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1.
Dermatol Surg ; 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32149872

RESUMO

BACKGROUND: The National Comprehensive Cancer Network (NCCN) has established guidelines for the treatment of keratinocyte carcinomas (KCs). Complete circumferential peripheral and deep margin assessment (CCPDMA) is recommended for "high-risk" tumors that cannot be closed primarily. If flap or grafts are needed and CCPDMA was not used, it is recommended that reconstruction be delayed until achieving clear margins. OBJECTIVE: To measure provider utilization rates of the NCCN guidelines for high-risk KCs and assess barriers that are limiting adherence. MATERIALS AND METHODS: A ten-item questionnaire was distributed to NCCN nonmelanoma skin cancer panel members and physicians participating in KC treatment at academic institutions. RESULTS: Response rate was 49% (57/116). Responses were categorized by practice area: Mohs surgery, pathology, and other specialties: General Dermatology, Otolaryngology, Plastic Surgery, Surgical Oncology, Radiation Oncology, and Oral and Maxillofacial Surgery. Mohs surgeons were most likely to use CCPDMA for tumors meeting NCCN criteria with 14/15 using this technique in a majority of their cases, versus 2/6 pathologists and 10/16 specialists from other fields. Reasons cited for not using CCPDMA included deference to pathologists to determine the appropriate method for margin assessment and logistical difficulty. CONCLUSION: Further efforts are needed to increase adherence to NCCN's guidelines regarding CCPDMA in KCs.

6.
Dermatol Ther (Heidelb) ; 7(2): 227-242, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28526915

RESUMO

INTRODUCTION: Psoriasis patients demonstrate high interest in the role of diet on their skin condition. However, data are lacking to describe dietary interventions among psoriasis patients and associated outcomes. This study aims to identify common dietary habits, interventions and perceptions among patients with psoriasis, and to examine patient-reported skin outcomes in response to these interventions. METHODS: We administered a 61-question survey to the National Psoriasis Foundation membership asking psoriasis patients about dietary habits, modifications, skin responses, and perceptions. RESULTS: A total of 1206 psoriasis patients responded to the survey. Compared to age- and sex-matched controls, psoriasis patients consumed significantly less sugar, whole grain fiber, dairy, and calcium (p < 0.001), while consuming more fruits, vegetables, and legumes (p < 0.01). Eighty-six percent of respondents reported use of a dietary modification. The percentage of patients reporting skin improvement was greatest after reducing alcohol (53.8%), gluten (53.4%), nightshades (52.1%), and after adding fish oil/omega-3 (44.6%), vegetables (42.5%), and oral vitamin D (41%). Specific diets with the most patients reporting a favorable skin response were Pagano (72.2%), vegan (70%), and Paleolithic (68.9%). Additionally, 41.8% of psoriasis respondents reported that a motivation for attempting dietary changes was to improve overall health. CONCLUSION: This national survey is among the first to report the dietary behaviors of patients with psoriasis. The data provided from this large cohort may benefit patients and clinicians as they discuss the role of diet in managing both psoriasis and associated cardiometabolic comorbidities.

7.
J Dermatolog Treat ; 28(6): 523-538, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28043181

RESUMO

BACKGROUND: Patients with atopic dermatitis (AD) commonly turn to dietary modifications to manage their skin condition. OBJECTIVES: To investigate patient-reported outcomes and perceptions regarding the role of diet in AD. METHODS: One hundred and sixty nine AD patients were surveyed in this cross-sectional study. The 61-question survey asked about dietary modifications, perceptions and outcomes. RESULTS: Eighty seven percent of participants reported a trial of dietary exclusion. The most common were junk foods (68%), dairy (49.7%) and gluten (49%). The best improvement in skin was reported when removing white flour products (37 of 69, 53.6%), gluten (37 of 72, 51.4%) and nightshades (18 of 35, 51.4%). 79.9% of participants reported adding items to their diet. The most common were vegetables (62.2%), fish oil (59.3%) and fruits (57.8%). The best improvement in skin was noted when adding vegetables (40 of 84, 47.6%), organic foods (17 of 43, 39.5%) and fish oil (28 of 80, 35%). Although 93.5% of patients believed it was important that physicians discuss with them the role of diet in managing skin disease, only 32.5% had consulted their dermatologist. CONCLUSIONS: Since dietary modifications are extremely common, the role of diet in AD and potential nutritional benefits and risks need to be properly discussed with patients.


