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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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What’s New in Dermatology – January 2021

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In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In the January 2021 issue of the JDD, groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

 

Heather Onorati

January always represents new beginnings. It’s the time of year we tend to reflect on the past, extract insight from experience and look toward the future with new hope and understanding. It is with this in mind that our January issue couples articles based in foresight and advances.

Groups of experts reflect on lessons learned this year in several articles offering guidance and recommendations for practice management and patient care moving into the future. While in other articles, investigators share findings that aim to improve disease understanding and patient care.

In Aesthetic Office Disaster Preparedness and Response Plan, authors look to their shared experiences to provide suggestions for a proactive approach to manage possible future disaster-related events that could affect aesthetic practice operations and financial viability. Leveraging Virtual Boot Camp to Alleviate First Year Dermatology Resident Anxiety illustrates compelling levels of anxiety among incoming first-year dermatology residents and suggests that formally addressing the tenets of the specialty at the onset of PGY-2 can strengthen the foundation and boost the confidence of trainees. And, in Prescribing Isotretinoin for Transgender Patients: A Call to Action and Recommendations, authors discuss how the field of dermatology must remain on the leading edge of patient safety and advocacy issues and remain compassionate and adaptable when facing new patient care issues.

In the spirit of advancing understanding, other articles look to build the knowledge well around therapeutic techniques and disease treatment. As we continue toward a better understanding COVID-19, New York and Brazilian researchers examine the cutaneous presentations that could be clues to diagnosis in Presentation and Management of Cutaneous Manifestations of COVID-19. In the article Aesthetic ONE21 Technique for Injecting IncobotulinumtoxinA into the Forehead: Initial Experience With 86 Patients, authors report safety and efficacy from a single-center, retrospective study. Researchers present a clinical evaluation of a drug-device combination product for the topical treatment of molluscum contagiosum in A Phase 2 Open-Label Study to Evaluate VP-102 for the Treatment of Molluscum Contagiosum.

In addition, experts examine the impact of psychosocial stress on skin health, investigate efficacy of a nutraceutical supplement for promoting hair growth, discuss recommendations for absorbable suspension sutures in nonsurgical facial rejuvenation, and much more.

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
January 2021 JDD 

 

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Top 10 Most Talked About Articles of 2020

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As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year.  

 

Heather Onorati

The second half of 2020 has seen the world still trying to navigate and overcome the COVID-19 pandemic, and the practice of dermatology has been no exception. However, while still an area of focus, dermatologists have been reading, sharing and discussing studies about a variety of other conditions and treatments relevant to their patients.  

In our year-end topten list, we’re sharing the case studies, reviews and investigations published by the Journal of Drugs in Dermatology that have been downloaded and read the most in the past 12 months.  

 

As the world sought to understand the emerging Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), or coronavirus disease 2019 (COVID-19), many potential signs and symptoms were investigated in connection with the virus, leading dermatologists to also grapple with identifying potentially afflicted patients. In a case study published early in the pandemic, authors in Cairo, Egypt, looked at whether a reported case of a pityriasis rosea-like rash could be connected with COVID-19. 

While COVID-19 remains a topic of interest, other issues like the use of neutraceuticals, approaches to treating melasma and hyperpigmentation, countering hair loss, and calming dermatitis have drawn attention.   

Nutrition and supplementation are topics of interest across medicine for their potential roles in overall health and wellness, including skincare. A literature review published in early 2019 examined the benefits of collagen supplementation in skin healing and anti-aging. The authors reported on a total of 11 studies that included 805 patients being treated for a range of issues from decubitus ulcers to anti-aging. In their analysis, the authors noted that collagen supplementation appeared to be promising with potential improvements in elasticity, hydration and dermal collagen density; however not all supplements are created equal and patients should be counselled with regard to ingredients and expectations, they noted. Another study that explored the use of a neutraceutical supplement for the treatment of hair loss highlighted botanical ingredients that may mitigate triggers for hair loss and help to restore balance to the follicle.   

In line with patient interest in “natural” treatments, investigators examined the mechanism of action for observed dermatologic benefits of colloidal oatmeal and found that extracts of colloidal oatmeal decreased pro-inflammatory cytokines in vitro. 

