CEBD Evidence Update

January 2018

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? Our map of systematic reviews on eczema has been updated with a new topic heading on systemic biologic therapies, while the map of systematic reviews on psoriasis now includes the recent Cochrane network meta-analysis of systemic pharmacological treatments and has a new topic heading for the IL-23 inhibitor tildrakizumab.

 

Do take a look to keep up to date with the evidence on the latest treatments:

http://www.nottingham.ac.uk/research/groups/cebd/resources/maps-of-systematic-reviews.aspx

 

 


 

Introduction

 

 

Welcome to this month’s CEBD Evidence Update, bringing you the latest evidence-based publications in dermatology, with an emphasis on clinical guidelines and systematic reviews.

 

CEBD Evidence Updates are compiled by the Centre of Evidence Based Dermatology at the University of Nottingham, with funding from Nottingham University Hospitals NHS Trust, as a service to the dermatology community. These updates are the first step in our aim of developing a CEBD Evidence Network, to bring together users of research evidence in dermatology. An archive of these updates is available on the list home page: CEBD-EVIDENCE-UPDATES.

 

The title of each item provides a link to the abstract in PubMed. If the paper is open-access (indicated in brown text towards the bottom of the PubMed record) or you have an institutional subscription to the journal concerned, you can access it by clicking on the full text link at the top right of the PubMed record.

 

It is important to appraise the quality of systematic reviews before applying to your practice—we recommend the AMSTAR 2 tool, which is very quick and easy to use. See also this open-access article: Research Techniques Made Simple: Assessing Risk of Bias in Systematic Reviews.

 

Do please forward this e-mail to other colleagues who might be interested and encourage them to sign up.

 

To join or leave this list, please visit the registration page on the JISCMail web site. Alternatively, you can e-mail [log in to unmask] to ask to be added to the list.

 

We welcome all feedback and suggestions for improvement—please e-mail Douglas Grindlay, [log in to unmask].

 

 


 

Contents

 

 

Guidelines

Systematic reviews & evidence summaries

Eczema & dermatitis

Psoriasis & psoriatic arthritis

Acne & rosacea

Skin cancers & sun protection

Infections of the skin

Drug & treatment reactions/safety

Vitiligo & pigmentary disorders

Hair & nail disorders

Oral disorders

Chronic wounds & ulcers

Other disorders affecting the skin

Skin conditions & dermatology in general

Skin surgery & lasers

Service delivery & management

Prescribing and safety alerts

CEBD publications & news

Other key publications that have caught our eye

Notes

 

 


 

Guidelines

 

 

UK

 

British Association of Dermatologists guidelines for the management of lichen sclerosus 2018.

Lewis FM, Tatnall FM, Velangi SS, Bunker CB, Kumar A, Brackenbury F, Mohd Mustapa MF, Exton LS.

Br J Dermatol. 2018 Jan 4. doi: 10.1111/bjd.16241. [Epub ahead of print]

 

“The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of lichen sclerosus (LS) in adults (18+ years), children (0-12 years) and young people (13-17 years). The document aims to:
Offer an appraisal of all relevant literature up to July 2017, focusing on any key developments
Address important, practical clinical questions relating to the primary guideline objective
Provide guideline recommendations and if appropriate research recommendations.”

 

 

British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018.

Millington GWM, Collins A, Lovell CR, Leslie TA, Yong ASW, Morgan JD, Ajithkumar T, Andrews MJ, Rushbook SM, Coelho RR, Catten SJ, Lee KYC, Skellett AM, Affleck AG, Exton LS, Mohd Mustapa MF, Levell NJ.

Br J Dermatol. 2018 Jan;178(1):34-60. doi: 10.1111/bjd.16117. No abstract available.

 

“The overall objective of the guidelines is to provide up-to-date, evidence-based recommendations on the investigation and management of secondary pruritus without underlying skin disorder and generalized pruritus of unknown origin (GPUO) in adults (excluding children aged < 18 years). The document aims to: (i) offer an appraisal of all relevant literature up to November 2016, focusing on any key developments; (ii) address important, practical clinical questions relating to the primary guidelines objective (i.e. accurate diagnosis and identification of cases and suitable treatment); (iii) provide guideline recommendations; (iv) where appropriate, provide practical and health economic implications; and (v) discuss potential developments and future directions.”

 

 

British Association of Dermatologists - UK guidance on the use of mobile photographic devices in dermatology (PDF)

 

“This guidance supplements the standards outlined in Quality Standards for Dermatology: Proving the Right Care for People with Skin Conditions (PCC, 2011) and those added in Quality Standards for Teledermatology: Using ‘Store and Forward’ Images (PCC, 2013). It applies wherever mobile devices are being used to capture and transfer patient images and has been written to support the safe use of mobile devices by healthcare professionals for patient care. It explains the risks and benefits of using mobile devices, particularly in relation to information governance.”

 

 

Department of Health and Social Care - Pressure ulcers: safeguarding adults protocol

 

“This guidance from the Chief Social Worker helps practitioners and managers across health and care organisations to provide caring and quick responses to people at risk of developing pressure ulcers.

It also offers a process for the clinical management of harm removal and reduction where ulcers occur, considering if an adult safeguarding response is necessary.”

 

 

NICE Medtech innovation briefing [MIB139] - EpiFix for chronic wounds

 

 

“The technology described in this briefing is EpiFix, an amniotic membrane allograft comprised of dehydrated human amniotic membrane. This briefing focuses on its use in treating chronic wounds such as diabetic foot ulcers and venous leg ulcers.

The innovative aspect is that it is an allograft of human amniotic membrane. It therefore differs from most wound-care products in being regulated as a human tissue product.

The intended place in therapy would be as an alternative to other advanced wound dressings for chronic, difficult-to-heal wounds in addition to standard treatments.”

 

 

 

Non-UK

 

Guidelines of care for the management of basal cell carcinoma.

Work Group, Baum C, Bordeaux JS, Brown M, Busam KJ, Eisen DB, Iyengar V, Lober C, Margolis DJ, Messina J, Miller A, Miller S, Mostow E, Mowad C, Nehal K, Schmitt-Burr K, Sekulic A, Storrs P, Teng J, Yu S, Huang C, Boyer K, Begolka WS, Alam M; Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P.

J Am Acad Dermatol. 2018 Jan 3. pii: S0190-9622(17)32529-X. doi: 10.1016/j.jaad.2017.10.006. [Epub ahead of print]

 

This guideline from the American Academy of Dermatology provides evidence-based recommendations for the management of patients with basal cell carcinoma [BCC].

“In these evidence-based guidelines of care, we provide recommendations for the management of patients with BCC, as well as an in-depth review of the best available literature in support of these recommendations. We discuss biopsy techniques for a clinically suspicious lesion and offer recommendations for the histopathologic interpretation of BCC. In the absence of a formal staging system, the best available stratification based on risk for recurrence is reviewed. With regard to treatment, we provide recommendations on treatment modalities along a broad therapeutic spectrum, ranging from topical agents and superficially destructive modalities to surgical techniques and systemic therapy. Finally, we review the available literature and provide recommendations on prevention and the most appropriate follow-up for patients in whom BCC has been diagnosed.”

 

 

Guidelines of care for the management of cutaneous squamous cell carcinoma.

Work Group; Invited Reviewers.

J Am Acad Dermatol. 2018 Jan 3. pii: S0190-9622(17)32530-6. doi: 10.1016/j.jaad.2017.10.007. [Epub ahead of print]

 

This guideline from the American Academy of Dermatology provides evidence-based recommendations for the management of patients with cutaneous squamous cell carcinoma [cSCC].

“Topics addressed include biopsy techniques and histopathologic assessment, tumor staging, surgical and nonsurgical management, follow-up and prevention of recurrence, and management of advanced disease. The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cSCC is noted, as is general information on the management of patients with metastatic disease.”

