Fifty-second issue
January 24, 2024
Get “psyched” about the lack of psychiatric risks of isotretinoin!
It has been hypothesized that isotretinoin, a commonly prescribed oral acne medication used to treat severe acne vulgaris, may increase risk of suicide or other psychiatric disorders. This meta-analysis, which included 25 studies and 1,625,891 patients, sought to clarify the absolute and relative risks for suicide and psychiatric conditions associated with isotretinoin use.
What did they find?
Limitations: Meta-analyses for various outcomes were limited by imprecision. Also, the majority of studies included in the analysis for RR only adjusted for age and sex, not other confounders. There may be incident psychiatric disorders that were missed. All studies were subject to confounding by indication and detection bias of psychiatric conditions.
Main Takeaway: There is no epidemiological evidence to indicate an increased risk of suicide or psychiatric conditions in patients using isotretinoin.
It has been hypothesized that isotretinoin, a commonly prescribed oral acne medication used to treat severe acne vulgaris, may increase risk of suicide or other psychiatric disorders. This meta-analysis, which included 25 studies and 1,625,891 patients, sought to clarify the absolute and relative risks for suicide and psychiatric conditions associated with isotretinoin use.
What did they find?
- 1-year absolute risk (AR) of…
- Completed suicide, suicide attempt, suicidal ideation, and self-harm among isotretinoin users was less than 0.5% each (95% CI, 2.45-5.93; I2 = 77%)
- Depression was 3.83% (95% CI, 2.45-5.93; I2 = 77%)
- Isotretinoin was not associated with increased risk of any psychiatric disorder (RR, 1.08; 95% CI, 0.99-1.19; I2 = 0%)
- Isotretinoin users were less likely to to attempt suicide 2-4 years following treatment compared to non-users
- 2 years (RR, 0.92; 95% CI, 0.84-1.00; I2 = 0%)
- 3 years (RR, 0.86; 95% CI, 0.77-0.95; I2 = 0%)
- 4 years (RR, 0.85; 95% CI, 0.72-1.00; I2 = 23%)
Limitations: Meta-analyses for various outcomes were limited by imprecision. Also, the majority of studies included in the analysis for RR only adjusted for age and sex, not other confounders. There may be incident psychiatric disorders that were missed. All studies were subject to confounding by indication and detection bias of psychiatric conditions.
Main Takeaway: There is no epidemiological evidence to indicate an increased risk of suicide or psychiatric conditions in patients using isotretinoin.
Berdazimer gel for molluscum contagiosum: An integrated analysis of 3 randomized controlled trials
Journal of American Academy Dermatology
Journal of American Academy Dermatology
Mollusum meltdown? Try Berdazimer for berdazzling skin– from the comfort of home!
Molluscum contagiosum (MC) is a common viral skin infection that primarily affects children, characterized by small, skin-colored to pink dome-shaped umbilicated papules. Treatment for MC varies due to the absence of standardized guidelines. Berdazimer gel, a topical antiviral, nitric-oxide releasing medication, has been proposed as a potential self-applied topical treatment for MC.
This integrated analysis of three randomized controlled trials (B-SIMPLE -1, -2, and -4; n=1598) sought to evaluate the efficacy and safety of berdazimer gel, 10.3% applied once daily to MC lesions for 12 weeks. The primary endpoint was the percentage of patients with complete clearance of all treatable MC lesions at week 12.
What did they find?
· At week 12, 30.0% of patients treated with berdazimer gel achieved complete clearance of MC lesions, compared to 19.8% in the vehicle group (OR: 1.75; 95% CI: 1.38-2.23; P < 0.001)
· Subgroup analyses of percent change from baseline in MC lesion count at week 12 demonstrated favorable efficacy for berdazimer across all subgroups analyzed, except for Black or African American and those with a history of AD
· A statistically significant treatment effect favoring berdazimer was observed in complete clearance rates over time, beginning as early as week 4
· The most common adverse events were application site pain (18.7%) and erythema (11.7%)
Main Takeaway: Berdazimer gel (10.3%) demonstrated favorable efficacy in achieving complete and partial clearance of MC lesions compared to vehicle at week 12, suggesting its potential to be the first self-applied treatment indicated for MC.
Molluscum contagiosum (MC) is a common viral skin infection that primarily affects children, characterized by small, skin-colored to pink dome-shaped umbilicated papules. Treatment for MC varies due to the absence of standardized guidelines. Berdazimer gel, a topical antiviral, nitric-oxide releasing medication, has been proposed as a potential self-applied topical treatment for MC.
This integrated analysis of three randomized controlled trials (B-SIMPLE -1, -2, and -4; n=1598) sought to evaluate the efficacy and safety of berdazimer gel, 10.3% applied once daily to MC lesions for 12 weeks. The primary endpoint was the percentage of patients with complete clearance of all treatable MC lesions at week 12.
What did they find?
