Topical opioid use in dermatologic disease: A systematic review.

Topical opioid formulations offer a potential solution to manage pain and decrease the use of systemic opioids. Synthesis of use and efficacy of topical opioids in dermatological conditions has not been well characterized. We conducted a systematic search of the PubMed, Embase, and Cochrane databases from 1980 to February 2021. This study analyzed data from 14 articles and 263 patients on the use of topical opioids for pain related to chronic ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts. Topical opioids included in this review were topical morphine and diamorphine. Common formulations consisted of 0.2-10 mg of opioid compounded with hydrogel or IntraSite gel. Topical opioids were variably effective in the use for pain control related to chronic ulcers and other dermatologic conditions. For example, the use of topical opioids appears to be effective in the reduction of pain related to pressure ulcers. Topical opioids were generally well tolerated. Insufficient data exist to adequately evaluate the efficacy and safety of topical opioid use in the context of nonpressure ulcers, burns, oral lichen planus, photodynamic therapy, and split-thickness skin grafts.

Differences in acne therapy prescribing patterns between dermatologists and pediatricians: A population-based study.

BACKGROUND/OBJECTIVES: Acne is a common skin condition that may be treated by both dermatologists and pediatricians. However, the treatments provided by dermatologists and pediatricians may differ. We aimed to describe acne therapy prescribing patterns of dermatologists and pediatricians. METHODS: We performed a population-based, cross-sectional analysis using data from the National Ambulatory Medical Care Survey from 2006 to 2016 for pediatric patients (age ≤ 18 years). RESULTS: There were approximately 30.5 million (weighted) outpatient acne visits between 2006 and 2016 for pediatric patients; 52% of visits were conducted by dermatologists, 29% by pediatricians, and 19% by other providers. Compared to pediatricians, dermatologists saw older patients (mean age 15.5 ± 0.12 vs 13.5 ± 0.35; P < .001), as well as a higher proportion of white patients (92.5% vs 76.3%; P < .001), non-Hispanic patients (89.5% vs 81.6%; P < .001), and patients with private insurance (84.6% vs 67.8%; P < .001). Compared to patients seen by dermatologists, patients seen by pediatricians were 68% less likely to receive topical retinoids (aOR 0.32, 95% CI 0.22-0.46), 38% less likely to receive topical antibiotics (aOR 0.62, 95% CI 0.41-0.95), and 48% less likely to receive oral antibiotics (adjusted aOR 0.52, 95% CI 0.36-0.75). CONCLUSIONS: Our findings demonstrate that pediatricians prescribe topical retinoids, topical antibiotics, and oral antibiotics less frequently compared to dermatologists. It is important to understand these differences in prescribing patterns for acne and to identify potential educational gaps.

Mental health outcomes in White patients versus patients with skin of color with psoriasis.

OBJECTIVE: To evaluate the relationship between psoriasis and mental health in patients from different racial backgrounds. METHODS: We performed a nationwide, cross-sectional study evaluating 7,519,662 (weighted) patients, comparing White patients versus patients with skin of color (SOC), using the 2004-2017 Medical Expenditure Panel Survey (MEPS). RESULTS: Psychological distress (measured by Kessler 6-Item Psychological Distress Scale) was similar between White and SOC patients (4.132 [95% CI,3.679-4.586] and 3.710 [95% CI,2.932-4.488], P=0.407). Depression (measured by Patient Health Questionnaire 2) was similar between White and SOC patients (0.886 [95% CI,0.744-1.027] and 0.748 [95% CI,0.506-0.989], P=0.385). Overall mental health (measured by Mental Component Summary) was similar between White and SOC patients (49.959 [95% CI,48.979-50.939] and 50.257 [95% CI,48.449-52.065], P=0.789). Perceived mental health state (measured by Perceived Mental Health Status) was similar between White and SOC patients (2.159 [95% CI,2.065-2.253] and 2.103 [95% CI,1.911-2.294], P=0.603). CONCLUSION: There were no significant differences in mental health outcome scores between White and SOC patients with psoriasis. Clinicians should screen for and manage mental health comorbidities in psoriasis patients of all racial backgrounds.

Are we contributing to the opioid epidemic? A systematic review on systemic opioid use in dermatology.