 

 

Cancer Care Ontario: Patient Indications for Mohs Micrographic Surgery

 

“GUIDELINE OBJECTIVES

a. To describe evidence-based indications for Mohs micrographic surgery (MMS);

b. To assess Mohs outcomes such as cure rates and recurrence rates, as well as quality of life (QOL) and complications;

c. To assess whether volume of patients treated affects outcomes of MMS.”

 

 

The EAACI/GA²LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis and Management of Urticaria. The 2017 Revision and Update.

Zuberbier T, Aberer W, Asero R, Abdul Latiff AH, Baker D, Ballmer-Weber B, Bernstein JA, Bindslev-Jensen C, Brzoza Z, Buense Bedrikow R, Canonica GW, Church MK, Craig T, Danilycheva IV, Dressler C, Ensina LF, Giménez-Arnau A, Godse K, Gonçalo M, Grattan C, Hebert J, Hide M, Kaplan A, Kapp A, Katelaris CH, Kocatürk E, Kulthanan K, Larenas-Linnemann D, Leslie TA, Magerl M, Mathelier-Fusade P, Meshkova RY, Metz M, Nast A, Nettis E, Oude-Elberink H, Rosumeck S, Saini SS, Sánchez-Borges M, Schmid-Grendelmeier P, Staubach P, Sussman G, Toubi E, Vena GA, Vestergaard C, Wedi B, Werner RN, Zhao Z, Maurer M.

Allergy. 2018 Jan 15. doi: 10.1111/all.13397. [Epub ahead of print]

 

This guideline is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the EU-founded network of excellence, the Global Allergy and Asthma European Network (GA²LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of 48 delegates of 42 national and international societies.

“This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.”

 

 

S2k Guidelines - Cutaneous Lymphomas Update 2016 - Part 2: Treatment and Follow-up (ICD10 C82 - C86).

Dippel E, Assaf C, Becker JC, von Bergwelt-Baildon M, Beyer M, Cozzio A, Eich HT, Follmann M, Grabbe S, Hillen U, Klapper W, Klemke CD, Lamos C, Loquai C, Meiß F, Mestel D, Nashan D, Nicolay JP, Oschlies I, Schlaak M, Stoll C, Vag T, Weichenthal M, Wobser M, Stadler R.

J Dtsch Dermatol Ges. 2017 Dec 27. doi: 10.1111/ddg.13401. [Epub ahead of print] No abstract available.

 

These guidelines on the classification and diagnosis of cutaneous lymphomas are prepared on behalf of the Working Group on Dermatological Oncology (ADO) of the German Cancer Society and the German Society of Dermatology. Part 1 (on classification and diagnosis) appeared in last month’s Update.

 

 

Diagnostic criteria, severity classification and guideline of lichen sclerosus et atrophicus.

Hasegawa M, Ishikawa O, Asano Y, Sato S, Jinnin M, Takehara K, Fujimoto M, Yamamoto T, Ihn H; Executive Committee of Guideline.

J Dermatol. 2017 Dec 19. doi: 10.1111/1346-8138.14171. [Epub ahead of print]

 

“We established diagnostic criteria and severity classification of lichen sclerosus et atrophicus, because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there is no clinical guideline for lichen sclerosus et atrophicus in Japan, so we proposed its clinical guideline. The clinical guidelines were formulated by clinical questions and recommendations on the basis of evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guidelines easy to use and reliable including the newest evidence, and to present guidance for various clinical problems in treatment of lichen sclerosus et atrophicus.”

 

 

Polyurethane Foam Dressings for the Prevention of Pressure Ulcers: Clinical and Cost-Effectiveness and Guidelines [Internet].

Poitras V, Frey N.

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Apr 3.

 

“The purpose of this report is to examine the clinical effectiveness, cost-effectiveness, and evidence-based guidelines regarding the preventive use of polyurethane foam dressings in adult patients at risk for developing pressure ulcers in any setting.”

 

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Systematic reviews & evidence summaries

 

 

Eczema & dermatitis

 

Efficacy and safety of dupilumab for the treatment of moderate-to-severe atopic dermatitis in adults.

Xu X, Zheng Y, Zhang X, He Y, Li C.

Oncotarget. 2017 Nov 18;8(65):108480-108491. doi: 10.18632/oncotarget.22499. eCollection 2017 Dec 12.

 

“Results: A total of 7 RCTs containing 2705 subjects were identified. Significantly more patients receiving dupilumab (611/1789) achieved Investigator's Global Assessment response compared with the control (89/916; RR, 3.95; P < 0.001). Dupilumab was significantly more effective in reducing Eczema Area and Severity Index, peak pruritus numerical rating scale score, and body surface area. Treatment duration rather than administration frequency slightly influenced the efficacy. Dupilumab treatment also contributed to marked improvement in patients' quality of life and psychological symptoms. Incidence of adverse events was similar in dupilumab group and control group.

Conclusions: Dupilumab is effective and safe for the treatment of moderate-to-severe atopic dermatitis in adults. This meta-analysis supports the role of dupilumab as a primary targeted biologic therapy in adult patients with moderate-to-severe atopic dermatitis.”

 

 

Systematic review of atopic dermatitis disease definition in studies using routinely-collected health data.

Dizon MP, Yu AM, Singh RK, Wan J, Chren MM, Flohr C, Silverberg J, Margolis DJ, Langan SM, Abuabara K.

Br J Dermatol. 2018 Jan 16. doi: 10.1111/bjd.16340. [Epub ahead of print]

 

“RESULTS: 59 studies met eligibility criteria. Medical diagnosis codes for inclusion and exclusion, number of occasions of a code, type of provider associated with a code, and prescription data were used to identify AD [atopic dermatitis] patients. Only two studies described validation of their methods and no study reported on disease severity. Prevalence estimates ranged from 0.18%-38.33% (median 4.91%) and up to 3-fold variation in prevalence was introduced by differences in the method for identifying AD patients.

CONCLUSIONS: This systematic review highlights the need for clear reporting of methods for identifying AD patients in routinely collected electronic health data to allow for meaningful interpretation and comparison of results.”

 

 

The prevalence of antibody responses against Staphylococcus aureus antigens in patients with atopic dermatitis: a systematic review and meta-analysis.

de Wit J, Totté JEE, van Buchem FJM, Pasmans SGMA.

Br J Dermatol. 2017 Dec 16. doi: 10.1111/bjd.16251. [Epub ahead of print]

 

“Twenty-six articles (2369 patients) were included of which 10 controlled studies. Study quality was fair to poor. AD [atopic dermatitis] patients had higher prevalences of IgE against staphylococcal enterotoxin (SE) A (OR 8.37, 95% CI 2.93-23.92) and SEB (OR 9.34, 95% CI 3.54-24.93) compared to controls. Prevalences of anti-staphylococcal IgE were 33% for SEA, 35% for SEB and 16% for toxic shock syndrome toxin (TSST)-1. However, study heterogeneity and imprecision should be taken into consideration when interpreting the results. Data on IgG, IgM and IgA as well as other antigens are limited. In conclusion, AD patients more often show an IgE antibody response directed against S. aureus superantigens compared to healthy controls supporting a role for S. aureus in the AD pathogenesis.”

 

 

Association of very preterm birth with decreased risk of eczema: A systematic review and meta-analysis.

Zhu T, Zhao J, Qu Y, Zhang L, Mu D.

J Am Acad Dermatol. 2017 Dec 12. pii: S0190-9622(17)32815-3. doi: 10.1016/j.jaad.2017.12.015. [Epub ahead of print]

 

“RESULTS: Eighteen studies were included in this study. Compared to full term birth, very preterm birth had a lower risk of eczema in unadjusted (relative risk 0.78, 95% confidence interval 0.72-0.85) and adjusted analyses (relative risk 0.76, 95% confidence interval 0.68-0.86). The risk became insignificant among children born moderate preterm (unadjusted: relative risk 0.88, 95% confidence interval 0.77-1.00; adjusted: relative risk 0.86, 95% confidence interval 0.73-1.01).