· At week 12, 30.0% of patients treated with berdazimer gel achieved complete clearance of MC lesions, compared to 19.8% in the vehicle group (OR: 1.75; 95% CI: 1.38-2.23; P < 0.001)
· Subgroup analyses of percent change from baseline in MC lesion count at week 12 demonstrated favorable efficacy for berdazimer across all subgroups analyzed, except for Black or African American and those with a history of AD
· A statistically significant treatment effect favoring berdazimer was observed in complete clearance rates over time, beginning as early as week 4
· The most common adverse events were application site pain (18.7%) and erythema (11.7%)
Main Takeaway: Berdazimer gel (10.3%) demonstrated favorable efficacy in achieving complete and partial clearance of MC lesions compared to vehicle at week 12, suggesting its potential to be the first self-applied treatment indicated for MC.
Are pediatric patients with AD at a higher risk of developing metabolic syndrome and NAFLD?
Pediatric Dermatology
Pediatric Dermatology
Scratching the surface: is pediatric eczema more than just an itch?
Atopic dermatitis (AD) is a common inflammatory skin disorder characterized by itchy, dry skin lesions. Research suggests a potential association between AD and metabolic abnormalities, including metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in children. This case-control study of 50 pediatric patients (aged 2 to 18) with AD and 50 age-and sex-matched healthy controls aimed to further understand the relationship between AD, MS, and NAFLD.
What did they find?
· Patients with AD were more likely to have acanthosis nigricans (6%) compared to healthy controls (0%)
· The AD group was also more likely to have elevated systolic blood pressure (12% vs 0% with SBP >90th percentile) and elevated diastolic blood pressure (14% vs 0% with DBP >90th percentile), compared to the healthy control group
· AD patients were more likely to have an elevated BMI (24% vs 8% with BMI >90th percentile) and waist circumference (28% vs 10% with waist circumference >90th percentile)
· Dyslipidemia, including raised triglyceride levels (36% vs 12%), was observed in AD patients, consistent with previous studies showing atherogenic lipid profiles in children with AD
· While there was a notable prevalence of metabolic syndrome (MS) in children with AD compared to controls (24% vs 2%), the study did not find a correlation between disease severity and metabolic abnormalities
· A higher grade 1 NAFLD prevalence was found in AD patients (6% vs 0%), exclusively in the moderate to severe disease group, suggesting a potential link between fatty liver and AD
Main Takeaways: AD is associated with a higher prevalence of high blood pressure, central obesity, elevated triglycerides, and metabolic syndrome. A higher prevalence of NAFLD is associated with moderate to severe AD, emphasizing the importance of metabolic health management for children with AD.
Atopic dermatitis (AD) is a common inflammatory skin disorder characterized by itchy, dry skin lesions. Research suggests a potential association between AD and metabolic abnormalities, including metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in children. This case-control study of 50 pediatric patients (aged 2 to 18) with AD and 50 age-and sex-matched healthy controls aimed to further understand the relationship between AD, MS, and NAFLD.
What did they find?
· Patients with AD were more likely to have acanthosis nigricans (6%) compared to healthy controls (0%)
· The AD group was also more likely to have elevated systolic blood pressure (12% vs 0% with SBP >90th percentile) and elevated diastolic blood pressure (14% vs 0% with DBP >90th percentile), compared to the healthy control group
· AD patients were more likely to have an elevated BMI (24% vs 8% with BMI >90th percentile) and waist circumference (28% vs 10% with waist circumference >90th percentile)
· Dyslipidemia, including raised triglyceride levels (36% vs 12%), was observed in AD patients, consistent with previous studies showing atherogenic lipid profiles in children with AD
· While there was a notable prevalence of metabolic syndrome (MS) in children with AD compared to controls (24% vs 2%), the study did not find a correlation between disease severity and metabolic abnormalities
· A higher grade 1 NAFLD prevalence was found in AD patients (6% vs 0%), exclusively in the moderate to severe disease group, suggesting a potential link between fatty liver and AD
Main Takeaways: AD is associated with a higher prevalence of high blood pressure, central obesity, elevated triglycerides, and metabolic syndrome. A higher prevalence of NAFLD is associated with moderate to severe AD, emphasizing the importance of metabolic health management for children with AD.
TYK2 inhibitors are “tyk”ing all the boxes
Psoriasis is a chronic, inflammatory skin condition. In recent years, there have been significant advancements in therapeutic options for patients with psoriasis. Tyrosine kinase 2 (TYK2) is a cytokine mediator that has been implicated in the pathomechanisms of psoriasis.
In two phase 3 clinical trials, inhibition of TYK2 with deucravacitinib (oral, selective, allosteric inhibitor) was found to be both effective and well-tolerated in patients with moderate to severe plaque psoriasis. In the POETYK long-term extension trial, researchers wanted to evaluate long-term safety and efficacy of deucravacitinib.
What did they find?