BACKGROUND: Although dermatologists treat many painful skin conditions and perform procedures that may require analgesic use, there is a lack of evidence synthesis on opioid use in dermatology. OBJECTIVE: To conduct a systematic review of the evidence on the use of opioid analgesics in dermatology. METHODS: We applied the PRISMA guidelines and systematically reviewed literature that examined opioid use in dermatology published between 1980 and 2020 in the PubMed, EMBASE, and Cochrane databases. This review was registered with PROSPERO (CRD42020204864). RESULTS: We identified 24 studies that analyzed 52,705,201 patients and 13,099 dermatologists. Between 34% and 87.5% of patients received opioids following dermatologic procedures; however, many did not use the entirety of their prescriptions, and 35-69% did not use any of their prescription. Top opioid prescribers were more likely to be Mohs surgeons, male, and practice in the South. Variability exists in the current evidence for opioid prescribing for nonprocedural dermatologic disease. CONCLUSION: While opioid prescribing in dermatology is low compared with other specialties, patients are not utilizing the entirety of their prescriptions. Opioid prescribing for nonprocedural dermatologic disease varies; treatments focused on targeting the pathogenesis of these diseases is important to minimize opioid use. Dermatologists should consider limiting opioid prescribing and utilizing nonnarcotic analgesics.

Study design of BETTER-BP: Behavioral economics trial to enhance regulation of blood pressure.

Background: Nonadherence to antihypertensive medications remains a persistent problem that leads to preventable morbidity and mortality. Behavioral economic strategies represent a novel way to improve antihypertensive medication adherence, but remain largely untested especially in vulnerable populations which stand to benefit the most. The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) was designed in this context, to test whether a digitally-enabled incentive lottery improves antihypertensive adherence and reduces systolic blood pressure (SBP). Design: BETTER-BP is a pragmatic randomized trial conducted within 3 safety-net clinics in New York City: Bellevue Hospital Center, Gouveneur Hospital Center, and NYU Family Health Centers - Park Slope. The trial will randomize 435 patients with poorly controlled hypertension and poor adherence (<80% days adherent) in a 2:1 ratio (intervention:control) to receive either an incentive lottery versus passive monitoring. The incentive lottery is delivered via short messaging service (SMS) text messages that are delivered based on (1) antihypertensive adherence tracked via a wireless electronic monitoring device, paired with (2) a probability of lottery winning with variable incentives and a regret component for nonadherence. The study intervention lasts for 6 months, and ambulatory systolic blood pressure (SBP) will be measured at both 6 and 12 months to evaluate immediate and durable lottery effects. Conclusions: BETTER-BP will generate knowledge about whether an incentive lottery is effective in vulnerable populations to improve antihypertensive medication adherence. If successful, this could lead to the implementation of this novel strategy on a larger scale to improve outcomes.

Bullous Dermatoses and Depression: A Systematic Review.

IMPORTANCE: There is a lack of evidence synthesis on the association between bullous skin disease and depression. OBJECTIVE: To synthesize and interpret the current evidence on the association between bullous skin disease and depression. EVIDENCE REVIEW: This review was conducted according to PRISMA guidelines and reviewed literature related to bullous skin disease and depression in the PubMed, Embase, PsycInfo, and Cochrane databases published between 1945 and February 2021. The quality of each included article was assessed via the Newcastle-Ottawa Scale. This review was registered with PROSPERO (CRD42021230750). FINDINGS: A total of 17 articles were identified that analyzed a total of 83 910 patients (55.2% female; specifically, 6951 patients with bullous pemphigoid, 1669 patients with pemphigus, and 79 patients with epidermolysis bullosa were analyzed). The prevalence of depressive symptoms among patients with bullous dermatoses ranged from 40% to 80%. The prevalence of depression diagnosis among patients with bullous dermatoses ranged from 11.4% to 28%. CONCLUSIONS AND RELEVANCE: In this systematic review, high rates of depression and depressive symptoms existed among patients with bullous skin disease. Adequate treatment of bullous dermatoses may be associated with a decrease in mental health burden on patients.

The Use of Biologics During the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, there has been considerable discussion regarding the use of biologics in patients with inflammatory skin conditions, such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. This article discusses clinical trial data, real-world evidence, and guidelines and recommendations for biologics that inhibit tumor necrosis factor, interleukin (IL)-12/23, IL-17, IL-23, and IL-4/13 during the COVID-19 pandemic. Across these inflammatory skin conditions, existing data generally suggest that biologics do not seem to increase the risk of COVID-19 infection or worsen COVID-19 outcomes. The impact of biologics on COVID-19 is an area of active exploration.