LIMITATIONS: Included studies used different assessments of eczema, and gestational age varied among studies.

CONCLUSIONS: The available evidence suggests an association between very preterm birth and a decreased risk of eczema.”

 

 

Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis.

Flanigan C, Sheikh A, DunnGalvin A, Brew BK, Almqvist C, Nwaru BI.

Clin Exp Allergy. 2018 Jan 13. doi: 10.1111/cea.13091. [Epub ahead of print]

 

“RESULTS: We identified 9,779 papers of which 30 studies (enrolling >6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, four were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema/dermatitis (OR 1.34, 95%CI 1.22-1.47), allergic rhinitis (OR 1.30, 95%CI 1.04-1.62), wheeze (OR 1.34, 95%CI 1.16-1.54) and asthma (OR 1.15, 95%CI 1.04-1.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early-onset and persistent than for late-onset wheeze. Bereavement of a child (HR 1.28, 95%CI 1.10-1.48) or a spouse (HR 1.40, 95%CI 1.03-1.90) increased the risk of offspring asthma.

CONCLUSIONS: Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester-specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding.”

 

 

The effects of early life polyunsaturated fatty acids and ruminant trans fatty acids on allergic diseases: A systematic review and meta-analysis.

Wu W, Lin L, Shi B, Jing J, Cai L.

Crit Rev Food Sci Nutr. 2018 Jan 17:0. doi: 10.1080/10408398.2018.1429382. [Epub ahead of print]

 

“BES [best evidence synthesis] showed a moderate evidence for the protective effect of vaccenic acid (VA) on eczema, while insufficient or no evidence was found in other associations. Meta-analysis showed that higher n-6/n-3 ratio and linoleic acid were associated with higher risk of eczema (pooled odds ratio [OR] = 1.06, 95% confidence intervals [CI]: 1.00-1.13; 1.08, 95% CI: 1.02-1.15). However, VA was inversely associated with eczema (pooled OR = 0.43, 95% CI: 0.26-0.72). Early life natural exposure to VA showed evident benefit on decreasing the risk of eczema, while PUFA [polyunsaturated fatty acids] and other R-TFA [ruminant trans fatty acids] showed limited effects on AD [allergic diseases]. More robust studies especially for R-TFA are required.”

 

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Psoriasis & psoriatic arthritis

 

Biologicals and small molecules in psoriasis: A systematic review of economic evaluations.

Kromer C, Celis D, Sonntag D, Peitsch WK.

PLoS One. 2018 Jan 3;13(1):e0189765. doi: 10.1371/journal.pone.0189765. eCollection 2018.

 

“Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder's interest.”

 

 

The comparative efficacy of brodalumab in patients with moderate-to-severe psoriasis: a systematic literature review and network meta-analysis.

Sawyer L, Fotheringham I, Wright E, Yasmeen N, Gibbons C, Holmen Møller A.

J Dermatolog Treat. 2018 Jan 11:1-39. doi: 10.1080/09546634.2018.1427205. [Epub ahead of print]

 

“RESULTS: A total of 54 studies were included. Based on PASI 100 response, the most efficacious therapies were brodalumab 210mg every two weeks (Q2W) and ixekizumab. Brodalumab 210mg Q2W was significantly more efficacious than adalimumab, apremilast, brodalumab 140mg Q2W, etanercept, infliximab, secukinumab and ustekinumab. Results were consistent for PASI 50, 75 and 90 outcomes and all sensitivity analyses.

CONCLUSIONS: Our findings are consistent with pivotal trials which indicate that high levels of complete clearance can be achieved with brodalumab. Based on existing evidence, induction-phase efficacy of brodalumab is similar to ixekizumab and superior to other approved therapies, including anti-TNFs, apremilast, secukinumab and ustekinumab.”

 

 

Management of psoriasis in patients with inflammatory bowel disease: From the Medical Board of the National Psoriasis Foundation.

Whitlock SM, Enos CW, Armstrong AW, Gottlieb A, Langley RG, Lebwohl M, Merola JF, Ryan C, Siegel MP, Weinberg JM, Wu JJ, Van Voorhees AS.

J Am Acad Dermatol. 2018 Feb;78(2):383-394. doi: 10.1016/j.jaad.2017.06.043.

 

“RESULTS: Of the 2282 articles identified, 132 were selected. Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative; colitis, and Crohn's disease. Ustekinumab has demonstrated efficacy in psoriasis, psoriatic arthritis, and Crohn's disease. Certolizumab has demonstrated efficacy in psoriatic arthritis and Crohn's disease. Etanercept, secukinumab, brodalumab, and ixekizumab have demonstrated efficacy in psoriasis and psoriatic arthritis but may exacerbate or induce IBD [inflammatory bowel disease]. Guselkumab has demonstrated efficacy in psoriasis.

LIMITATIONS: There are no known clinical trials of treatment specifically for concurrent psoriasis and IBD.

CONCLUSIONS: Infliximab and adalimumab have demonstrated efficacy in psoriasis, psoriatic arthritis, ulcerative colitis, and Crohn's disease; other agents have demonstrated efficacy for some, but not all, of these indications.”

 

 

Analysis of the prevalence of mental disorders in psoriasis: The relevance of psychiatric assessment in dermatology.

Ferreira BR, Pio-Abreu JL, Reis JP, Figueiredo A.

Psychiatr Danub. 2017 Dec;29(4):401-406. doi: 10.24869/psyd.2017.401.

 

“RESULTS: The most prevalent mental disorders in these patients are sleep disorders (average prevalence: 62.0%), sexual dysfunction (45.6%), personality (35.0%), anxiety (30.4%), adjustment (29.0%), depressive (27.6%) and substance-related and addictive disorders (24.8%). Other mental disorders have been less described, namely somatic symptoms and related disorders, schizophrenia and other psychoses, bipolar disorder and eating disorders.

CONCLUSIONS: This updated research shows that the prevalence of psychiatric conditions in psoriasis may range from 24% to 90%. The study of the mind-skin connection in psoriasis may improve the knowledge about psoriasis and its psychiatric comorbidities. The link between psoriasis and associated mental disorders is frequently forgotten or not considered in the clinical practice. Psychiatric disorders in patients with psoriasis may be underdiagnosed. These patients would really benefit from psychiatric assessment, with therapeutic relevance.”

 

 

Association between circulating 25-hydroxyvitamin D levels and psoriasis, and correlation with disease severity: a meta-analysis.

Lee YH, Song GG.

Clin Exp Dermatol. 2018 Jan 16. doi: 10.1111/ced.13381. [Epub ahead of print]

 

“RESULTS: Ten articles with a total of 571 patients with psoriasis and 496 HCs [healthy controls] were included. The 25(OH)D [25-hydroxy vitamin D] level was significantly lower in the psoriasis group than in the HC group. Subgroup analysis by sample size revealed a significantly lower level of 25(OH)D in the psoriasis group for large (N > 80) but not for small (N < 80) sample sizes. Stratification by adjustment for age and/or sex or sample type revealed a significantly lower 25(OH)D level in the psoriasis group after adjustment for serum but not after nonadjustment for plasma. Meta-analysis of the correlation coefficients revealed a small but statistically significant positive correlation between circulating 25(OH)D levels and PASI [Psoriasis Area and Severity Index].

CONCLUSIONS: This meta-analysis demonstrated that circulating 25(OH)D levels are lower in patients with psoriasis, and that a small but statistically significant negative correlation exists between 25(OH)D levels and psoriasis severity.”

 

 

Evaluating risk tolerance from a systematic review of preferences: The case of patients with psoriasis.

Gonzalez JM.

