Update on antibacterial soaps: the FDA takes a second look at triclosans.

In December of 2013 the Food and Drug Administration announced it would look further into the safety and efficacy of the biocide triclosan and requested further safety data as part of a new review with the Environmental Protection Agency. The use of triclosan has increased exponentially since its introduction in in 1972, to the point that 75% of commercial soap brands contain triclosan and 76% of a nationwide sample of adults and children excrete triclosan in the urine. This announcement raised an important dialog about the appropriate use of all over the counter biocides. Particular concerns include whether these biocides are more effective than regular soaps, whether they may create new drug resistant bacteria, and whether they may also act as hormone disruptors in humans or the environment.

News, views, and reviews. Less may be more for MRSA: the latest on antibiotics, the utility of packing an abscess, and decolonization strategies.

The management of skin infections has evolved over time and new evidence suggests that less acute intervention may be as good or better. For acute treatment, evidence from the emergency medicine literature shows that empiric oral antibiotics may not improve outcomes relative to incision and drainage alone. The use of packing material for wounds after draining does not lead to a decreased rate of recurrence, more rapid healing, or fewer physician visits, but does cause more pain. For patients with multiple or recurrent skin and soft tissue infections, a comprehensive decolonization or eradication strategy is the most effective at preventing further recurrences. Several decolonization approaches exist and can be tailored to find the most appropriate for a particular individual.

News, views, and reviews. Carrots before sticks: appealing to vanity promotes sun protection.

Daily broad-spectrum sunscreen use is an important intervention to prevent squamous cell carcinoma and invasive melanoma. Now dermatologists can feel confident confirming that it prevents photoaging in middle aged adults as well. A new randomized trial from Australia confirms that consistent use of broad-spectrum sunscreen can slow photoaging in adults in as little as four years in middle-aged adults. Because young adults respond better to anti-aging messages than anti-cancer messages regarding sun exposure, this data may help motivate younger patients to avoid indoor tanning and pursue consistent sun protection. Visual examples of aging over time are particularly effective for teens and young adults.

Chronic urticaria: omalizumab and review of therapeutic options.

Chronic idiopathic urticaria is a rare but significantly life-altering skin disease. Recent developments in immunology have promoted our understanding of its autoimmune pathology, but treatment options have not yet developed at the same pace. When antihistamines aren't sufficient, the next steps for treatment have less evidence for support. Fortunately, a Phase III clinical trial has shown that the monoclonal antibody omalizumab, approved for use in asthma, can reduce symptoms of chronic idiopathic urticaria when added to maximal doses of H1-antihistamines. Therapeutic options for chronic idiopathic urticaria are reviewed.

Truth or fiction: risk factors for childhood atopic dermatitis.

Atopic dermatitis is increasing in prevalence throughout the developed world, in parallel with asthma and hay fever. The reasons for the increase remain unclear. As a practical question, it is valuable to understand which interventions might decrease risk for childhood atopic disease. Prospective studies among infants and children are challenging to design and to execute. Fortunately, several large studies from Europe and the United States are better characterizing whether behavioral interventions such as breastfeeding, delayed introduction of solid foods, hydrolyzed protein infant formulas, or pets in the home might be protective or impart increased risk of developing atopic dermatitis. As this body of literature grows, physicians will be able to recommend behavioral interventions that can prevent atopic dermatitis in individuals and ideally decrease prevalence over the population.

Merkel cell carcinoma: banal-appearing, aggressive actor.

Merkel cell carcinoma is a rare but often deadly cutaneous malignancy. It carries a 40 percent five-year mortality rate, in contrast to 15 percent for malignant melanoma, and the incidence is increasing among older and immunosuppressed patients. Dermatologists need to be aware of the particular diagnostic and treatment challenges as the incidence increases. New data is helping to identify patients most at risk, accurately stage the tumor and to optimize treatment regimens. With the recent discovery of a virus as part of the etiology of this tumor, approaches to use the body's immune system to attack the tumor have potential to significantly increase survival rates in the future. Merkel Cell carcinoma (MCC) is a rare but aggressive cutaneous malignancy. Its aggressive behavior, combined with its asymptomatic clinical presentation, means that tumors are often allowed to grow and spread before detection. As the tumor becomes better characterized and its etiology better understood, research is rapidly advancing in both pathogenesis and treatment. Since the discovery of a viral etiology for this tumor in 2008, progress is advancing rapidly.