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Oral Antibiotics for Acne: Basic Concepts & Practical Considerations

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Oral Antibiotics for Acne: Basic Concepts & Practical Considerations

Drs. Mahmoud Ghannoum, Emmy Graber & Adam Friedman

 

Antibiotic use for inflammatory skin diseases is a staple in dermatology. Like milk is the answer to a chunky peanut butter sandwich (just go with me on this), so too have tetracycline antibiotics has been married to the management of Acne Vulgaris. And just as that delicious combo comes at a fattening cost, the overuse and abuse of antibiotics has an impressive and significant impact both on the risk for antimicrobial resistance and gut/cutaneous dysbiosis.

To get to the piloseabeous unit of the matter, JDD Podcast host Dr. Adam Friedman picks the brains of AAA experts Dr. Emmy Graber and Dr. Mahmoud Ghannoum to provide a true bench to bedside review of the issues at hand. Pop in to learn how to interpret minimum inhibitory concentrations (MIC), understand newly identified information on dysbiosis (including impaired microbiota), and appreciate the implications of indiscriminate use of broad-spectrum antibiotics in acne therapy including the clinical consequence of antibiotic resistance and benefits of narrow-spectrum agents.

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Learning Objectives
Upon completion of this podcast participants should be able to:
  • Describe the differences between antibiotic types and their use in acne therapy
  • Discuss interpretation and measurement of MIC, resistance and dysbiosis
  • Summarize the clinical implications of antibiotic resistance
  • Summarize the clinical implications of dysbiosis
This enduring activity is supported by an independent medical education grant provided by Almirall, LLC.
Disclosures
Adam Friedman, MD, FAAD – Grant/Research: Aclaris, CPN, Almirall. Consultant: SanovaWorks, Oakstone Institute, L’oreal, La Roche Posay, Galderma, Aveeno, Valeant, Microcures, Biogen, Pfizer, G&W Laboratories, Novartis, Occulus, Intraderm, Encore, Exeltis, Menlo, Lilly, Aclaris, Dermira, Berg, Allergan, Zylo Therapeutics, Hoth. Speakers’ Bureau: Regeneron, Dermira, Janssen, AbbVie. Major Stock Shareholder: Zylo, Minorcures.
Mahmoud Ghannoum, PhD – Grant/Research: Almirall. Consultant: Almirall.
Emmy M. Graber, MD, MBA – Grant/Research: Ortho Dermatologics. Consultant: Almirall, Digital Diagnostics, Sebacia, SolGel. Speakers’ Bureau: Almirall

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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

By Aesthetics, Featured Articles, Psoriasis, The Latest No Comments

Featured Article

Featured Article

Used alone, absorbable suspension sutures offer a dual mechanism of action

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Used alone, absorbable suspension sutures offer a dual mechanism of action

Heather Onorati

As the use of absorbable suspension sutures continues to grow, it’s important for physicians to understand the technique and mechanism of action to optimize their use alone and in combination with other facial aesthetic tools, according to a recent paper published in the Journal of Drugs in Dermatology. 

First, patient selection is central to obtaining optimal results, write authors Sabrina Fabi, M.D., Robert Weiss, M.D., and Susan Weinkle, M.D., in “Absorbable Suspension Sutures: Recommendations for Use in a Multimodal Nonsurgical Approach to Facial Rejuvenation.”

Setting appropriate expectations is also important to an ideal outcome. Patients need to understand that nonsurgical positioning cannot produce the same results as surgery, the authors write, noting a study that demonstrated older patients (those ≤60), were less likely to view absorbable sutures as an effective treatment at 24 months compared with younger patients (those ≤50). Similarly, patients who had received prior surgical treatments were less likely to view absorbable suspension sutures as effective compared with patients who had no experience with surgical treatment.

In their paper, Drs. Fabi, Weiss and Weinkle discuss the mechanism of action for absorbable suspension sutures as well as provide guidance based on their extensive experience for combining absorbable suspension sutures with other nonsurgical modalities, including sequencing and timing.

Used alone, absorbable suspension sutures offer a dual mechanism of action, they write. They lift and stimulate collagen. Based on previous studies of duration, the authors suggest that with optimal technique, most patients should experience a duration of effect up to 24 months.