Patient. 2018 Jan 13. doi: 10.1007/s40271-017-0295-z. [Epub ahead of print]

 

“RESULTS: Nine publications with maximum acceptable risk results, or with enough information to derive maximum acceptable risks, were identified from the search and screening of preference studies. The most commonly evaluated treatment benefits were duration of benefits, percentage and probability of improvement, and reductions in the coverage of lesions. The adverse-event risks most often included in the publications were those commonly associated with biologics, such as serious infections and malignancies. As expected, maximum acceptable risks changed with treatment benefits and treatment-related adverse events.

CONCLUSIONS: The results confirm the feasibility of using previously published preference information to characterize patient risk tolerance. The estimated distributions of maximum acceptable risk provide a benchmark against which future results can be compared, and signal gaps in our understanding of risk tolerance for specific health outcomes.”

 

 

Comparative effectiveness of abatacept, apremilast, secukinumab and ustekinumab treatment of psoriatic arthritis: a systematic review and network meta-analysis.

Kawalec P, Holko P, Moćko P, Pilc A.

Rheumatol Int. 2017 Dec 28. doi: 10.1007/s00296-017-3919-7. [Epub ahead of print]

 

“Our study revealed no significant differences among non-anti-TNF-α biologics in the treatment of PsA [psoriatic arthritis] in the comparisons performed with regards to the highest efficacy and safety. Both in the overall population and in the analyzed subpopulations, secukinumab 300 mg was ranked the highest for the ACR20 response rate. Secukinumab 300 mg was the safest drug in terms of any AEs [adverse events], and ustekinumab 90 mg presented the lowest overall risk of SAEs [serious adverse events]. Head-to-head trials and evaluation of comparative efficacy and safety between non-TNF-α biologics are warranted to inform clinical decision making with a relevant treatment paradigm.”

 

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Acne & rosacea

 

Ablative fractional CO2 laser for facial atrophic acne scars.

Xu Y, Deng Y.

Facial Plast Surg. 2018 Jan 5. doi: 10.1055/s-0037-1606096. [Epub ahead of print]

 

“The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.”

 

 

Light-emitting diodes in dermatology: A systematic review of randomized controlled trials.

Jagdeo J, Austin E, Mamalis A, Wong C, Ho D, Siegel D.

Lasers Surg Med. 2018 Jan 22. doi: 10.1002/lsm.22791. [Epub ahead of print]

 

See below under Skin surgery and lasers

 

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Skin cancers & sun protection

 

Alcohol, alcoholic beverages, and melanoma risk: a systematic literature review and dose-response meta-analysis.

Gandini S, Masala G, Palli D, Cavicchi B, Saieva C, Ermini I, Baldini F, Gnagnarella P, Caini S.

Eur J Nutr. 2018 Jan 11. doi: 10.1007/s00394-018-1613-5. [Epub ahead of print]

 

“RESULTS: We included 20 independent studies (encompassing 10,555 melanoma cases and over 1.6 million non-cases/controls) published during 1986-2016, of which six had a prospective cohort study design. Adjustment for phenotypic characteristics and sunlight exposure was performed in 11 and nine studies, respectively. Alcohol intake was moderately associated with melanoma risk: the SRR were 1.29 (95% CI 1.14-1.45) for those in the highest vs. lowest category of current alcohol intake, and 1.96 (95% CI 1.02-3.76, I2 = 0%) for cumulative intake. In the dose-response analysis, the increase in risk associated with a 10 g increment in daily alcohol intake was 1.07 (95% CI 1.03-1.11). Risk estimates did not differ by gender, study design and adjustment for confounders; between-studies heterogeneity was acceptable, and there was no evidence of publication bias.

CONCLUSIONS: Our findings suggest that alcohol drinking may be moderately associated with increased melanoma risk, although residual confounding and bias cannot be ruled out. Further research is needed to confirm these findings, clarify the role of the different alcohol sources, and investigate the interaction with known melanoma risk factors.”

 

 

Solarium use and risk for malignant melanoma: Meta-analysis and evidence-based medicine systematic review.

Burgard B, Schöpe J, Holzschuh I, Schiekofer C, Reichrath S, Stefan W, Pilz S, Ordonez-Mena J, März W, Vogt T, Reichrath J.

Anticancer Res. 2018 Feb;38(2):1187-1199.

 

“RESULTS: Two cohort and twenty-nine case-control studies were eligible. Overall, quality of included studies was poor as a result of severe limitations, including possible recall and selection bias, and due to lack of interventional trials. Summary risk estimates suggested a weak association (odds ratio (OR)=1.19, 95% confidence interval (CI)=1.04-1.35, p=0.009) for ever-exposure to UV radiation from a solarium with melanoma risk. However, sensitivity analyses did not show an association for studies from Europe (OR=1.10; 95%CI=0.95-1.27, p=0.218), studies with low risk of bias (OR=1.15; 95%CI=0.94-1.41, p=0.179), and studies conducted after 1990 (OR 1.09; 95%CI=0.93-1.29, p=0.295). Moreover, moderate associations were found for first exposure to UV radiation from a solarium at younger age (<25 years) and high exposure (>10 sessions in lifetime) with melanoma risk. However, for all outcomes analyzed, overall study quality and resulting levels of evidence (3a-) and grades of recommendation (D) were low due to lack of interventional studies and severe limitations including unobserved or unrecorded confounding.

CONCLUSION: Current scientific knowledge is mainly based on observational studies with poor quality data, which report associations but do not prove causality. At present, there is no convincing evidence that moderate/responsible solarium use increases melanoma risk.”

 

 

Skin cancer in the military: a systematic review of melanoma and non-melanoma skin cancer incidence, prevention, and screening among active duty and veteran personnel.

Riemenschneider K, Liu J, Powers JG.

J Am Acad Dermatol. 2017 Dec 29. pii: S0190-9622(17)32897-9. doi: 10.1016/j.jaad.2017.11.062. [Epub ahead of print]

 

“RESULTS: Nine studies describing skin cancer incidence in the United States military were identified, with four studies specific to melanoma. The study findings reveal an increased risk of melanoma associated with service in the military or prisoner of war status. Service in tropical environments was associated with an increased incidence of both melanoma and non-melanoma skin cancer among World War II soldiers. Two studies found that increased melanoma risk was also branch-dependent, with the highest rates among the United States Air Force (USAF) branch. Several of the reviewed studies implicated increased sun exposure during military service and lack of sufficient sun protection as the causes of higher rates of skin cancer among U.S. military and veteran populations as compared to the non-military population in the US.”

 

 

Appearance-based interventions to reduce UV exposure: A systematic review.

Persson S, Benn Y, Dhingra K, Clark-Carter D, Owen AL, Grogan S.

Br J Health Psychol. 2018 Jan 22. doi: 10.1111/bjhp.12291. [Epub ahead of print]

 

“This review concludes that photoageing information in combination with UV photo is associated with a medium positive effect size on sun protection intentions. Photoageing can be manipulated according to theoretical constructs (e.g., Theory of Alternative Behaviours), which may contribute to its effectiveness. Issues such as homogeneity of settings and participants and limited a priori power calculations in the included studies have been identified. This review specifically recommends that future research is conducted in locations with less overall sun exposure, and with a more diverse participant range (e.g., more males and older participants).”

 

 

The impact of UV-dose, body surface area exposed and other factors on cutaneous vitamin D synthesis measured as serum 25(OH)D concentration: Systematic review and meta-analysis.

Jager N, Schöpe J, Wagenpfeil S, Bocionek P, Saternus R, Vogt T, Reichrath J.

Anticancer Res. 2018 Feb;38(2):1165-1171.

 

“CONCLUSION: Our results indicate that partial BSA [body surface area] exposure (e.g. 10%) with moderate UV doses (e.g. 1 SED [standard erythema dose]) is effective in generating or maintaining a healthy vitamin D status. However, due to limitations that include possible confounding factors such as skin type, which could not be considered, these findings should be interpreted with caution.”

