The Potential Uses of Omega-3 Fatty Acids in Dermatology: A Review.

BACKGROUND: A growing interest exists in the relationship between diet and skin disease, with many recent studies identifying a role for omega-3 fatty acids (O3FAs) in various dermatological conditions. OBJECTIVE: Our objective was to identify the spectrum of uses for O3FA supplementation reported in literature and to evaluate the current level of evidence for its clinical application in skin disease prevention and management. METHODS: A search was conducted using Ovid MEDLINE for primary literature that examined O3FA intake and skin health. A manual search of reference lists was performed to identify additional articles for inclusion. RESULTS: A total of 38 studies met eligibility for review, reporting benefits for O3FA supplementation in the treatment of psoriasis, atopic dermatitis, acne, and skin ulcers. Additionally, a reduced incidence of skin cancer and a decrease in the severity of drug-associated mucocutaneous side effects were reported with O3FA supplementation. CONCLUSION: This review yielded many well-studied benefits of O3FA uses in dermatology. Given its high safety profile, low cost, and ease of supplementation, O3FA is a reasonable supplement that may benefit patients wishing to improve inflammatory skin conditions through diet. Areas of particular clinical interest where supplementation may be valuable include O3FAs for systemic UV photoprotection, as well as adjuvant treatment for acne to reduce both inflammatory lesion count and the severity of mucocutaneous side effects associated with isotretinoin use.

The modern management of untreated large (>2 cm) brain metastases: a narrative review.

OBJECTIVE: Our objective was to identify contemporary management options for large brain metastases reported in literature, specifically evaluating local control and risk of toxicity. BACKGROUND: Large brain metastases are typically defined as lesions >2 cm in diameter, and historically conferred poor outcomes due to the high rates of radiation necrosis and less local control in comparison to smaller brain metastases. METHODS: A literature search examining modern management of large brain metastases was performed using ovid-MEDLINE. A total of 18 articles met criteria for review, evaluating single fraction radiosurgery [stereotactic radiosurgery (SRS)] and multi-fraction stereotactic radiation therapy (MFSRT) in both the definitive and post-operative cavity setting, as well as targeted therapies. CONCLUSIONS: Multi-fractionated radiosurgery represents a modern and attractive treatment approach in the definitive management of patients with large brain metastases, with equivalent local control and reduced rates of radionecrosis less than 13% in comparison to single fraction SRS. In cases where surgery is indicated, fractionated cavity radiation should be considered for large tumor bed volumes. More research is needed for the optimal dose and fractionation regimen for optimal tumor control with reduced risk of radiation toxicity, but common regimens include 3-5 fractions while meeting appropriate biologically effective dose (BED) goals. Future areas of interest include targeted therapies in the initial management of brain metastases as well as pre-operative radiation therapy to reduce risk of leptomeningeal disease (LMD).