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2.
WMJ ; 122(2): 146-148, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-37141484

RESUMEN

INTRODUCTION: Fremanezumab is a humanized monoclonal antibody administered through a subcutaneous injection. It is used for treatment of migraines, and occasional injection site reactions have developed after usage. CASE PRESENTATION: This case report describes a nonimmediate injection site reaction on the right thigh of a 25-year-old female patient after starting treatment with fremanezumab. The injection site reaction presented as 2 warm, red annular plaques 8 days following a second injection of fremanezumab and about 5 weeks following the first injection. She was prescribed a 1-month course of prednisone that relieved her symptoms of redness, itching, and pain. DISCUSSION: Similar nonimmediate injection site reactions have been reported before, but this particular injection site reaction was significantly more delayed. CONCLUSIONS: Our case illustrates that injection site reactions to fremanezumab can be delayed after the second dose and may require systemic therapy to alleviate symptoms.


Asunto(s)
Reacción en el Punto de Inyección , Trastornos Migrañosos , Femenino , Humanos , Adulto , Reacción en el Punto de Inyección/tratamiento farmacológico , Anticuerpos Monoclonales/efectos adversos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/diagnóstico , Inyecciones Subcutáneas , Resultado del Tratamiento
3.
Arthritis Care Res (Hoboken) ; 75(8): 1838-1848, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36358025

RESUMEN

OBJECTIVE: Cutaneous lupus erythematosus (CLE), with or without systemic lupus erythematosus (SLE), can be debilitating and cause psychological distress. Belimumab, a monoclonal antibody that inhibits B cell activation, is a Federal Drug Administration-approved SLE medication, but less is known on its use in CLE. Moreover, the time to response after starting belimumab in CLE is unknown, which may lead to premature discontinuation in the absence of early perceivable benefits. Thus, the objectives of this meta-analysis were to examine the efficacy of belimumab, as well as the time to response after starting belimumab in patients with CLE with or without SLE. METHODS: A comprehensive literature search was performed to include studies that examined clinical response in patients with CLE with or without SLE receiving belimumab. A clinical response at 52 weeks in belimumab users versus nonusers was summarized in a random-effects model. Additionally, we calculated the pooled odds ratio (OR) for each consecutive 4-week observation interval to identify time to a clinical response in CLE with or without SLE after starting belimumab. RESULTS: Among 747 screened studies, 14 were included. The pooled odds of clinical response at 52 weeks in belimumab users were 44% higher compared to nonusers (OR 1.44 [95% confidence interval (95% CI) 1.20-1.74], I2  = 0%). A clinical response was first noted after 20 weeks of starting belimumab (OR 1.35 [95% CI 1.01-1.81], I2  = 0%), with a sustained clinical response through 1 year. CONCLUSION: The findings support belimumab as an effective therapy for CLE with SLE. Likewise, the findings inform patient counseling regarding estimates of 20 weeks to achieve a response.


Asunto(s)
Lupus Eritematoso Cutáneo , Lupus Eritematoso Sistémico , Humanos , Resultado del Tratamiento , Índice de Severidad de la Enfermedad , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Cutáneo/diagnóstico , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Inmunosupresores/efectos adversos
6.
Int J Womens Dermatol ; 6(3): 182-185, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32637541

RESUMEN

BACKGROUND: Many patients with inflammatory vulvovaginal skin diseases, such as lichen planus and lichen sclerosus, experience a delay in diagnosis and lack of appropriate treatment. Unfortunately, patients experience significant morbidity with these conditions. OBJECTIVE: The aim of this study was to assess the adequacy of training in vulvar dermatoses for dermatology and obstetrics-gynecology residents (in the United States), with a secondary goal of identifying the most ideal modality to broadly reach these residents with high quality instruction. METHODS: We created a survey with questions relating to attitudes about training in vulvovaginal disease, quantity of current education on the subject, and opinions on ways to improve training. The survey was distributed to obstetrics-gynecology and dermatology residents and program directors nationwide. RESULTS: Most respondents reported that training was not adequate in this area and that additional education was needed. CONCLUSION: We propose that online, interactive, case-based learning modules, created by vulvovaginal experts, could help improve graduate medical education and lead to better patient outcomes.