 

 

Skin CanceR Brachytherapy vs External beam radiation therapy (SCRiBE) meta-analysis.

Zaorsky NG, Lee CT, Zhang E, Galloway TJ.

Radiother Oncol. 2018 Jan 19. pii: S0167-8140(18)30014-8. doi: 10.1016/j.radonc.2017.12.029. [Epub ahead of print]

 

“BACKGROUND AND PURPOSE: To compare cosmesis and local recurrence (LR) of definitive external beam radiation therapy (EBRT) vs brachytherapy (BT) for indolent basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin…”

“RESULTS: A total of 9965 patients received EBRT and 553 received BT across 24 studies. Mean age was 73 years, median follow-up was 36 months, and median dose was 45 Gy/10 fractions at 4.4 Gy/fraction. At BED3 of 100 Gy, "good" cosmesis was more frequently observed in patients receiving BT, 95% (95% CI: 88-100%) vs 79% (95% CI: 60-82%), p < 0.05. Similar results were found for "good" cosmesis at BED3 >100 Gy. No difference in "poor" cosmesis was noted at any BED3. LR was <7% for both at one year.

CONCLUSION: BT has favorable cosmesis over EBRT for skin SCCs/BCCs at common fractionation regimens. Prospective studies comparing EBRT vs BT are warranted.”

 

 

Role of graft versus host disease in the development of secondary skin cancers in hematopoietic stem cell transplant recipients: A meta-analysis.

Rambhia PH, Conic RZ, Atanaskova-Mesinkovska N, Piliang M, Bergfeld WF.

J Am Acad Dermatol. 2018 Jan 12. pii: S0190-9622(18)30096-3. doi: 10.1016/j.jaad.2018.01.012. [Epub ahead of print] No abstract available.

 

“Six retrospective studies and one prospective study met inclusion criteria, and yielded a total of 50,951 HSCT [hematopoietic stem cell transplant] patients, of which 166 developed skin cancers post transplant. Acute GVHD (aGVHD) [graft versus host disease] was not associated with increased risk of basal cell carcinoma (BCC) (p=0.88), squamous cell carcinoma (SCC) (p=0.90), or melanoma (p=0.28). Study heterogeneity for aGVHD with BCC, SCC or melanoma was low (I2= 0%, 0% and 19% respectively). Chronic GVHD (cGVHD) was associated with increased incidence of BCC (RR: 1.95, 95%CI 1.29-2.95, p=0.002) and SCC (RR: 5.31, 95%CI 2.39-11.81, p<0.001), but had no effect on MM [malignant melanoma] (p=0.1). Heterogeneity of studies for cGVHD with SCC, BCC or melanoma was low (I2= 0%, 0% and 43% respectively).”

 

 

Themes in literature related to incidence, risk, and prevention of cancer in solid-organ transplantation recipients on immunosuppressive therapy.

Rashti SL.

Cancer Nurs. 2018 Jan 12. doi: 10.1097/NCC.0000000000000558. [Epub ahead of print]

 

“RESULTS: Six articles met the inclusion criteria. Results indicate that malignancy is a prominent postoperative finding in at least 4% to 5% of solid-organ transplant recipients, with evidence of various cancer types. Risk factors include male sex, increased age, number of years posttransplant, fair skin, white race, and UV exposure. Screening intervals and educational tools have been found to increase awareness and target those at greater risk.

CONCLUSION: Skin cancer and non-Hodgkin lymphoma were the most commonly diagnosed cancers in transplant recipients.

IMPLICATIONS FOR PRACTICE: Practitioners may find utility in screening tools, self-examination education for patients, and follow-up protocols to prevent further complications in this patient population. Early detection of cancer and those at risk may help decrease morbidity and mortality rates in organ recipients.”

 

 

Use of antihypertensive drugs and risk of keratinocyte carcinoma: A meta-analysis of observational studies.

Tang H, Fu S, Zhai S, Song Y, Asgari MM, Han J.

Pharmacoepidemiol Drug Saf. 2018 Jan 10. doi: 10.1002/pds.4384. [Epub ahead of print]

 

“RESULTS: Ten eligible studies were included. Compared with nonuse, diuretic use was significantly associated with increased risk of both BCC (OR, 1.10; 95% CI, 1.01-1.20) and SCC (OR, 1.40; 95% CI, 1.19-1.66). Use of β-blockers or CCBs [calcium channel blockers] was associated with increased risk of BCC (but not SCC); the OR with β-blockers was 1.09 (95% CI, 1.04-1.15) and with CCBs was 1.15 (95% CI, 1.09-1.21). Use of ACE inhibitors or ARBs [angiotensin receptor blockers] was associated with decreased risk of both BCC (OR, 0.53; 95% CI, 0.39-0.71) and SCC (OR, 0.58; 95% CI, 0.42-0.80) in high-risk individuals.

CONCLUSIONS: Current evidence indicates that use of diuretics might be associated with increased risk of KC [keratinocyte carcinoma], while ACE inhibitors or ARBs might be associated with decreased risk in high-risk individuals. β-blockers or CCBs might be positively associated with BCC risk. Further postmarketing surveillance studies and investigations to clarify the possible underlying mechanisms are warranted.”

 

 

Nonmelanoma skin cancer risk in patients with inflammatory bowel disease undergoing thiopurine therapy: A systematic review of the literature.

Hagen JW, Pugliano-Mauro MA.

Dermatol Surg. 2018 Jan 8. doi: 10.1097/DSS.0000000000001455. [Epub ahead of print]

 

“CONCLUSION: Patients with IBD [inflammatory bowel disease] using thiopurines seem to have a moderately increased risk of NMSC [nonmelanoma skin cancers] that is proportional to therapy duration. Risk of NMSC seems to decrease or return to baseline after discontinuing therapy, although additional data are needed to support this trend. Younger patients with IBD using thiopurines seem to be at greater risk of NMSC. Appreciating NMSC risk in patients with IBD undergoing thiopurine therapy should help direct skin cancer screening recommendations and sun protective measures.”

 

 

Night shift work increases the risks of multiple primary cancers in women: A systematic review and meta-analysis of 61 articles.

Yuan X, Zhu C, Wang M, Mo F, Du W, Ma X.

Cancer Epidemiol Biomarkers Prev. 2018 Jan;27(1):25-40. doi: 10.1158/1055-9965.EPI-17-0221.

 

“A positive relationship was revealed between long-term night shift work and the risks of breast [OR = 1.316; 95% confidence interval (CI), 1.196-1.448], digestive system (OR = 1.177; 95% CI, 1.065-1.301), and skin cancer (OR = 1.408; 95% CI, 1.024-1.934). For every 5 years of night shift work, the risk of breast cancer in women was increased by 3.3% (OR = 1.033; 95% CI, 1.012-1.056). Concerning the group of nurses, long-term night shift work presented potential carcinogenic effect in breast cancer (OR = 1.577; 95% CI, 1.235-2.014), digestive system cancer (OR = 1.350; 95% CI, 1.030-1.770), and lung cancer (OR = 1.280; 95% CI, 1.070-1.531). This systematic review confirmed the positive association between night shift work and the risks of several common cancers in women. We identified that cancer risk of women increased with accumulating years of night shift work, which might help establish and implement effective measures to protect female night shifters.”

 

 

Photodynamic therapy interventions in facial photodamage: A systematic review.

Sanclemente G, Ruiz-Cañas V, Miranda JM, Ferrín AP, Ramirez PA, Hernandez GN.

Actas Dermosifiliogr. 2017 Dec 30. pii: S0001-7310(17)30522-7. doi: 10.1016/j.ad.2017.05.021. [Epub ahead of print] English, Spanish.

 

“RESULTS: Search was conducted up to May 4th 2016. Four authors independently selected and assessed methodological quality of each RCT. According to inclusion criteria, twelve studies were included (6 aminolevulinate (ALA) trials and 6 methyl aminolevulinate (MAL) trials), but the majority of them had methodological constraints particularly in randomization description and patients/outcome assessors blindness.