 

“Clinical evaluations showed that the colloidal oatmeal skin protectant lotion significantly improved dryness, scaling and roughness as early as 1 day after use, and these improvements were maintained over the duration of the study with continued use of the lotion,” the authors wrote. 

Among the investigations into treatments for common but challenging conditions, authors from the University of Kansas Medical Center, Kansas City, KS, reported on a case of chronic bilateral nasolabial fold seborrheic dermatitis. They hypothesized that Crisaborole 2% ointment, a PDE4 inhibitor would reduce the inflammation. After 2 treatments per week for 4 weeks, the investigators observed a notable reduction in scaling and erythema on the treatment site.  

Another commonly seen condition, xanthelasma palpebrae, can be a significant cosmetic concern for patients. In a case study published in 2016, researchers report on a case in which they used a hyfrecator for superficial tissue destruction resulting in excellent cosmetic results, the authors showed. 

Melasma and hyperpigmentation are among the challenging conditions dermatologists see. One study still garnering attention is an investigation into the benefit of Vitamin C plus iontophoresis. Investigators observed a mean 73% improvement in abnormal pigmentation after treatment combining Vitamin C with a full-face iontophoresis mask. A mean improvement of 15.7 on the Melasma Area and Severity Index was also noted.  

A review of 10 studies examining the efficacy of retinoids and azelaic acid for the treatment of acne and subsequent post-inflammatory hyperpigmentation in skin of color reported growing evidence that retinoids are well-tolerated and could be considered as first-line therapies to treat acne people with skin of color. In addition, azelaic acid may offer improvement in both acne and hyperpigmentation, the authors noted.  

Finally, a more recent review evaluated 35 randomized controlled trials of topical agents for the treatment of melasma found strong evidence for the recommendation of cysteamine, triple combination therapy, and tranexamic acid. 

As 2020 comes to a close, we are excited as we look to 2021. We are incredibly grateful to the researchers who have chosen to publish their work with JDD. And, we look forward to continuing to play a role in highlighting the benefits of the most promising treatments for your patients in the New Year. 

Heather Onorati is an experienced medical writer and editor with more than 20 years covering the dermatology industry.
Read the top 10 most discussed articles in 2020: 

 

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Watch On Demand: Proper Hydration and Exfoliation Support Treatments for Patients with Inflammatory Skin Conditions

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This exclusive #SkinChat webinar originally aired on December 16th, 2020. Dr. Leon H. Kircik and Professor Petra Staubach-Renz  discussed the importance of adjunctive skincare solutions for your patients with Keratosis Pilaris and Psoriasis.

Proper hydration and exfoliation support treatments for patients with inflammatory skin conditions

By Heather Onorati

People with conditions characterized by an impaired skin barrier and hyperkeratosis can benefit from incorporating a uniquely formulated skincare regimen with other recommended treatments, according to two experts who shared insights into how a variety of ingredients work to complement therapeutic selections and improve outcomes for these patients. 

In a recent webinar, Professor Petra Staubach-Renz, department of dermatology, University Medical Center, Mainz, Germany, and Leon H. Kircik, M.D., Icahn School of Medicine at Mount Sinai, New York, delivered very relevant presentations on adjunctive skincare solutions for hyperkeratolytic conditions.

Dry, rough, uneven skin is a common symptom for many of these hyperkeratolytic conditions, according to Prof. Staubach-Renz. This is characterized by a build-up of cells on the skin’s surface that create an irregular, thick texture. Hyperkeratosis commonly presents in patients with conditions like keratosis pilaris, ichythyosis, psoriasis, and atopic dermatitis.  

More than 40% of people around the world suffer from keratosis pilaris, also called follicular keratosis, Prof. Staubach-Renz noted. In addition, there are more than 125 million people globally who suffer from psoriasis, 60% of which report that the disease significantly affects their lives, Dr. Kircik added. The biggest problems that those affected report are the appearance of the skin and the scaling, which result from transepidermal water loss and a dysfunctional epidermal barrier, he explained. 

Dry, rough, uneven skin is a common symptom for many of these hyperkeratolytic conditions, according to Prof. Staubach-Renz. This is characterized by a build-up of cells on the skin’s surface that create an irregular, thick texture. Hyperkeratois commonly presents in patients with conditions like keratosis pilaris, ichythyosis, psoriasis, and atopic dermatitis.  