7.
Clin Dermatol ; 37(4): 373-378, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31345326

RESUMEN

Basal cell carcinoma (BCC) is the most commonly diagnosed type of skin cancer. BCCs are especially prevalent in the elderly population, given their association with cumulative sun exposure and other risk factors. In this contribution, we outline geriatric concepts related to the care of older adults with BCCs. We describe how a patient's life expectancy can be estimated and combined with tumor characteristics to determine lag time to benefit, a concept to better understand whether patients will experience the efficacy of a treatment within their life span. We also review the possibility of current BCC overdiagnosis and summarize the effectiveness, benefits, and risks of common treatments for BCCs, noting that all treatment modalities have special considerations when administered to older adults. In particular, nonsurgical treatments might be preferable for older adults with a limited life expectancy. Ultimately, we argue that the decision of whether and how to treat a BCC should be the result of shared decision-making between the provider and the patient and take into account not only tumor characteristics, but also patient values and preferences.


Asunto(s)
Carcinoma Basocelular/terapia , Neoplasias Cutáneas/terapia , Factores de Edad , Anciano , Envejecimiento , Humanos , Medición de Riesgo , Resultado del Tratamiento
8.
J Grad Med Educ ; 10(3): 269-275, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29946382

RESUMEN

BACKGROUND: Minimally anchored Standard Rating Scales (SRSs), which are widely used in medical education, are hampered by suboptimal interrater reliability. Expert-derived frameworks, such as the Accreditation Council for Graduate Medical Education (ACGME) Milestones, may be helpful in defining level-specific anchors to use on rating scales. OBJECTIVE: We examined validity evidence for a Milestones-Based Rating Scale (MBRS) for scoring chart-stimulated recall (CSR). METHODS: Two 11-item scoring forms with either an MBRS or SRS were developed. Items and anchors for the MBRS were adapted from the ACGME Internal Medicine Milestones. Six CSR standardized videos were developed. Clinical faculty scored videos using either the MBRS or SRS and following a randomized crossover design. Reliability of the MBRS versus the SRS was compared using intraclass correlation. RESULTS: Twenty-two faculty were recruited for instrument testing. Some participants did not complete scoring, leaving a response rate of 15 faculty (7 in the MBRS group and 8 in the SRS group). A total of 529 ratings (number of items × number of scores) using SRSs and 540 using MBRSs were available. Percent agreement was higher for MBRSs for only 2 of 11 items-use of consultants (92 versus 75, P = .019) and unique characteristics of patients (96 versus 79, P = .011)-and the overall score (89 versus 82, P < .001). Interrater agreement was 0.61 for MBRSs and 0.51 for SRSs. CONCLUSIONS: Adding milestones to our rating form resulted in significant, but not substantial, improvement in intraclass correlation coefficient. Improvement was inconsistent across items.


Asunto(s)
Acreditación , Competencia Clínica , Evaluación Educacional/métodos , Recuerdo Mental , Educación de Postgrado en Medicina/organización & administración , Docentes Médicos/organización & administración , Femenino , Humanos , Internado y Residencia/organización & administración , Masculino , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Grabación de Cinta de Video
9.
J Grad Med Educ ; 10(6): 657-664, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30619523