DISCUSSION AND CONCLUSIONS: Overall results indicated that PDT either with ALA or with MAL was effective and safe for facial photodamage treatment, but high quality of evidence was found mainly for MAL studies.”

 

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Infections of the skin

 

Oral medications to treat toenail fungal infection.

Kreijkamp-Kaspers S, Hawke KL, van Driel ML.

JAMA. 2018 Jan 23;319(4):397-398. doi: 10.1001/jama.2017.20160.

 

This is a summary of the 2017 Cochrane Review Oral antifungal medication for toenail onychomycosis.

“CLINICAL QUESTION: Which oral antifungal medication is associated with the highest clinical (ie, normal appearance of the toenail) and mycological (negative culture, microscopy, or both) cure rates vs placebo or other antifungals when used to treat fungal infections?

BOTTOM LINE: Both terbinafine and azole-based medications were associated with higher clinical and mycological cure rates compared with placebo (high-quality evidence). Azoles were associated with lower cure rates than terbinafine when compared directly.”

 

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Drug & treatment reactions/safety

 

Incidence, risk and prognostic role of anti-epidermal growth factor receptor-induced skin rash in biliary cancer: a meta-analysis.

Wei F, Shin D, Cai X.

Int J Clin Oncol. 2017 Dec 30. doi: 10.1007/s10147-017-1231-x. [Epub ahead of print]

 

“RESULTS: Fourteen clinical trials published between 2006 and 2017 comprising 1,106 patients with advanced biliary cancer were included. The overall incidence of all-grade and high-grade (grade ≥3) rash was 78.2% [95% confidence interval (CI) 70.4-84.3] and 11.3% (7.6-16.5), respectively. Anti-EGFR [anti-epidermal growth factor receptor] treatment correlates with a significantly increased risk of all-grade [risk ratio (RR) 7.37, 95% CI 5.11-10.64, p < 0.0001] and high-grade (RR 6.94, 95% CI 1.89-25.45, p = 0.0035) rash compared with control medication. Higher grades of skin rash correlate with a higher objective response rate (RR 3.50, 95% CI 1.47-8.33, p = 0.0048), and a longer overall [hazard ratio (HR) 0.47, 95% CI 0.31-0.71, p = 0.0003) and progression-free survival (HR 0.51, 95% CI 0.36-0.72, p = 0.0001) compared with lower grades or no rash in patients who received anti-EGFR treatment.

CONCLUSIONS: Anti-EGFR treatment correlates with an increased risk of skin rash in advanced biliary cancer. Stratifying patients by the severity of rash may have major implications for survival benefit regarding anti-EGFR treatment for biliary cancer.”

 

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Vitiligo & pigmentary disorders

 

Critical appraisal of the oxidative stress pathway in vitiligo: A systematic review and meta-analysis.

Speeckaert R, Dugardin J, Lambert J, Lapeere H, Verhaeghe E, Speeckaert MM, van Geel N.

J Eur Acad Dermatol Venereol. 2018 Jan 17. doi: 10.1111/jdv.14792. [Epub ahead of print]

 

“RESULTS: A deregulated oxidative pathway is clearly evident with elevated superoxide dismutase (SOD), decreased catalase (CAT) and increased lipid peroxidation. However, similar results have been obtained in other inflammatory skin diseases such as psoriasis, atopic dermatitis, lichen planus and urticaria. This questions the unique role of oxidative stress in the development of vitiligo. Some isolated successes have been reported with oral ginkgo biloba, polypodium leucotomos and vitamin C and E preparations, while other clinical trials have failed to show reproducible results. The use of topical antioxidants delivers in general no beneficial results.

CONCLUSION: The oxidative pathway is affected in vitiligo but its unique initiating or contributory role in the pathogenesis is less evident. Interesting data support the added value of oral antioxidants in vitiligo although confirmatory studies are missing.”

 

 

Efficacy and safety of noncultured melanocyte-keratinocyte transplant procedure for vitiligo and other leukodermas: a critical analysis of the evidence.

Vakharia PP, Lee DE, Khachemoune A.

Int J Dermatol. 2018 Jan 10. doi: 10.1111/ijd.13895. [Epub ahead of print]

 

“Numerous trials and case series/reports have demonstrated tolerability and efficacy of MKTP [melanocyte-keratinocyte transplantation procedure] with repigmentation for patients with refractory, stable vitiligo. However, the response rates have been variable, likely influenced by vitiligo type and affected areas. Future research and clinical reporting will provide more insight on which phenotypes may benefit from MKTP.”

 

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Hair & nail disorders

 

Systematic review of low-level laser therapy for adult androgenic alopecia.

Delaney SW, Zhang P.

J Cosmet Laser Ther. 2017 Dec 29:1-8. doi: 10.1080/14764172.2017.1400170. [Epub ahead of print]

 

“Low-level laser therapy appears to be a promising noninvasive treatment for AA in adults that is safe for self-administration in the home setting. Although shown to effectively stimulate hair growth when compared to sham devices, these results must be interpreted with caution. Further studies with larger samples, longer follow-up, and independent funding sources are necessary to determine the clinical effectiveness of this novel therapy.”

 

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Oral disorders

 

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: a systematic review.

Al-Maweri SA, Ashraf S, Kalakonda B, Halboub E, Petro W, AlAizari NA.

J Oral Pathol Med. 2018 Jan 19. doi: 10.1111/jop.12684. [Epub ahead of print]

 

“RESULTS: Five clinical studies were included. The risk of bias was considered high in four studies and moderate in one study. The efficacy of PDT [photodynamic therapy] was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation and power density ranged between 420 - 660 nm, 30s - 10 min, and 10-500 mW/cm2 , respectively. All studies reported PDT to be effective in the management of symptomatic OLP [oral lichen planus]. Two studies reported PDT to be as effective as corticosteroids, one study reported a better efficacy of PDT compared to corticosteroids, whereas two studies found PDT to be inferior to corticosteroids.

CONCLUSIONS: The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted.”

 

 

Oral lichen sclerosus: a systematic review of reported cases and two new cases.

Kakko T, Salo T, Siponen MK.

Int J Dermatol. 2018 Jan 4. doi: 10.1111/ijd.13870. [Epub ahead of print]

 

“Cases with clinical and histopathological confirmation of diagnosis of OLS [oral lichen sclerosus] were included. A total of 41 (39 published and 2 new) histologically confirmed OLS cases were available. The median age of OLS patients was 31 years, and 66% of the patients were female. Most of the OLS lesions were asymptomatic. They were located in the labial mucosa (n = 20), lip (n = 15), buccal mucosa (n = 14), gingiva (n = 12), tongue (n = 12), and palate (n = 7). OLS is rare and typically presents as asymptomatic, white, plaque-like lesions. Malignant transformation of preexisting OLS has not been reported.”

 

 

Recurrent aphthous ulceration: A review of potential causes and novel treatments.

Saikaly SK, Saikaly TS, Saikaly LE.

J Dermatolog Treat. 2017 Dec 26:1-57. doi: 10.1080/09546634.2017.1422079. [Epub ahead of print]

 

“RESULTS: RAU [recurrent aphthous ulceration] can result from systemic disease and trauma, but recent studies have shown a variety of potential etiologies, ranging from vitamin deficiencies, oral microbiota derangements, hematological considerations, stress, genetic polymorphisms to oxidant-antioxidant imbalances, among others. Many modalities of therapy are available and have proven efficacious.

CONCLUSIONS: As the exact etiology of RAU is still unknown, therapy is based on symptomatic relief.”

 

 

Clinical features and treatment of fibrous histiocytomas of the tongue: A systematic review.

Nguyen A, Vaudreuil A, Haun P, Caponetti G, Huerter C.