Through several case studies, the authors illustrate the utility of combining additional therapies, such as filers, toxins and energy-based devices.

When selecting an optimal combination of both sutures and filler, the authors note that it is important to determine whether the patient is in need of volume or tissue repositioning. If a patient has already received filler, absorbable sutures should be used six to 12 weeks later. If treating for residual ptosis, fillers should be placed after the sutures and in a separate anatomical plane or area. For patients naïve to fillers, sutures should be placed six to 12 weeks after filler.

The authors recommend administering toxin two weeks prior to suture placement, because the toxin effect can reduce the mechanical load on the suture and prevent the disengagement of the cones which may improve the lifting effect and duration, they write.

Ideally, treatment with ablative lasers should be performed six weeks prior to suture placement but no less than two weeks prior to allow for resolution of any swelling and inflammation that might interfere with placement. However, treatment with non-ablative lasers and IPL can generally be performed in the same day as suture placement, the authors note. Radiofrequency treatments should be performed four weeks before or after suture placement, they suggest. And, they add, microneedling should be performed at least two weeks before or five to eight weeks after suture placement.

“As the use of absorbable suspension sutures continues to increase, it is important that physicians are aware of how modalities can be safely layered and combined to produce an optimal aesthetic effect.”

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

Discover new clinical findings in  Aesthetics.  View the latest articles, case reports, supplements, CME activities, Podcast episodes and more.
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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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Used alone, absorbable suspension sutures offer a dual mechanism of action Used alone, absorbable suspension sutures offer a dual mechanism of action Heather Onorati As the use of absorbable suspension…

In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional…

February issue highlights new perspectives in chronic skin conditions

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

By Featured Articles, The Latest No Comments

Featured Article

Featured Article

Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

More Psoriasis Articles

Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

Heather Onorati

Successful psoriasis treatment is dependent upon accurate assessment of disease severity; however, a recent survey indicates that dermatologists report a wide variation in cutoffs for moderate disease classification on traditional quantification methods.

Due to the nature and complexity of psoriasis, authors of the survey, reported in the Journal of Drugs in Dermatology, say that a clinically useful definition of moderate plaque psoriasis is necessary to improve patient care.

“Because assessment of severity informs therapeutic decision-making, it is critical to clearly define psoriasis disease severity and offer patients therapy that is appropriate for their condition,” writes Melinda Gooderham, M.D., M.Sc., SKiN Centre for Dermatology, Ontario, Canada, who was the lead author of the report.

In the study, which is detailed in “Dermatologists’ Perspectives on Defining Moderate Psoriasis: The Canadian Moderate Psoriasis Survey,” researchers distributed a survey to 69 dermatologists asking questions about their approach to identifying and managing patients with psoriasis.

Most of the responding dermatologists reported they used the psoriasis-involved body surface area (BSA) and Psoriasis Area and Severity Index (PASI) measures to evaluate a patient’s disease severity. However, BSA has been shown to have a weak correlation with patient perception of psoriasis severity and PASI measure has a tendency to underrepresent involvement of areas such as the scalp, nail, genital and palmoplantar areas, the authors report. Therefore, these traditional measures may not adequately capture psoriasis impact on quality of life.

In using traditional classification methods, respondents reported cutoff ranges varying from 5% to 5.3% (mean) for the lower end of the BSA and 10% to 11.5% (mean) on the upper end. Similarly, the lower and upper cutoff ranges for the PASI, Dermatology Life Quality Index (DLQI) and the Physicians Global Assessment (PGA) were reported at 6 to 6.3 (mean)  and 12 to 12.2 (mean), 7 to 7.3 (mean) and 11.5 to 13.0 (mean), and 2 to 2.2 and 3 to 3.2 (mean), respectively.

Dr. Palm and colleagues retrospectively reviewed the medical records of 1,002 patients who received 4,483 treatments over about 12 years to evaluate the safety of Sculptra Aesthetic at reconstitution volumes of 7-10 mL based on noted adverse events. Questionnaires were also completed by 32 injectors about their general injection procedures.

