI MID and PASI-75, alefacept was the least cost-effective agent up to a 10% level of variation at all doses except 0.025 mg/kg once weekly. LIMITATIONS: This study was limited by the use of efficacy data from 12-week clinical trials that did not compare treatments head to head to determine relative efficacy and may not be generalizable to longer treatment periods. Additionally, the estimated cost of treatment did not take into account indirect costs or variations in costs due to insurance company price contracting. CONCLUSIONS: Biologic treatments that were most cost effective were so in respect to both the cost per patient achieving DLQI MID and per patient achieving PASI-75. This suggests that the same agents that are effectively clearing the disease are also effective in improving the patients' subjective assessment of dermatology-related quality of life.


Asunto(s)
Terapia Biológica/economía , Costos de la Atención en Salud , Psoriasis/tratamiento farmacológico , Psoriasis/patología , Adalimumab , Adulto , Alefacept , Anticuerpos Monoclonales/economía , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Terapia Biológica/métodos , Costo de Enfermedad , Análisis Costo-Beneficio , Etanercept , Femenino , Humanos , Inmunoglobulina G/economía , Inmunoglobulina G/uso terapéutico , Infliximab , Masculino , Persona de Mediana Edad , Psoriasis/economía , Calidad de Vida , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Proteínas Recombinantes de Fusión/economía , Proteínas Recombinantes de Fusión/uso terapéutico , Resultado del Tratamiento , Estados Unidos
19.
J Drugs Dermatol ; 12(4): 410-8, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23652888

RESUMEN

BACKGROUND: Pseudofolliculitis barbae (PFB) is an inflammatory condition of the face with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, all of which develop in response to shaving. Prevalent in African American men, a limited amount of data have been published on the shave outcomes as they relate to clinically measurable responses and patient satisfaction scoring. The primary purpose of this study is to evaluate the impact of a daily shaving regimen and advanced shaving products on exacerbation of lesions and symptoms in patients with PFB. METHODS: Ninety African American men were randomized to 1 of 3 treatment groups shaving 2 to 3 times per week with standard products (control group), shaving daily with standard products (daily standard group) or shaving daily with advanced products (daily advanced). The number of pustules, papules, ingrown hairs, and investigator's assessment of severity and subjective symptoms of itching and burning/stinging were assessed at baseline, week 6, and week 12. The response to treatment was also assessed by the investigator and the subject at weeks 6 and 12. Secondary measures including questionnaires regarding baseline shave practices were also correlated with outcomes variables. RESULTS: There were no significant differences noted between the 3 groups for papule (P=.32) or pustule (P=.46) count for the 12-week study. However, there was a significant mean papule reduction from baseline detected for both the control and daily advanced groups. In addition, compared to baseline, there was a significant reduction in ingrown hairs for the control group, and a directional reduction in ingrown hairs for the daily advanced group. There were significant group differences between the control group and both daily shaving groups, with the control group seeing significantly fewer ingrown hairs (P=.005 for control vs daily standard group and P=.04 for control vs daily advanced group). There were no significant group differences among the 3 groups for investigator-graded severity (P=.43) and response to treatment (P=.51). There was a significant perceived improvement in the response to treatment (P=.007) and itching (P=.002) for the daily advanced group vs the control group.


Asunto(s)
Negro o Afroamericano , Enfermedades del Cabello/terapia , Remoción del Cabello/métodos , Cuidados de la Piel/métodos , Adulto , Estudios de Seguimiento , Enfermedades del Cabello/etiología , Enfermedades del Cabello/patología , Enfermedades del Cabello/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Prurito/etiología , Prurito/prevención & control , Índice de Severidad de la Enfermedad , Método Simple Ciego , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
20.
J Dermatolog Treat ; 24(6): 439-43, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23541214

RESUMEN

BACKGROUND: Cold sores are a common condition that can cause significant morbidity and mortality. Antivirals are the typical treatment for cold sores, but the ways in which these medications are used to treat cold sores are not well studied. PURPOSE: To determine the main treatments prescribed for cold sores and trends in their management over time. METHODS: A retrospective analysis of the National Ambulatory Medical Care Survey database was used to analyze outpatient visits for cold sores from 1993 to 2009. Patients were included in the data analysis if they had one of the following three diagnoses reported for their reason-for-visit codes: cold sores (CS), herpes simplex (HS) or herpes simplex with cold sores (HS/CS). RESULTS: There was a decreasing trend in the number of annual patient visits for cold sores. The majority of patients were mainly young to middle adulthood, white women. The top two most commonly prescribed medications were acyclovir followed by valacyclovir. Valacyclovir use increased in all three populations, while acyclovir use decreased. CONCLUSIONS: The trends observed may indicate that physicians are evolving their treatment strategies to implement newer antiviral medications. This may prove more efficacious for the treatment of cold sores.


Asunto(s)
Antivirales/uso terapéutico , Herpes Labial/tratamiento farmacológico , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Adolescente , Adulto , Atención Ambulatoria/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Herpes Simple/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/tendencias , Estudios Retrospectivos , Valaciclovir , Valina/análogos & derivados , Valina/uso terapéutico
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