Int Arch Otorhinolaryngol. 2018 Jan;22(1):94-102. doi: 10.1055/s-0037-1602819. Epub 2017 May 2.

 

“Conclusion: Benign fibrous histiocytomas are consistent in clinical and histopathologic presentation. Surgical treatment provides excellent outcome, with no recurrence in all excised cases. Malignant tumors have a more aggressive clinical and pathological presentation. Surgical treatment with possible adjuvant radiotherapy resulted in recurrence in 40% of cases (follow-up of 24 months), and death due to disease in 47% of patients (follow-up of 19 months).”

 

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Chronic wounds & ulcers

 

Contribution of photodynamic therapy in wound healing: A systematic review.

Nesi-Reis V, Lera-Nonose DSSL, Oyama J, Paula Silva-Lalucci MP, Demarchi IG, Aristides SMA, Teixeira JJV, Silveira TGV, Lonardoni MVC.

Photodiagnosis Photodyn Ther. 2017 Dec 28. pii: S1572-1000(17)30423-4. doi: 10.1016/j.pdpdt.2017.12.015. [Epub ahead of print]

 

“RESULTS: The main types of wound described in selected articles in this review were chronic ulcer, non-melanoma skin cancer. For accomplishing the PDT [photodynamic therapy], second generation of photosensitizing agents with laser or light emitting diode were used. The studies demonstrated that PDT contribute in several ways to the wound healing process: leading to cellular death; reducing or increasing inflammation; stimulating fibroblasts proliferation and, consequently, of collagen and elastin; raising transforming growth factor beta and metalloproteinases. Based on this, PDT provided good results in wound healing process, acting in several steps and accelerating tissue repair.

CONCLUSIONS: PDT improved healing in many wound models in humans, revealing itself as a promising therapeutic modality, stimulating wound healing and remodelling.”

 

 

Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis.

Yin Y, Zhang R, Li S, Guo J, Hou Z, Zhang Y.

Int J Surg. 2017 Dec 29;50:43-48. doi: 10.1016/j.ijsu.2017.12.020. [Epub ahead of print]

 

“RESULTS: Five cohort studies and seven RCTs including 653 patients were eligible for inclusion. Patients treated with NPWT [negative-pressure wound therapy] had a significantly higher rate of graft take compared to those treated with conventional therapy [MD = 7.02, (95% CI 3.74, 10.31)] (P = .00). NPWT was associated with a reduction in reoperation [RR = 0.28, (95% CI 0.14, 0.55)] (P = .00). The reduction in wound infection was not significant [RR = 0.63, (95% CI 0.31, 1.27)] (P = .20).

CONCLUSION: Compared with conventional therapy, NPWT significantly increases the rate of graft take and reduces the rate of reoperation when applied to cover the wound bed with split-thickness skin graft. No significant impact on wound infection was found in this study.”

 

 

Use of oxidized regenerated cellulose/collagen matrix in chronic diabetic foot ulcers: A systematic review.

Chicone G, de Carvalho VF, Paggiaro AO.

Adv Skin Wound Care. 2018 Feb;31(2):66-71. doi: 10.1097/01.ASW.0000527297.95688.76.

 

“RESULTS: At first, 316 related studies were located in the databases. After evaluating these studies for methodological similarities, only 3 were considered eligible for the review. One RCT was considered at high risk of bias. Results from this meta-analysis of 2 studies showed no significant improvement in wound healing rates of DFUs when ORC+C [oxidized regenerated cellulose/collagen matrix] was compared with standard wound care.

CONCLUSIONS: Because of several methodology flaws in the reviewed studies, these results suggest that there is currently no research evidence to suggest that the use of ORC+C improves wound healing rates of DFUs [diabetic foot ulcers]. Additional research with high-quality RCTs focused on diabetic ulcers is necessary.”

 

 

Efficiency of stem cell based therapy in the treatment of diabetic foot ulcer: a meta-analysis.

Shu X, Shu S, Tang S, Yang L, Liu D, Li K, Dong Z, Ma Z, Zhu Z, Din J.

Endocr J. 2018 Jan 22. doi: 10.1507/endocrj.EJ17-0424. [Epub ahead of print]

 

“A total of 7 studies that involved 224 diabetic foot patients, classified as Wagner grades 1-5, were analyzed. The pooled results confirmed the benefits of using the stem cell treatment. Partial and/or complete healing were significantly higher in the stem cell group compared with the control group (77.4% vs. 31.9%; RR: 2.22; 95% CI, 1.65-2.98). Subgroup analysis on ABI and TCP02 also confirmed the results. The present meta-analysis indicates that stem cell-based therapy can enhance the healing of diabetic foot ulcers and is associated with lesser pain, lower amputation rate and improved prognosis compared with normal treatment. Well-designed randomized controlled trials are required in the future in order to confirm and update these findings.

 

 

[The epidemiology of pressure ulcer in Germany: Systematic review].

Tomova-Simitchieva T, Akdeniz M, Blume-Peytavi U, Lahmann N, Kottner J.

Gesundheitswesen. 2018 Jan 12. doi: 10.1055/s-0043-122069. [Epub ahead of print] German.

 

“RESULTS: 219 epidemiologic figures were found in 67 studies and documents. Most data were identified for the hospital setting. The majority of figures in long-term care was based on primary research. Considering sources of high methodological quality, prevalence in long-term care varied between 2% and 5% and between 2% to 4% in hospitals (category 2 and above). Routine data collections showed heterogeneous results from the hospital settings with prevalence from 0.07% to 4.37%. No incidence figures and no routine data collections were identified for ambulatory settings. Prevalence varied between 2 and 4% (including category 1).

CONCLUSION: Review results indicate that pressure ulcers are frequent within all health care settings in Germany. Disregarding methodological limitations, pressure ulcer prevalence is between 2% and 5% in long-term care patients. Due to the heterogeneity of the available data, generalizable statements are not possible for the hospital settings. Pressure ulcer prevalence is most likely at least 2%. Results indicate that pressure ulcer preventive measures need to be improved in Germany.”

 

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Other disorders affecting the skin

 

Association between bullous pemphigoid and malignancy: A meta-analysis.

Lucariello RJ, Villablanca SE, Mascaró JM Jr, Reichel M.

Australas J Dermatol. 2018 Jan 4. doi: 10.1111/ajd.12764. [Epub ahead of print]

 

“This meta-analysis included 16 studies with a total of 9398 cases of bullous pemphigoid. The rate of malignancy in patients with bullous pemphigoid was 11% (95% CI: 9-14, P < 0.001); 9% (95% CI: 6-13, P < 0.003) for women and 13% (95% CI: 9-18, P < 0.03) for men, with a statistically insignificant higher risk in men (OR = 1.30, 95% CI: 0.99-1.71, P = 0.06). The event rate was 9% (95% CI: 5-14, P < 0.001) in the Asian population and 13% (95% CI: 10-17, P < 0.001) in the European population, with a statistically significant lower risk in the Asians population (OR = 0.69, 95% CI: 0.57-0.84; P < 0.001). The event rate of malignancy was higher in patients with bullous pemphigoid than in matched controls (OR = 2.08, 95% CI: 1.22-3.55; P = 0.005). The overall event rate of malignancy was higher in the bullous pemphigoid group than in matched controls. Caution is required when interpreting these results, as potential confounding variables were not controlled for.”

 

 

Diagnosis and management of peristomal pyoderma gangrenosum: A systematic review.

Afifi L, Sanchez IM, Wallace MM, Braswell SF, Ortega-Loayza AG, Shinkai K.