According to the review, treatments were most commonly performed in the midface/cheek, temple and jawline areas, and about half of the patients received three or four treatments during the study period. Patients averaged about 0.51-1.50 vials per treatment, which was not affected by age. All of the injectors questioned indicated they added lidocaine to their solution, which resulted in final reconstitution volumes of 8-10 mL. Mild adverse events were reported by only 36 patients (3.6%), the most common being injection site bruising and ecchymosis. Only four patients reported nodules, which were resolved with follow-up.

More than three quarters (78%) of the dermatologists in this survey estimated that less than 40% of their patients with moderate plaque psoriasis were being treated with traditional systemic therapies.

According to the authors, more than one-third of patients with psoriasis were classified as having moderate disease in the US National Psoriasis Foundation national survey data. Among patients with moderate psoriasis, more than half reported dissatisfaction with their treatment.

“Despite these efforts to classify psoriasis disease severity, psoriasis categories are often combined or collapsed for diagnostic, research, and therapeutic purposes, which may leave therapeutic needs of patients with moderate psoriasis unmet,” the authors write. “It is therefore important to clearly define this population to better understand and address their treatment goals.”

The authors write that, according to this first survey of Canadian dermatologists on moderate psoriasis, data indicate that not only is there a need to develop a more meaningful and useful definition of moderate plaque psoriasis to improve care for these patients but it also essential to raise awareness about the definition among regulatory agencies and reimbursement authorities.

 

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Treating Acne in Adolescents and Young Adults

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JDD Webinars

Register Now to Earn 1.0 CE Credit! 

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Treating Acne in Adolescents and Young Adults

Featuring Leon H. Kircik, MD, Anthony J. Mancini, MD, FAAP, FAAD, Adelaide A. Hebert, MD

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Earn 1.0 CE Credit:

Join Drs. Leon H. Kirick, Anthony Mancini, and Adelaide Hebert, as they  explore the categorization and grading of acne by age of onset in children and adolescents. They will also review and discuss new and evolving acne treatment strategies that offer optimal outcomes in children and young adults presenting with acne.

Upon completion of this live, internet-based CE activity, participants should be able to:

  • Appreciate the updated pediatric care classification, including appropriate evaluations and treatment, when needed 
  • Review acne treatment strategies offering optimal outcomes for pre-adolescents and adolescents with acne.

Faculty

Leon Kircik, MD
Clinical Professor of Dermatology
Icahn School of Medicine at Mount Sinai, New York, NY
Indiana University Medical Center, Indianapolis, IN
Medical Director
Physicians Skin Care, PLLC, Louisville, KY
DermResearch, PLLC, Louisville, KY
Skin Sciences, PLLC, Louisville, KY

Anthony J. Mancini, MD, FAAP, FAAD
Head, Division of Dermatology, Ann & Robert H. Lurie Children’s Hospital of Chicago
Professor of Pediatrics and Dermatology, Northwestern University Feinberg School of Medicine
Chicago, Illinois
Adelaide A. Hebert, MD
Chief of Pediatric Dermatology
McGovern School of Medicine
Childrens’ Memorial Hermann Hospital
Houston, Texas
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Thinning Hair Through Menopause: Results of a First-of-its-Kind Randomized Controlled Trial on Nutraceuticals

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JDD Multimedia

JDD Webinars

Originally aired on February 9th, 2021, this Webcast features Dr. Glynis Ablon who discusses age and menopause related hair changes. She also presents results from two studies on the clinical benefits of standardized nutraceuticals on hair in women going through the menopausal transition and beyond.

Supported By

Nutrafol

 

Thinning Hair Through Menopause: Results of a First-of-its-Kind Randomized Controlled Trial on Nutraceuticals

Featuring Dr. Glynis Ablon, MD, FAAD

Watch On Demand

We understand that hair loss and thinning is an accumulation of multiple factors, this presentation will focus on hair thinning during menopause and results from a first-of-its-kind randomized controlled trial on nutraceuticals.

Originally aired on February 9th, 2021, this Webcast features Dr. Glynis Ablon who discusses age and menopause related hair changes. She also presents results from two studies on the clinical benefits of standardized nutraceuticals on hair in women going through the menopausal transition and beyond.

Faculty

Glynis Ablon, MD, FAAD
Ablon Skin Institute and Research Center

 

Watch on Vimeo

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Recognizing Nuances in the Diagnosis & Management of Acne in Skin of Color Patients

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JDD Multimedia

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Register Now to Earn 1.0 CE Credit! 