Malnutrición por exceso, alteraciones de salud mental y autoconcepto en población infanto-juvenil: revisión integrativa / Malnutrition due to excess, mental health disorders and self-concept in children and adolescents: an integrative review / Desnutrição por excesso, transtornos mentais e autoconceito em crianças e adolescentes: uma revisão integrativa

Introducción: Tanto la malnutrición por exceso como enfermedades de salud mental han afectado a los jóvenes y se ha buscado conocer cómo repercuten entre sí. El objetivo de esta revisión fue determinar si la malnutrición por exceso afecta la salud mental y/o el autoconcepto de la población infanto-juvenil. Material y método: Se realizó una revisión integrativa de la literatura en el período comprendido entre los años 2016 a 2021 a través de las bases de datos: PubMed, LILACS y EBSCO. Se identificaron 3.985 artículos de forma inicial, en donde sólo 9 cumplían criterios de inclusión y exclusión, dentro de los cuales destaca la disponibilidad del texto completo de forma gratuita o mediante las bases de datos de la Universidad Nacional Andrés Bello. Resultados: Los niños/adolescentes diagnosticados con problemas de malnutrición por exceso experimentan dificultades psicosociales por su autopercepción, dependiendo no sólo de su condición física, sino también de factores socioeconómicos, familiares y sociales, estableciéndose una relación directa bidireccional. Discusión: A partir de la primera infancia se adquieren ciertas pautas de comportamiento y aprendizajes que guían las conductas de cada individuo, dentro de estas pautas se encuentran los estereotipos de género, estándares de belleza implantados por la sociedad y medios de comunicación, estos se encuentran directamente relacionados con los problemas de autopercepción y autoestima presentes en la población infanto-juvenil, afectando en mayor porcentaje al género femenino. Conclusión: Los profesionales de Enfermería deben intervenir desde temprana edad en la promoción y prevención de la salud física y mental en la población infanto-juvenil.

Introduction: Both malnutrition due to excess and mental health diseases have affected young people and it has been sought to know how they affect each other. The objective of this review was to determine if malnutrition due to excess affects the mental health and/or self-concept of the child and adolescent population. Material and method: An integrative review of the literature was carried out in the period between 2016 and 2021 through the databases: PubMed, LILACS and EBSCO. Initially, 3,985 articles were identified, where only 9 met inclusion and exclusion criteria, among which the availability of the full text for free or through the databases of the Universidad Nacional Andrés Bello stands out. Results: Children/adolescents diagnosed with problems of malnutrition due to excess experience psychosocial difficulties due to their self-perception, depending not only on their physical condition, but also on socioeconomic, family and social factors, establishing a direct bidirectional relationship. Discussion: From early childhood certain patterns of behavior and learning are acquired that guide the behavior of each individual, within these guidelines are gender stereotypes, beauty standards implemented by society and the media, these are directly related to the problems of self-perception and self-esteem present in the child-juvenile population, affecting the female gender in a greater percentage. Conclusion: Nursing professionals should intervene from an early age in the promotion and prevention of physical and mental health in the child and adolescent population.

Introdução: Tanto a desnutrição por excesso quanto as doenças de saúde mental têm afetado os jovens e tem-se procurado saber como elas afetam umas às outras. O objetivo desta revisão foi de-terminar se a desnutrição por excesso afeta a saúde mental e/ou autoconceito da população infantil e adolescente. Material e método: Foi realizada uma revisão integrativa da literatura no período entre 2016 e 2021 por meio das bases de dados: PubMed, LILACS e EBSCO. Inicialmente, foram identificados 3.985 artigos, onde apenas 9 atenderam aos critérios de inclusão e exclusão, dentre os quais se destaca a disponibilização do texto completo gratuitamente ou por meio das bases de dados da Universidade Nacional Andrés Bello. Resultados: As crianças/adolescentes diagnostica-das com problemas de desnutrição por excesso vivenciam dificuldades psicossociais devido à sua autopercepção, dependendo não apenas de sua condição física, mas também de fatores socioeconômicos, familiares e sociais, estabelecendo uma relação direta bidirecional. Discussão: Desde a primeira infância são adquiridos determinados padrões de comportamento e aprendizagem que orientam o comportamento de cada indivíduo, dentro dessas diretrizes estão os estereótipos de gênero, padrões de beleza implementados pela sociedade e pela mídia, estes estão diretamente relacionados aos problemas de autopercepção e autoconhecimento presente na população infanto-juvenil, afetando em maior percentual o gênero feminino. Conclusão: Os profissionais de enfermagem devem intervir desde cedo na promoção e prevenção da saúde física e mental da população infanto-juvenil.