RESUMEN

BACKGROUND: Geriatric patients account for a growing proportion of dermatology clinic visits. Although their biopsychosocial needs differ from those of younger adults, there are no geriatrics training requirements for dermatology residency programs. OBJECTIVE: This study explored the state of geriatrics education in dermatology programs in 2016. METHODS: This constructivist study employed cross-sectional, mixed-methods analysis with triangulation of semistructured interviews, surveys, and commonly used curricular materials. We used purposive sampling of 5 US academic allopathic dermatology programs of different sizes, geographic locations, and institutional resources. Participants were interviewed about informal curricula, barriers, and suggestions for improving geriatrics education, and they also completed a survey about the geriatrics topics that should be taught. The constant comparative method with grounded theory was used for qualitative analysis. We identified formal geriatrics curricular content by electronically searching and counting relevant key texts. RESULTS: Fourteen of 17 participants (82%) agreed to be interviewed, and 10 of 14 (71%) responded to the survey. Themes of what should be taught included diagnosing and managing skin diseases common in older adults, holistic treatment, cosmetic dermatology, benign skin aging, and the basic science of aging. Topics currently covered that could be expanded included communication, systems-based challenges, ethical issues, safe prescribing, quality improvement, and elder abuse. Cosmetic dermatology was the most commonly taught formal geriatrics curricular topic. CONCLUSIONS: There were discrepancies among topics participants felt were important to teach about geriatric dermatology and curricular coverage of these areas. We identified challenges for expanding geriatrics curricula and potential solutions.


Asunto(s)
Curriculum/normas , Dermatología/educación , Geriatría/educación , Internado y Residencia/normas , Estudios Transversales , Educación de Postgrado en Medicina/métodos , Humanos , Evaluación de Necesidades , Encuestas y Cuestionarios , Estados Unidos
10.
Dermatol Online J ; 23(3)2017 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-28329519

RESUMEN

TNF-α-inhibitors are known to induce skin adverseeffects including psoriasis and alopecia areata. Here, wedescribe a unique pattern of hair loss that has psoriaticand alopecia areata-like features. Diagnosis requiresclinical-pathologic correlation and is supportedby increased catagen/telogen hairs, psoriasiformepidermal hyperplasia, perifollicular lymphocyticinfiltrate, and the presence of eosinophils and plasmacells. Although there are no treatment consensusguidelines, management options include stoppingtherapy, switching to a different TNF-α inhibitor orustekinumab (in severe cases), or continuing TNF-αinhibitor therapy with addition of topical, intralesional,or systemic immunosuppressants.


Asunto(s)
Adalimumab/efectos adversos , Alopecia/inducido químicamente , Antirreumáticos/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Alopecia/diagnóstico , Alopecia/tratamiento farmacológico , Alopecia/patología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Triamcinolona/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto Joven
11.
Dermatol Online J ; 22(3)2016 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-27136633

RESUMEN

It is known that eosinophilic fasciitis can be associated with monoclonal gammopathy. There is clinical similarity between eosinophilic fasciitis and morphea profunda, but it is unclear whether morphea profunda might be associated with monoclonal gammopathy. The temporal quantification of gammopathy in morphea profunda has not been well characterized. We describe four patients with morphea profunda that were associated with monoclonal gammopathy. Three were associated with monoclonal IgG protein and one with IgM. No patients in our series developed myeloma. In conclusion, the association of monoclonal gammopathy is not unique to eosinophilic fasciitis and scleromyxedema. Further studies are necessary to characterize further the relationship between the two conditions.


Asunto(s)
Gammopatía Monoclonal de Relevancia Indeterminada/complicaciones , Esclerodermia Localizada/complicaciones , Adulto , Anciano , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Masculino , Persona de Mediana Edad , Gammopatía Monoclonal de Relevancia Indeterminada/inmunología , Esclerodermia Localizada/patología , Piel/patología
13.
Ann Intern Med ; 163(8): 647-8, 2015 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-26502127
16.
Dermatol Surg ; 40(8): 906-11, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25022709