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Recognizing Nuances in the Diagnosis & Management of Acne in Skin of Color Patients

Featuring Leon Kircik, MD & Andrew Alexis, MD, MPH

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Earn 1.0 CE Credit:

Join Dr. Leon H. Kircik and Andrew Alexis, MD, MPH as they discuss they nuances in the diagnosis and management of acne in skin of color patients.

Upon completion of this enduring, internet-based webinar, participants should be able to:

  • Summarize the role of androgen and androgen receptors in the development and management of acne in skin of color patients
  • Recognize clinical nuances in acne grade and severity in skin of color patients
  • Differentiate therapeutic approaches in treating acne in patients with darker skin vs. lighter skin
  • Discuss new therapies in development for the management of acne

Faculty

Leon Kircik, MD
Clinical Professor of Dermatology
Icahn School of Medicine at Mount Sinai, New York, NY
Indiana University Medical Center, Indianapolis, IN
Medical Director
Physicians Skin Care, PLLC, Louisville, KY
DermResearch, PLLC, Louisville, KY
Skin Sciences, PLLC, Louisville, KY

Andrew Alexis, MD, MPH
Chair, Department of Dermatology
Mount Sinai West and Mount Sinai Morningside
Professor, Icahn School of Medicine at Mount Sinai
New York, New York
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Rocking the Red: A Rosacea Research and Real World Roundup

By Podcast Highlights, Rosacea No Comments

JDD Multimedia

JDD Podcast

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Rocking the Red: A Rosacea Research and Real World Roundup

Dr. Richard Gallo & Dr. Adam Friedman

 

Rosacea is a complex, chronic inflammatory skin disease that is certainly not rockin for those who suffer with it. The pathophysiology is a smorgasbord of barrier dysfunction, reduced antioxidant capacity, inappropriate immune response, dysbiosis, and neurovascular dysregulation just to name a few. Much of what we know about this biological mess and translational understanding of our therapies comes from the legendary Dr. Richard Gallo, Distinguished Professor and Founding Chairman of the Department of Dermatology at the University of California, San Diego.
Join host Dr. Adam Friedman as he readily runs through the bench to bedside gamut of rosacea. What are the major pathophysiologic pathways we should all know about? If we are to follow the data, how does out armament of FDA approved therapeutics fit in? So glad you asked! Re(a)dy, set, press play.
This podcast is supported by an independent medical education grant provided by Galderma.
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Discover new clinical findings in Rosacea.  View the latest articles, case reports, supplements, Editorials,  and more.

 

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Thinning Hair Through Menopause: Results of a First-of-its-Kind Randomized Controlled Trial on Nutraceuticals

By JDD Webinars No Comments

JDD Multimedia

JDD Webinars

In this free live webinar, Dr. Glynis Ablon will discuss age and menopause related hair changes and she will present results from two studies on the clinical benefits of standardized nutraceuticals on hair in women going through the menopausal transition and beyond.

Register Now

Register Now!
Supported By

 

Thinning Hair Through Menopause: Results of a First-of-its-Kind Randomized Controlled Trial on Nutraceuticals

Featuring Dr. Glynis Ablon

Register Now

Register Now!

We understand that hair loss and thinning is an accumulation of multiple factors, this presentation will focus on hair thinning during menopause and results from a first-of-its-kind randomized controlled trial on nutraceuticals.

Dr. Glynis Ablon will discuss age and menopause related hair changes and she will present results from two studies on the clinical benefits of standardized nutraceuticals on hair in women going through the menopausal transition and beyond.

Faculty

Glynis Ablon, M.D., FAAD

Glynis Ablon, M.D., FAAD, is a dermatologist and cosmetic surgeon, and Associate Clinical Professor of Dermatology at UCLA. She founded the Ablon Skin Institute and Research Center 20 years ago in Manhattan Beach, where in addition to a thriving medical and cosmetic practice, she guides pioneering research in dermatology products and procedures. Dr. Ablon is a Fellow of the American Academy of Dermatology, American Academy of Liposuction Surgery, American Society for Laser Medicine and Surgery, and American Society for Dermatologic Surgery, while on staff at Providence Little Company of Mary Medical Center and UCLA. She has also appeared as an on-camera medical consultant for the Emmy Award Winning The Doctors television show, as well as Entertainment Tonight, ABC, NBC, CBS, KCAL and Lifetime.