-Deucravacitinib taken once daily was effective in management of psoriasis throughout the course of the 2 year study, as measured by PASI scores
-The 2-year safety profile was comparable to the 1-year safety profile in prior clinical trials (similar exposure-adjusted incidence rates for adverse effects)
Main Takeaways: Deucravacitinib continues to be an effective and well-tolerated medication after 2 years of consistent administration.
Psoriasis is a chronic, inflammatory skin condition. In recent years, there have been significant advancements in therapeutic options for patients with psoriasis. Tyrosine kinase 2 (TYK2) is a cytokine mediator that has been implicated in the pathomechanisms of psoriasis.
In two phase 3 clinical trials, inhibition of TYK2 with deucravacitinib (oral, selective, allosteric inhibitor) was found to be both effective and well-tolerated in patients with moderate to severe plaque psoriasis. In the POETYK long-term extension trial, researchers wanted to evaluate long-term safety and efficacy of deucravacitinib.
What did they find?
-Deucravacitinib taken once daily was effective in management of psoriasis throughout the course of the 2 year study, as measured by PASI scores
-The 2-year safety profile was comparable to the 1-year safety profile in prior clinical trials (similar exposure-adjusted incidence rates for adverse effects)
Main Takeaways: Deucravacitinib continues to be an effective and well-tolerated medication after 2 years of consistent administration.
Improved method for cleaning hair follicular grafts for hair transplantation
Journal of American Academy Dermatology
Journal of American Academy Dermatology
A not so hairy situation
Hair transplantation is a surgical procedure where hair follicles are grafted from one part of the body and implanted elsewhere - most commonly to the scalp. Grafts must be cleaned prior to transplantation, despite being fragile. Current cleaning methods may damage the grafts and influence survival. Additionally, current tools are expensive and difficult to sterilize. It was proposed that two square dressing bowls be used in tandem to clean the follicles, as an effective way of keeping the hair follicle intact, while being cost-effective and easy to implement.
How does it work??
Hair transplantation is a surgical procedure where hair follicles are grafted from one part of the body and implanted elsewhere - most commonly to the scalp. Grafts must be cleaned prior to transplantation, despite being fragile. Current cleaning methods may damage the grafts and influence survival. Additionally, current tools are expensive and difficult to sterilize. It was proposed that two square dressing bowls be used in tandem to clean the follicles, as an effective way of keeping the hair follicle intact, while being cost-effective and easy to implement.
How does it work??
- Two disposable square dressing bowls are placed on top of each other The top layer contains poked holes through the base every 2 mm using a 20G needle creating a total of 60 holes
- The follicular graft is placed in the top layer and the bottom layer is filled with 30ml of sterile Ringer’s solution
- The top layer is jiggled to clean the graft, preserving the structure and causing little coagulated blood on its surface
Figure 1. Hair follicle graft cleaning device. The top bowl contains the follicle grafts and bottom bowl contains the Ringer’s solution.
Main Takeaway: This novel technique offers a cheap solution for cleaning grafts. By using readily available material that allows for sterility, the structure of the graft is preserved, increasing survival rate of the hair follicles.
Limitation: There is no quantitative data to exhibit the effectiveness of the technique or the enhanced survival of the grafts.
Main Takeaway: This novel technique offers a cheap solution for cleaning grafts. By using readily available material that allows for sterility, the structure of the graft is preserved, increasing survival rate of the hair follicles.
Limitation: There is no quantitative data to exhibit the effectiveness of the technique or the enhanced survival of the grafts.
Our study explores skin tone representation in dermatomyositis (DM) rashes within medical education materials. Diversity in visual educational materials is crucial for equitable clinical dermatology training.
We reviewed 93 textbooks and 3 online databases (2011–2021), evaluating 621 images. Skin tones were graded on the Massey and Martin Skin Colour Scale (MMSCS). Inter-rater reliability was high (W = 0.835).
Results:
Main Takeaway: Images of lighter skin patients dominate DM-related educational materials, hindering accurate recognition in patients with darker skin tones. This disparity may impact inclusion in clinical trials due to inaccurate skin scoring. Diversifying visuals will enhance clinicians' proficiency in recognizing DM across all skin tones, contributing to more equitable healthcare practices.
We reviewed 93 textbooks and 3 online databases (2011–2021), evaluating 621 images. Skin tones were graded on the Massey and Martin Skin Colour Scale (MMSCS). Inter-rater reliability was high (W = 0.835).
Results:
- Of 561 analyzed images, 73.1% represented MMSCS 1-2, 13.4% MMSCS 3-4, 11.8%
- Online databases had 59.2% MMSCS 5-10 images, while dermatology textbooks contributed 80.6% of MMSCS 5-10 images.
Main Takeaway: Images of lighter skin patients dominate DM-related educational materials, hindering accurate recognition in patients with darker skin tones. This disparity may impact inclusion in clinical trials due to inaccurate skin scoring. Diversifying visuals will enhance clinicians' proficiency in recognizing DM across all skin tones, contributing to more equitable healthcare practices.