RESUMEN

BACKGROUND: Little is known about postoperative opioid prescribing patterns among dermatologic surgeons. OBJECTIVE: To better understand postoperative opioid prescribing patterns among dermatologic surgeons in the United States. MATERIALS AND METHODS: Two-part analysis consisting of a retrospective chart review of 233 dermatologic surgery patients at a single institution and an e-mail survey of American Society for Dermatologic Surgery (ASDS) members. RESULTS: (1) Retrospective review: 35% (82/233) of the patients received an opioid prescription. Larger defect size, repair of the defect, perioral and nasal site, and surgeon A or B performing surgery predicted opioid prescription. (2) E-mail survey: 556 ASDS members practicing within the United States responded. Sixty-four percent (357/556) reported prescribing opioids after ≤10% of cases. Surgeons younger than 55 years old, male surgeons, and surgeons in the southern and western United States were more likely to prescribe opioids after >10% of cases. Seventy-six percent (397/520) believed patients used ≤50% of the opioid pills prescribed. CONCLUSION: The retrospective review suggests that opioid prescribing is predicted by characteristics of the surgery (i.e., size, defect repair type, and anatomic location) and characteristics of the surgeon (i.e., age, sex, and practice location) with significant heterogeneity in prescribing habits. The national survey results raise the possibility that patients might not take all prescribed opioid pills after dermatologic surgery. Further investigation is warranted to determine how patients are actually using prescription pain pills to balance pain control with patient safety.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Neoplasias Faciales/cirugía , Cirugía de Mohs/efectos adversos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Neoplasias Cutáneas/cirugía , Acetaminofén/uso terapéutico , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Codeína/uso terapéutico , Combinación de Medicamentos , Femenino , Encuestas de Atención de la Salud , Humanos , Hidrocodona/uso terapéutico , Masculino , Melanoma/cirugía , Persona de Mediana Edad , Oxicodona/uso terapéutico , Dolor Postoperatorio/etiología , Ubicación de la Práctica Profesional , Estudios Retrospectivos , Factores Sexuales , Sociedades Médicas , Estados Unidos
17.
J Am Med Dir Assoc ; 14(10): 724-30, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23664020

RESUMEN

There is a paucity of data to guide evidence-based treatment decisions in managing older dermatologic patients, in part because of the frequent exclusion of older adults from clinical trials. Hence, we provide a comprehensive review of important conditions in geriatric dermatology, or "dermatogeriatrics." It is our hope the field of "dermatogeriatrics" will become more evidence-based and recognized as a field in its own right so that we can better meet the needs of our growing numbers of older patients, now and in the future.


Asunto(s)
Envejecimiento de la Piel/fisiología , Inmunidad Adaptativa/fisiología , Anciano , Anciano de 80 o más Años , Epidermis/fisiología , Vacuna contra el Herpes Zóster , Humanos , Inmunidad Innata/fisiología , Enfermedades de la Piel/fisiopatología , Enfermedades de la Piel/terapia , Cicatrización de Heridas/fisiología
18.
J Am Acad Dermatol ; 68(4): 521.e1-521.e10, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23522421

RESUMEN

Issues related to prescribing dermatologic drugs in the elderly are less recognized than age-related skin findings. This is related in part to the lack of a standardized residency training curriculum in geriatric dermatology. As the number of elderly patients rises in the United States, drug-related iatrogenic complications will become increasingly important. This review discusses age-related changes in pharmacokinetics and pharmacodynamics of common dermatologic drugs. These changes include volume of distribution, renal function, liver toxicity from interactions of commonly prescribed drugs, and medications that can decompensate cognition in the older patient population. We outline seven prescribing principles related to older dermatology patients, including useful strategies to reduce polypharmacy and improve drug adherence, using an evidence-based approach whenever possible.


Asunto(s)
Enfermedades de la Piel/tratamiento farmacológico , Factores de Edad , Anciano , Dermatología , Geriatría , Humanos , Polifarmacia , Guías de Práctica Clínica como Asunto
19.
J Am Acad Dermatol ; 68(4): 533.e1-533.e10, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23522422

RESUMEN

Cutaneous signs may be the most visible hint of elder mistreatment. Dermatologists are in a unique position to recognize and report physical abuse and neglect in the older patient population. In this review, we describe the scope and impact, risk factors, cutaneous signs, and appropriate responses to suspected elder mistreatment. There is a critical need for additional evidence to inform clinical practice in the field of elder abuse and neglect. Recognition and reporting of suspected elder mistreatment by the dermatologist can be life-saving for the older patient.


Asunto(s)
Abuso de Ancianos/diagnóstico , Enfermedades de la Piel/diagnóstico , Piel/lesiones , Anciano , Dermatología , Humanos , Guías de Práctica Clínica como Asunto , Factores de Riesgo
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