 

In her book What’s Stressing Your Face: A Skin Doctor’s Guide to Healing Stress-Induced Facial Conditions, Dr. Ablon provides comprehensive evaluations of case stories and her own personal experience of skin conditions and their relationships to stress in our daily lives. Her talk, What’s Stressing Your Face, will address how stress, facial skin problems, and age related conditions can show up, and offers effective healing methods combining holistic techniques and cutting-edge products and procedures to treat, control and reduce these conditions. Learn techniques to take control of your stress before it takes control of your skin.

 

Register Now!

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February issue highlights new perspectives in chronic skin conditions

By Acne, Aesthetics, Featured Articles, JDD Highlights No Comments

Dermatology News

JDD Highlights

It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging.

Read the February JDD Now

Acne, Anti-Aging, Aesthetics, Psoriasis, and more

by Heather Onorati

February marks a transition period from the month of new beginnings (January) to a month of advancement (March). In many ways our collective focus is shifting. With new vaccines now rolling out, there has been a shift in the pandemic; our national leadership has shifted; our seasons are transitioning (with many on the East Coast looking forward to warmer days ahead). It’s a hopeful time of year, and the articles published in this month’s issue underscore this hope and transition with researchers bringing forward new perspectives on chronic skin conditions like acne as well as anti-aging. Here’s a glimpse into the findings reported this month:

Article Highlights

  • As we age, the body’s ability to manage inflammation decreases due to a gradual increase in pro-inflammatory systemic cytokines that result in chronic, low-grade inflammation, termed “inflammaging”. This is thought to play a role in many age-related chronic conditions like cardiovascular disease, diabetes, certain cancers and Alzehiemr’s disease. Other studies suggest the human microbiome also may play a role in inflammaging. In “Inflammaging in Dermatology: A New Frontier for Research,” researchers examine inflammaging within the context of the skin microbiome and its impact on chronic disease. The authors write that the skin, our largest organ, may be responsible for a larger role in promoting or preventing inflammaging.

  • Psoriasis is a condition continually studied as it has such a significant impact on patients and their quality of life. While many advances have been made, researchers continue to exam ways in which clinicians can improve treatment and disease management for these patients. In “Hospitalization in Patients With Psoriasis: Impact of Biological Therapies on Temporal Evolution,” researchers recognized the need to improve understanding of the impact of biological therapies on hospitalization. They retrospectively collected data on patients diagnosed with psoriasis within one institution who had at least one hospital admission during the study period. They established methods to compare hospitalizations at specified time periods since the evolution of biological therapies. While their data point to a gradual decrease in average hospitalization rate since 2004, they advise that there have been no extensive data to evaluate the impact of biological therapies on patient hospitalization.

  • In another recently published study, “Dermatologists’ Perspectives on Defining Moderate Psoriasis: The Canadian Moderate Psoriasis Survey,” researchers noted that there is a need to more fully define what constitutes “moderate plaque psoriasis” in order to improve care. In their survey of 69 responding Canadian dermatologists, the authors found that body surface area was used most commonly by respondents to describe disease severity. And, many consider disease location to be an indicator of severity.

  • Another skin condition that causes significant social and psychosocial distress is acne. As oral antibiotics are among the most commonly used systemic treatment, their use may be limited by potential side effects, according to the authors of “Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics”. While isotretinoin is one of the most effective therapies, the authors note its potential side effects as well as controversy around its association with depression and suicidal ideation.

    “A critical knowledge gap exists in defining the association between systemic anti-acne treatments and mental health outcomes,” the authors write. To explore this further, they examined the differences in mental health outcomes between patients treated with isotretinoin vs oral antibiotics and found that patients treated with isotretinoin experiences less psychosocial distress and symptoms related to depression compared with those patients treated with oral antibiotics.

  • And, since antimicrobial resistance continues to be a concern, physicians need to weigh this risk when considering treatments for patients with various skin infections. In “Do Antimicrobial Resistance Patterns Matter? An Algorithm for the Treatment of Patients With Impetigo,” a group of experts used a modified Delphi technique to develop a treatment algorithm to guide clinicians in the treatment of children and adults with impetigo.