According to Prof. Staubach-Renz, this is important to understand in order to treat the skin with the proper basic therapy. There are several critical components, and those include mild exfoliation with keratolytics and an occlusive moisturizer. 

Keratolytics break down the outer layers of the skin, which ultimately allow for other topical therapeutics like corticosteroids to penetrate, Dr. Kircik explained. Often, people who are prescribed topical corticosteroid treatments will complain they are unsatisfied and that the treatment is not working. 

“This is where the keratolytics come into the picture, Dr. Kircik said. Compounds like urea and salicylic acid break down that thick skin and allow the topical medication to penetrate. 

Pairing this activity with humectants and an occlusive will support repair of the epidermal barrier by allowing the skin to attract and then retain moisture.  

One over-the-counter skincare system that utilizes this combination of ingredients in a unique timed-release delivery system demonstrated both efficacy and tolerability in two studies cited by Prof. Staubach-Renz, which examined their use in the treatment of keratosis pilaris. 

Researchers found in one study that patients experienced a decrease in transepidermal water loss 1 hour following use of both a cleanser and cream, cell turnover time accelerated at 3-5 days, and 9 of 10 patients subjectively agreed that the skin felt softer, smoother and more comfortable after week 4. In a second study, the severity of dryness, texture and erythema began to improve at two weeks on dermatologic exam. At 8 weeks, skin dryness was reduced by 76%, and there was a visual improvement in roughness and erythema.

 

 

 

 

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

 

 

 

 

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Current Understanding of the Pathophysiology, Etiology, Prevalence & Burden of AD

Dr. Peter Lio and Dr. Adam Friedman

 

In part 2 of this 5 part podcast homage to Atopic Dermatitis, JDD Podcast host Dr. Adam Friedman is joined by the dynamic dermatitis duo Dr. Anna De Benedetto, Associate Professor of Dermatology at the University of Florida, and Dr. Eric Simpson, Professor of Dermatology at the School of Medicine at Oregon Health & Science University, to dissect established and emerging pathophysiologic details of this dastardly dermatitis.

Dig in to determine best evidence based management practices to dampen the long standing burden of disease. Discover delightful discourse between three dedicated AD investigators/caregivers. Do listen, don’t scratch.

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This podcast is supported by an independent medical education grant provided by Sanofi Genzyme & Regeneron Pharmaceuticals.

 

 

Learning Objectives:
Upon completion of this podcast, learners should be able to:
  • Summarize recent scientific understanding of the pathophysiology, etiology and prevalence of atopic dermatitis in patients of all age groups
  • Recognize the implications of long-term treatment options on effective patient outcomes.

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various mechanisms of action including direct anti-inflammatory, anti-pruritic, anti-oxidant, anti-fungal, pre-biotic, barrier repair properties, and beneficial effects on skin pH. These have been shown to be of particular benefit in the treatment of atopic dermatitis.

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various mechanisms of action including direct anti-inflammatory, anti-pruritic, anti-oxidant, anti-fungal, pre-biotic, barrier repair properties, and beneficial effects on skin pH. These have been shown to be of particular benefit in the treatment of atopic dermatitis.

Blair Allais MD, Adam Friedman MD FAAD

 

 

Oatmeal has a longstanding and rich history pertaining to its dermatologic use. The first documentation of oatmeal for skin health dates back as early as 2000 BC in Arabia and Egypt, where it was described as soothing and protecting in dry or itchy, inflamed skin. Oatmeal flour was subsequently recognized as a topical therapy for a variety of dermatologic conditions in Roman medical literature. The first scientific studies on the skin benefits of oatmeal appeared in the 1930s, including information about the cleansing properties of oatmeal, its role in relieving itch, and its function as a skin protectant.

In the 1940s and 1950s colloidal oatmeal became commercially available both in powder form and mixed with emollient oils, instigating medical studies examining the benefits of colloi-dal oatmeal baths in various xerotic dermatoses.

The results of this open-label clinical study suggest that a topical cream containing retinol 0.5% in combination with niacinamide, resveratrol, and hexylresorcinol is efficacious and tolerable for skin brightening/anti-aging when used with a complementary skin care regimen including SPF 30 sun protection.