Assuntos
Dieta , Medidas de Resultados Relatados pelo Paciente , Adulto , Atitude , Estudos Transversais , Dermatite Atópica/dietoterapia , Dermatite Atópica/patologia , Dermatite Atópica/psicologia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/patologia , Inquéritos e Questionários
9.
Artigo em Inglês | MEDLINE | ID: mdl-27799808

RESUMO

INTRODUCTION: Chronic skin conditions have been well reported to affect a patient's quality of life on multiple dimensions, including the psychosocial domain. Psychosocial is defined as the interrelation of social factors with an individual's thoughts and behavior. The assessment of the psychosocial impact of skin disease on a patient can help direct the dermatologists' treatment goals. To evaluate the psychosocial impact of skin disease, we conducted a review of the literature on three skin conditions with onsets at various stages of life: acne, vitiligo, and psoriasis. METHODS: A PubMed search was conducted in March 2015 using the terms "psychosocial" AND "acne", "psychosocial" AND "vitiligo", and "psychosocial" AND "psoriasis". The results were limited to articles published in English in the past 5 years studying patients of all ages. Results and their references were evaluated for relevance according to their discussion of psychosocial qualities in their patients and the validity of psychosocial assessments. The search for acne yielded 51 results, and eleven were found to be relevant; vitiligo yielded 30 results with ten found to be relevant; and psoriasis yielded 70 results with seven found to be relevant. RESULTS: According to the articles evaluated, 19.2% of adolescent patients with acne were affected in their personal and social lives. Social phobia was present in 45% of patients with acne compared to 18% of control subjects. Race and sex played a role in self-consciousness and social perceptions of the disease. Vitiligo negatively affected marriage potential and caused relationship problems in >50% of patients. Psoriasis negatively affected multiple domains of life, including work, relationships, and social activities. Anxiety and depression affected not only psoriasis patients but also their cohabitants; up to 88% of cohabitants had an impaired quality of life. CONCLUSION: Though all three skin conditions resulted in an increase in anxiety and depression among their patient populations, the psychosocial focus varied slightly for each disease. Overall, acne, vitiligo, and psoriasis can have negative psychosocial impact in different stages of life development.

11.
Clin Dermatol ; 34(3): 314-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27265068

RESUMO

The most recent reclassification of dermatoses of pregnancy includes polymorphic eruption of pregnancy, atopic eruption of pregnancy, and pemphigoid gestationis; intrahepatic cholestasis of pregnancy, strictly not a dermatosis, was included in specific dermatoses of pregnancy for working purposes. Another dermatosis, pustular psoriasis of pregnancy, could be included for similar reasons. The nomenclature of these pregnancy-specific eruptions has been revised several times, generating potential confusion among practitioners. Clouding the picture further are misnomers that have been used to describe dermatoses of pregnancy. In addition, several cutaneous conditions that are associated with, but not specific to, pregnancy, have been misunderstood, which has resulted in certain myths among patients and physicians. In this contribution, we describe how the nomenclature of each dermatosis of pregnancy has evolved to fit the current classification scheme. We then identify several misnomers that have generated confusion within the scheme. Finally, we debunk several myths that have developed around cutaneous conditions outside of this scheme, in both mother and newborn.


Assuntos
Aleitamento Materno , Complicações na Gravidez/classificação , Dermatopatias/classificação , Colestase Intra-Hepática/classificação , Dermatite Atópica/prevenção & controle , Dieta , Feminino , Humanos , Recém-Nascido , Penfigoide Gestacional/classificação , Gravidez , Prurigo/classificação , Psoríase/classificação , Estrias de Distensão/prevenção & controle , Terminologia como Assunto , Urticária/classificação
13.
J Dermatolog Treat ; 27(6): 552-555, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27052387

RESUMO

BACKGROUND: The negative impact of psoriasis on quality of life is well documented. Psoriasis is also associated with impairments in work productivity and daily activities. OBJECTIVES: This study was conducted to prospectively measure the impact of ustekinumab treatment on work productivity and daily activity impairments due to psoriasis, using the Work Productivity and Activity Index: Psoriasis instrument. METHODS: Thirty-two patients with moderate-to-severe plaque psoriasis received 36 weeks of ustekinumab and were followed every 4 weeks. During each visit, patients were evaluated using the Psoriasis Area Severity Index and Work Productivity and Activity Index: Psoriasis instrument. RESULTS: Thirty-two patients completed the study. There was no change in unemployment rate after treatment. Twenty-two patients who were employed at both baseline and week 36 experienced a significant decrease in total work productivity impairment, presenteeism and a non-significant decrease in absenteeism. All patients demonstrated significant reduction in total activity impairment. LIMITATIONS: This study was limited by the lack of a placebo group and a small sample size. CONCLUSIONS: This study demonstrates the benefits of ustekinumab treatment in terms of reducing psoriasis-related work productivity and activity impairments among patients with moderate-to-severe psoriasis.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Eficiência/efeitos dos fármacos , Psoríase/tratamento farmacológico , Ustekinumab/uso terapêutico , Absenteísmo , Atividades Cotidianas , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
14.
J Drugs Dermatol ; 15(3): 272-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26954311