    The authors conducted a systematic literature review of recommendations for the current practice of impetigo treatment, which included research studies, clinical guidelines, consensus papers, and reviews published between 2014 and February 2020.  They developed a step-by-step method to standardize and support clinical decision making, they write, which includes guidance for education and prevention, diagnosis and classification, treatment measures and follow-up. In addition, they discuss a newer topical antibiotic that appears to be safe and effective.

    “The panel recognized that doctors need education in antibiotic stewardship principles, as, for some of them, it is an unknown field,” the authors write.

  • And finally, in an ongoing effort to better understand the impact of COVID-19 in the dermatology setting, researchers in one study reported that patients found teledermatology appointments to be a convenient and effective alternative to in-person visits during the pandemic. While the lack of physical touch and inability to provide close inspection can be frustrating for patients, this can be overcome by appropriate patient selection, the authors report in Patient Perceptions and Satisfaction With Teledermatology During the COVID-19 Pandemic: A Survey-Based Study.

  • Another impact of pandemic restrictions on the dermatology setting is the interaction between dermatologists and pharmaceutical company representatives, who often provide clinicians with educational information on drugs as well as samples for patients. In “The Impact of the COVID-19 Pandemic on Physician-Pharmaceutical Office-Based Interactions,” researchers examined the changing dynamic in the format of visits with and access to physicians by pharmaceutical representatives.

Editor's Picks

These articles and more make up this month’s February issue. Read more on aging, melasma and skin cancer in these articles also included:

  • Efficacy and Tolerability of a Novel Topical Treatment for the Neck: A Randomized, Double-Blind, Regimen-Controlled Study
  • New Protocol for Long-Term Results With a Multi-Pulse Nd:YAG Laser for Melasma Treatment: A Descriptive Cohort Study
  • A Review of Hedgehog Inhibitors Sonidegib and Vismodegib for Treatment of Advanced Basal Cell Carcinoma
  • Ingenol Mebutate as Treatment of Squamous Cell Carcinoma In Situ: A Case Series
  • Intralesional 5-Fluorouracil for Treatment of Non-Melanoma Skin Cancer: A Systematic Review
 
 

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Experts Offer Recommendations for Use of Absorbable Suspension Sutures

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Used alone, absorbable suspension sutures offer a dual mechanism of action Used alone, absorbable suspension sutures offer a dual mechanism of action Heather Onorati As the use of absorbable suspension…

In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Review Highlights Need for More Effective Rosacea Treatments

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“The inflammatory pathways underlying rosacea are becoming increasingly elucidated. What remains unknown is the mechanism of progression of these pathways, and how they can result in papules/pustules and/or phyma in some patients but not others”

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“The inflammatory pathways underlying rosacea are becoming increasingly elucidated. What remains unknown is the mechanism of progression of these pathways, and how they can result in papules/pustules and/or phyma in some patients but not others.”

Heather Onorati

While much progress has been made in better understanding the pathogenesis of rosacea, a need remains for more effective treatments to address the underlying inflammation and to improve clearance.

Current therapies for facial erythema provide temporary relief and are not consistent at helping patients achieve complete clearance of papules and pustules, according to authors Jerry Tan, MD, of Western University in Ontario, Canada, and J. Mark Jackson, MD, of the University of Louisville in Louisville, Ky, who published a review in the Journal of Drugs in Dermatology (“Treating Inflammation in Rosacea: Current Options and Unmet Needs”). They examined what is known about the underlying inflammatory nature of rosacea and its available treatments.

Ideally, the future of rosacea treatment should include addressing both the papules and pustules  as well as the inflammatory pathways leading to erythema and phyma, the authors say. Longer-term control and the ability to reduce the signs and symptoms of rosacea would be an important advance, they write.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

Discover new clinical findings in Rosacea.  View the latest articles, case reports, supplements, Editorials,  and more.

 

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In Support of a More Useful Definition for ‘Moderate’ Psoriasis

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Psoriasis Clearance Motivates Patients to Seek Cometic Procedures, Study Finds

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Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

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Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

Heather Onorati

A significant reduction in psoriasis body surface area (BSA) may motivate patients to seek cosmetic procedures, according to findings from a recent study, “Increased Trend of Cosmetic Procedures in Patients With Psoriasis Who Attain 75% or Greater Improvement.”