In 1989, the United States Food and Drug Administration (FDA) approved colloidal oatmeal as a safe and effective over-the-counter drug. In 2003, the FDA noted that colloidal oatmeal could relieve irritation and itching due to a number of dermatoses, providing temporary skin protection.5 Colloidal oatmeal is one of the few products that the FDA recognizes as a safe over the counter treatment. Today it is available in various forms including creams, lotions, shampoos, shaving gels, bath treat-ments, and body wash.

Colloidal oatmeal is the powder obtained from the grinding and processing of whole oat grain. Under strict protocols es-tablished by the US Pharmacopeia, oat grain is ground and processed until no more than 3% of the total particles in the powder exceed 150 μm in size and no more than 20% exceed 75 μm in size.6 The small size of the particles contributes to their ability to deposit on the skin and form an occlusive barrier when dispersed in water. Oat is composed of various types of phytochemicals, which contribute to its wide-ranging function and clinical use. Col-loidal oatmeal consists of sugars and amino acids (65%), proteins (15–20%), lipids (11%), and fiber (5%).7 The most important groups of phytochemicals present in oats include phenolics, β-glucans, lignans, avenanthramides, carotenoids, vitamin E, and phytosterols.

Of the phenolics present in oats, ferulic acid and caffeic acid are strong antioxidants, and fe-rulic acid also has UV absorbing properties.8 Flavonoids, a group of phenolic compounds present in oat, also are capable of absorbing ultraviolet A light from 320–370 nm. β-glucans are polysaccharides of D-glucose monomers and have a high viscosity largely due to their β-(1–3)-linkages.This viscosity contributes to the water-binding properties of oat. Oats also contain a wide range of minerals and vitamins, of which vita-min E is the most clinically relevant. Vitamin E is a naturally occurring antioxidant that protects against oxidative stress, inflammation, and photo-induced aging.

Learn more about the history, basic science, mechanism of Action, and clinical efficacy of colloidal oatmeal in the treatment of Atopic Dermatitis now.

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The October issue of the Journal of Drugs in Dermatology is available now. This month, we focus on atopic dermatitis with special features on Public Health, Anti-aging, Aesthetic, and Medical Dermatology.

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Atopic Dermatitis, Public Health, Anti-Aging, and Medical Dermatology

The October issue of the Journal of Drugs in Dermatology is available now. This month, we focus on atopic dermatitis, with special features on Public Health, Anti-aging, Aesthetic, and Medical Dermatology.

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2019 Scientific Poster Abstracts from Skin of Color Update

By Derm Community

Education Credits

September 12: 8.5 | September 13 = 4.5

Category 1
Creighton University Health Sciences Continuing Education designates this live activity for a maximum of 13 AMA PRA Category 1 Credit(s) TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

AAPA accepts AMA category 1 credit for the PRA from organizations accredited by ACCME

Nurse CE
Creighton University Health Sciences Continuing Education designates this activity for 13 contact hours for nurses.  Nurses should claim only credit commensurate with the extent of their participation in the activity.

View a selection of scientific poster abstracts from the 2019 Skin of Color Update below.

SOCU is the largest CE event dedicated to trending evidence-based research and new practical pearls for treating skin types III – VI, will be held  held September 12 – 13 at the Sheraton Times Square in New York City.

Each year, SOCU presents exclusive content and learning opportunities on topics including,  Acne, Rosacea, Psoriasis, Scalp Psoriasis, Skin Cancer, Atopic Dermatitis, Hidradenitis Suppurativa, Nail and Fungal Disorders, and how they affect the patient of color.

 

Impact of High Coverage Make-up Coverage against Visible Light Exposure

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Twenty Nail Dystrophy; a case report from DISHARC, Nepal

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Treatment of Central Centrifugal Cicatricial Alopecia: A Retrospective Chart Review

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A Rare Case of Lipedematous Scalp in an African American Female

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Cysteamine- Towards A Novel First Line Treatment for Melasma?

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Influences of therapeutic choices and treatment outcome in acne vulgaris among patients in South Nigeria

Acne Vulgaris (AV), a chronic inflammatory disease of the skin and hair follicles is one of the most common reasons to present to the dermatologist. In Nigeria, as with most parts of the world, patients will typically present when they have persistent or worsening lesions and following treatment trial with over the counter (OTC) medications and suggestions from concerned individuals.

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