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BACKGROUND: Rosacea is a chronic, relapsing inflammatory dermatosis predominantly affecting the central face and can result in significant psychosocial impacts. Isotretinoin has been studied for rosacea due to its anti-inflammatory and sebum reduction properties, but its use remains limited likely due to its off-label use and potential adverse events. OBJECTIVE: This systematic review and meta-analysis investigated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the four main types of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea. METHODS: Randomized and non-randomized studies evaluating LDI for rosacea were included. Incomplete studies, non-English studies and case reports were excluded. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation scale. RESULTS: Of 435 studies, and 16 studies involving 1445 patients were included. LDI decreased lesion count (p = 0.03) and erythema (p = 0.01) with large effect [standardized mean difference (SMD) > 0.8]. Compared to topical retinoids and topical antimicrobials, isotretinoin had larger reductions in lesion count (p = 0.03) with moderate effect (SMD > 0.5). Mean lesion count and erythema remained reduced by 70% and 47%, respectively, at 16 weeks after LDI cessation. Relapse rate was 35% at 5.5 months post-isotretinoin, and three patients (0.4%) experienced worsening of rosacea. Three patients (0.4%) experienced serious adverse events. CONCLUSIONS: Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.
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Individuals with chronic spontaneous urticaria (CSU) experience significant sleep disturbances and are at risk of anxiety and depression.
Assuntos
Antialérgicos , Urticária Crônica , Omalizumab , Humanos , Omalizumab/uso terapêutico , Omalizumab/administração & dosagem , Urticária Crônica/tratamento farmacológico , Urticária Crônica/epidemiologia , Antialérgicos/administração & dosagem , Antialérgicos/uso terapêutico , Ansiedade/epidemiologia , Ansiedade/tratamento farmacológico , Depressão/tratamento farmacológico , Depressão/epidemiologia , Transtornos do Sono-Vigília/tratamento farmacológico , Transtornos do Sono-Vigília/epidemiologia , ComorbidadeRESUMO
Pyoderma gangrenosum is a rare neutrophilic dermatosis that results in painful cutaneous ulcers and is frequently associated with underlying hematologic disorders, inflammatory bowel disease, or other autoimmune disorders. Pathogenesis involves an imbalance between proinflammatory and anti-inflammatory mediators, leading to tissue damage from neutrophils. First-line treatment options with the greatest evidence include systemic corticosteroids, cyclosporine, and tumor necrosis factor alpha inhibitors. Other steroid-sparing therapies such as dapsone, mycophenolate mofetil, intravenous immunoglobulin, and targeted biologic or small molecule inhibitors also have evidence supporting their use. Wound care and management of underlying associated disorders are critical parts of the treatment regimen.
Assuntos
Pioderma Gangrenoso , Úlcera Cutânea , Humanos , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/patologia , Imunossupressores/uso terapêutico , Ciclosporina/uso terapêutico , Corticosteroides/uso terapêuticoAssuntos
Doenças Autoimunes , Doenças do Tecido Conjuntivo , Pioderma Gangrenoso , Humanos , Pioderma Gangrenoso/complicações , Pioderma Gangrenoso/diagnóstico , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/imunologia , Doenças Autoimunes/complicações , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnósticoAssuntos
Procedimentos de Cirurgia Plástica , Neoplasias Cutâneas , Humanos , Carcinoma Basocelular/cirurgia , Pavilhão Auricular/cirurgia , Neoplasias da Orelha/cirurgia , Cirurgia de Mohs/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Retalhos Cirúrgicos/transplanteAssuntos
Hipopigmentação , Lúpus Eritematoso Sistêmico , Vitiligo , Humanos , Vitiligo/epidemiologia , ComorbidadeRESUMO
INTRODUCTION: Vaccines for SARS-CoV-2 have been accessible to the public since December 2020. However, only 58.3% of Americans are fully vaccinated as of 5 November 2021. Numerous studies have supported YouTube as a source of both reliable and misleading information during the COVID-19 pandemic. Misinformation regarding the safety and efficacy of COVID-19 vaccines has negatively impacted vaccination intent. To date, the literature lacks a systematic evaluation of YouTube's content on COVID-19 vaccination using validated scoring tools. The objective of this study was to evaluate the accuracy, usability and quality of the most widely viewed YouTube videos on COVID-19 vaccination. METHODS: A search on YouTube was performed on 21 July 2021, using keywords 'COVID-19 vaccine' on a cleared-cache web browser. Search results were sorted by 'views', and the top 150 most-viewed videos were collected and analysed. Duplicate, non-English, non-audiovisual, exceeding 1-hour duration, or videos unrelated to COVID-19 vaccine were excluded. The primary outcome was usability and reliability of videos, analysed using the modified DISCERN (mDISCERN) score, the modified Journal of the American Medical Association (mJAMA) score and the COVID-19 Vaccine Score (CVS). RESULTS: CONCLUSION: As the COVID-19 pandemic evolves, widespread adoption of vaccination is essential in reducing morbidity, mortality, and returning to some semblance of normalcy. Providing high-quality and engaging health information from reputable sources is essential in addressing vaccine hesitancy.
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COVID-19 , Mídias Sociais , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Comunicação , Humanos , Disseminação de Informação/métodos , Pandemias/prevenção & controle , Reprodutibilidade dos Testes , SARS-CoV-2 , Vacinação , Gravação em VídeoAssuntos
Banho de Sol , Indústria da Beleza , Comunicação , Humanos , Prevalência , Raios UltravioletaRESUMO
BACKGROUND: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma. OBJECTIVE: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma. METHODS: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded. RESULTS: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported. LIMITATIONS: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling. CONCLUSION: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.
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Melanose , Ácido Tranexâmico , Administração Cutânea , Ácido Ascórbico/efeitos adversos , Ácido Ascórbico/uso terapêutico , Humanos , Melanose/tratamento farmacológico , Estudos Prospectivos , Ácido Tranexâmico/efeitos adversos , Ácido Tranexâmico/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Topical measures are the mainstay treatment for postinflammatory hyperpigmentation (PIH). Numerous studies have assessed the efficacy of topical medications for the treatment of PIH, but few have evaluated the quality of evidence supporting these topical therapies. We performed a systematic review to evaluate the evidence of topical treatments for PIH. METHODS: We included English-language studies that evaluated topical medications for PIH. We searched PubMed, MEDLINE, and EMBASE from conception to March 29 2021. We used the modified Grading of Recommendations, Assessment, Development and Evaluation scale (GRADE) scale to assess quality of evidence. RESULTS: Forty-seven of 1,224 studies with 1,853 subjects were included. Topical agents with high-quality studies included retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide and plant-derived products. Sunscreens with SPF30 or greater was recommended in almost every study. Common side effects included desquamation, burning, stinging, dryness, and pruritus. CONCLUSIONS: Retinoids, hydroxy acids and broad-spectrum sunscreen were supported by the greatest number of high-quality studies. Ongoing inflammation may be subtle, especially in darker skin phenotypes. Herein, we proposed an evidence-based algorithm for PIH based on the high-quality studies. There is a need to adopt a validated outcome measure for PIH to better compare efficacy between various treatments in future studies.