RESUMO

INTRODUCTION: A significant portion of patients with psoriasis have scalp and nail involvement. It has been reported that 40% to 45% of patients with psoriasis have nail psoriasis, and up to 80% have scalp involvement. Nail and scalp psoriasis have often been found to be difficult to treat, due to the poor penetration and poor compliance of topical medication. Oral and biologic therapies have shown significant efficacy but often with undesirable side effects. Herein, we analyze the efficacy of apremilast, an oral phosphodiesterase-4 (PDE-4) inhibitor, in the treatment of nail and scalp psoriasis at 16-, 32-, and 52 weeks. METHODS: We reviewed the results of the phase IIb and phase III clinical trials for apremilast in treating nail and scalp psoriasis. RESULTS: In ESTEEM 1, patients on apremilast showed a 22.5%, 43.6%, and 60.2% improvement in NAPSI at weeks 16, 32, and 52. 33.3%, 45.2%, and 63% of patients achieved NAPSI-50, respectively. In ESTEEM 2, patients on apremilast showed a 29%, 60%, and 59.7% improvement in NAPSI at weeks 16, 32, and 52, with 44.6%, 55.4%, and 68.6% of patients achieving NAPSI-50. In PSOR-005 at week 16, patients on a dose of 30 mg twice weekly had a 42.9% improvement in NAPSI with 45.5% reaching NAPSI-50. For scalp psoriasis, 46.5%, 37.4%, and 73% of patients achieved an Sc-PGA of 0 or 1 at weeks 16, 32, and 52 in ESTEEM 1. In ESTEEM 2, 40.9%, 32.4%, and 62.5% of patients achieved an Sc-PGA of 0 or 1 at weeks 16, 32, and 52. CONCLUSION: With its limited safety profile of only diarrhea and headache and no additional lab requirements, apremilast may be a safer and more convenient alternative for patients with severe nail and scalp psoriasis.


Assuntos
Doenças da Unha/tratamento farmacológico , Inibidores da Fosfodiesterase 4/uso terapêutico , Psoríase/tratamento farmacológico , Dermatoses do Couro Cabeludo/tratamento farmacológico , Talidomida/análogos & derivados , Administração Oral , Doença Crônica , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Método Duplo-Cego , Humanos , Inibidores da Fosfodiesterase 4/administração & dosagem , Inibidores da Fosfodiesterase 4/efeitos adversos , Índice de Gravidade de Doença , Talidomida/administração & dosagem , Talidomida/efeitos adversos , Talidomida/uso terapêutico , Resultado do Tratamento
18.
J Dermatolog Treat ; 27(3): 210-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26329774

RESUMO

A common therapeutic modality for psoriasis includes the combination of phototherapy with topical treatments. The recent development of targeted phototherapy with the excimer laser and spray formulations for topical treatments has increased the efficacy and convenience of these combinational therapies. Herein, we aim to assess the efficacy of a novel combination of therapies using the 308 nm excimer laser, clobetasol propionate spray and calcitriol ointment for the treatment of moderate to severe generalized psoriasis. In this 12-week study, patients with moderate to severe psoriasis received twice weekly treatments with a 308-nm excimer laser combined with clobetasol proprionate twice daily for a month followed by calcitriol ointment twice daily for the next month. Of the 30 patients enrolled, 83% of patients (25/30) achieved PASI-75 [65-94%, 95% confidence interval (CI)] at week 12. For PGA, there was an estimated decrease of 3.6 points (3.1-4.1, 95% CI, p < 0.0005) by week 12. In conclusion, the combination of excimer laser with alternating clobetasol and calcitriol application has shown to be a promising combination of therapies for the treatment of moderate to severe generalized psoriasis. Further evaluation may be conducted with a larger study inclusive of control groups and head-to-head comparisons against topical steroid and UVB therapy as monotherapies.


Assuntos
Calcitriol/administração & dosagem , Agonistas dos Canais de Cálcio/administração & dosagem , Clobetasol/administração & dosagem , Glucocorticoides/administração & dosagem , Lasers de Excimer/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Psoríase/terapia , Administração Tópica , Adulto , Química Farmacêutica , Terapia Combinada , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Pomadas/uso terapêutico , Projetos Piloto , Psoríase/tratamento farmacológico , Psoríase/radioterapia
19.
Dermatol Online J ; 21(10)2015 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-26632808

RESUMO

Over the previous decade, several innovative teaching methods have been introduced to overcome the decreasing allotment of time dedicated to dermatology in U.S. medical school curricula. We report our experience of increasing medical student exposure to clinical dermatology thorough involvement in an extracurricular, volunteer-driven dermatology clinic. The clinic was well received by students and faculty. Our experience demonstrates that volunteer-driven dermatology clinics may be an effective method of teaching and engendering a culture of community outreach among medical students and faculty.


Assuntos
Currículo , Dermatologia/educação , Educação de Graduação em Medicina/métodos , Faculdades de Medicina , Estudantes de Medicina/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Humanos , São Francisco
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