Patients with moderate to severe psoriasis who achieved 75% or greater reduction in BSA showed an increased uptake in cosmetic procedures and this increase correlated with a reported improvement in quality of life after psoriasis clearance, the authors found.

Researchers lead by Michelle Walters, M.D., Harbor-UCLA Medical Center, Torrance, Calif., examined the relationship between improvement in quality of life following a reduction in BSA and the use of cosmetic procedures. They identified 138 patients with a history of moderate to severe psoriasis from  the Dermatology Institute and Skin Cancer Center in Santa Monica, Calif., and surveyed them using the Dermatology Life Quality Index (DLQI), adding an additional 5 questions related to the patients’ cosmetic procedures.

Of the group, 119 patients said they had never before undergone a cosmetic procedure due to their psoriasis. All of the patients responded that their quality of life had improved with their psoriasis treatment, and the majority (91%) said this improvement motivated them to undergo the cosmetic procedure.

The most common cosmetic procedures sought by these patients were neurotoxins, soft tissue augmentation and chemical peels. In addition, 79% of the patients purchased skincare products dispensed through the office.

“The improvement in quality of life following treatment of psoriasis with systemic or biologic agents noted in our study reflects results from previous studies,” the authors note. However, the authors state that there have been no studies that have examined a correlation between the improvement in quality of life following psoriasis treatment and an uptake in surgical or nonsurgical cosmetic procedures.

“We found that a common motive for patients who sought cometic procedures was the desire to further improve their quality of life after clearance of their psoriasis,” the authors say. They add that this study indicates that successful treatment of the condition may be a motivator for patients to seek cosmetic procedures for other skin indications.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

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Atopic Dermatitis Philipines

Recommendations for Topical AD Management in the Philippines

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Atopic Dermatitis Philipines

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

Heather Onorati

The prevalence of atopic dermatitis is increasing in Asia, patients have indicated they are not satisfied with disease control; yet, research indicates they are not correctly applying treatments or they prefer alternative therapies.

“AD is considered incurable, thus, there is a need for accepted guidelines to manage and reduce the burden that this condition brings,” write authors of a recent review (“The ABC Topical Management of Atopic Dermatitis in Philippines: Expert Recommendations“) published in the Journal of Drugs in Dermatology. 

Data from 744,673 dermatological consults in the Philippine Dermatological Society-accredited outpatient institutions collected between 2007 and 2011 showed that 65% of patients were children between 1-12 years old and 24% of patients were infants less than one year old. Because children rely on caregivers to administer treatments, disease control depends largely on the education, resources and attitudes toward treatment of the caregivers, the researchers note.

An earlier paper cited by the authors proposed an easy-to-follow ABC scheme based on characteristics of Atopic Dermatitis. In the current review, the authors build on this scheme with their suggestions.

The Anti-inflammatory phase focuses on using topical corticosteroids and/or topical calcineurin inhibitors to control inflammation during flare ups. The authors suggest considering patient characteristics in disease management as well as characteristics of anti-inflammatory agents. They also add, “Monitoring for overt signs of infection is another important focus, as this can further aggravate an AD flare.”

In the Barrier Restoration phase, the focus of treatment is on reestablishing the integrity of the skin barrier and lengthening time between flares.

“Existing AD guidelines have not provided consistent recommendations about the optimal frequency of moisturizer application but recent guidelines state that moisturizers should be prescribed in adequate amounts (ie, minimum of 250g/week, used at least twice daily) even on non-inflamed skin,” the authors note.

Finally, managing patients in the Basic Care phase focuses on maintaining an intact skin barrier through proper skin care, emollient application and avoiding potential irritants and allergans, the authors write.

The panel identified a lack of proper patient and caregiver education regarding chronicity, course, prognosis, and disease avoidance strategies; the inability to identify disease triggers; the absence of definite guidelines on the effective moisturizer amount and frequency of application; and the lack or absence of proper management of microbial colonization as contributing to the challenges of disease management.

“A holistic approach is essential in the success of AD management,” the authors write. “The ABC scheme presents a simple guide on AD management for the healthcare provider based on the key problems in the different phases of the disease.”

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry

Atopic Dermatitis Resource Center

 

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