J Am Acad Dermatol. 2017 Dec 26. pii: S0190-9622(17)32889-X. doi: 10.1016/j.jaad.2017.12.049. [Epub ahead of print]

 

“RESULTS: We describe 335 patients with PPG [peristomal pyoderma gangrenosum] from 79 studies. Clinical features include a painful, rapidly progressing ulcer with undermined, violaceous borders with a history of ostomy leakage and local skin irritation or trauma. Systemic steroids are first line therapy; infliximab and adalimumab provide concomitant control of active IBD. Combination local and systemic therapy was commonly utilized. Wound dressings, vehicle selection, and appropriate ostomy devices to minimize leakage, irritation, and pressure-induced ischemia can improve healing. Distinct from classic ulcerative PG, surgical approaches, such as stoma closure and resection of active IBD, have an effective role in PPG management.”

 

 

Dermatologic manifestations of solid organ transplantation-associated graft-versus-host disease: A systematic review.

Kim GY, Schmelkin LA, Davis MDP, El-Azhary RA, Farrell AM, Meves A, Lehman JS.

J Am Acad Dermatol. 2017 Dec 26. pii: S0190-9622(17)32890-6. doi: 10.1016/j.jaad.2017.12.050. [Epub ahead of print] No abstract available.

 

“CAPSULE SUMMARY

·         Dermatologic manifestations of graft-versus-host disease after solid organ transplantation (SOT GVHD) are not well-known.

·         Skin eruption appears early on and has varied clinical presentations.

·         In patients who develop dermatologic signs following solid-organ transplantation, we advise dermatologists to have a high index of suspicion for this rare but potentially fatal entity.”

 

 

Effect of topical timolol on response rate and adverse events in infantile hemangioma: a meta-analysis.

Zheng L, Li Y.

Arch Dermatol Res. 2018 Jan 23. doi: 10.1007/s00403-018-1815-y. [Epub ahead of print]

 

“A total of 10 studies, comprising 887 infants with hemangioma, were included. The response rate was reported in eight trials; these studies compared the topical timolol to laser, observation, placebo, or propranolol. The heterogeneity was statistically significant (P < 0.00001, I2 = 83%). The difference in the response rate was significant (RR = 2.86, 95% CI 1.31-6.24) while comparing the topical timolol to the controls. However, no significant difference in the response rate was observed while comparing the topical timolol to propranolol (RR = 0.99, 95% CI 0.70-1.42). The difference in the adverse events was found to be significant (RR = 0.21, 95% CI 0.05-0.97) when the timolol group was compared to the control group. This meta-analysis confirmed that the topical timolol alone was more beneficial on response rate and adverse event than laser, placebo, and observation. The response rate did not differ significantly when comparing the topical timolol to propranolol. However, further studies are essential using an improved design of the study.”

 

 

Cutaneous hypersensitivity-like reactions associated with breast implants: A review.

Labadie JG, Korta DZ, Barton N, Mesinkovska NA.

Dermatol Surg. 2017 Dec 28. doi: 10.1097/DSS.0000000000001448. [Epub ahead of print]

 

“RESULTS: In total, 10 studies on hypersensitivity-like reactions from breast implants were included in the review. Potential allergenic compounds in breast implants include silicone, polyurethane texturing, and acellular dermal matrix. Perivascular lymphocytic infiltrate was a common finding on histopathology. Patch testing and preoperative silicone cube implantation were used to determine sensitivity. Attempted treatments included topical and oral corticosteroids, montelukast and antibiotics. Most cases required implant removal for resolution of symptoms.

CONCLUSION: Cutaneous hypersensitivity-like reactions to breast implants seem to be rare complications, sometimes necessitating implant removal. Future studies are needed to establish their incidence and etiology, and the diagnostic role of patch testing and preoperative screening.”

 

 

Laser treatment of primary axillary hyperhidrosis: a review of the literature.

Cervantes J, Perper M, Eber AE, Fertig RM, Tsatalis JP, Nouri K.

Lasers Med Sci. 2018 Jan 11. doi: 10.1007/s10103-017-2434-0. [Epub ahead of print]

 

“In this literature review, we examined the use of lasers, particularly the Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) and diode lasers, in treating hyperhidrosis. Due to its demonstrated effectiveness and limited side effect profile, our review suggests that Nd:YAG laser may be a promising treatment modality for hyperhidrosis. Nevertheless, additional large, randomized controlled trials are necessary to confirm the safety and efficacy of this treatment option.”

 

 

Effectiveness of non-steroidal anti-inflammatory drugs among patients with primary hypertrophic osteoarthropathy: A systematic review.

Shakya P, Pokhrel KN, Mlunde LB, Tan S, Ota E, Niizeki H.

J Dermatol Sci. 2017 Dec 28. pii: S0923-1811(17)31016-2. doi: 10.1016/j.jdermsci.2017.12.012. [Epub ahead of print]

 

“INTRODUCTION: Primary hypertrophic osteoarthropathy (PHO), also known as pachydermoperiostosis is a rare genetic disease which predominantly affects skin, bone and soft connective tissue. It is characterized by the triad of pachydermia, digital clubbing and periostosis of long bones. Arthralgia or arthritis is also present in most of the cases. Genetic studies have identified the impaired PGE2 metabolism as a culprit for hypertrophic osteoarthropathy in PHO cases. We conducted a systematic review to examine the effectiveness of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), a PGE2 synthesis blocker to reduce the symptoms among PHO patients…”

“RESULTS: Out of 238 identified studies, we selected 26 for the synthesis. All were case reports which included a total of 54 patients. Among them, 39 patients were treated with at least one type of NSAIDs. Around 70% of the patients treated with NSAIDs had clinical improvement for their symptoms, mostly arthritis or arthralgia symptoms.

CONCLUSION: NSAIDs were effective in improving arthralgia or arthritis symptoms in majority of the PHO patients. Therefore, we recommend the use of NSAIDs in PHO patients to treat arthralgia or arthritis.”

 

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Skin conditions & dermatology in general

 

Disease-specific health related quality of life patient reported outcome measures in genodermatoses: a systematic review and critical evaluation.

Frew JW, Davidson M, Murrell DF.

Orphanet J Rare Dis. 2017 Dec 29;12(1):189. doi: 10.1186/s13023-017-0739-5.

 

“RESULTS: 15 HRQoL [Health Related Quality of Life] PROMs [patient reported outcome measures] in genodermatoses were identified. Major areas of deficiency in development were internal consistency, reliability and structural validity. No PROM satisfied measurement property standards for agreement, responsiveness or floor and ceiling effects. Four PROMs included Minimal Important Change scores for interpretability. Issues regarding the generalisability of the evaluated PROMs in culturally diverse and paediatric populations remain unresolved.

CONCLUSIONS: The overall standards of development and measurement properties in PROMs in genodermatoses is fair, despite no single instrument meeting all requirements. None are perfectly validated according to COSMIN criteria but seven of the fifteen PROMs may be appropriate pending further validation. The development of culturally appropriate and child-specific variants of PROMs should be a priority in order to increase the utility of patient based outcome measures in genodermatoses in various patient populations.”

 

 

The validity and reliability of using ultrasound elastography to measure cutaneous stiffness, a systematic review.

DeJong HM, Abbott S, Zelesco M, Kennedy BF, Ziman MR, Wood FM.

Int J Burns Trauma. 2017 Dec 20;7(7):124-141. eCollection 2017.

 

“RESULTS: From a total of 688 articles, 14 met the inclusion criteria for full review. Within the 14 studies, elastography was used to evaluate tumors, systemic sclerosis, lymphedema, abscess, and post-radiation neck fibrosis. Only three robust studies demonstrated good interrater reliability, whereas all validity studies had low sample sizes and demonstrated risks of bias.

CONCLUSION: Robust evidence supporting the use of ultrasound elastography as a diagnostic tool in cutaneous conditions is low, however, initial indicators support further research to establish the utility of ultrasound elastography in dermatology.”

 

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Skin surgery and lasers

 

Light-emitting diodes in dermatology: A systematic review of randomized controlled trials.

Jagdeo J, Austin E, Mamalis A, Wong C, Ho D, Siegel D.

Lasers Surg Med. 2018 Jan 22. doi: 10.1002/lsm.22791. [Epub ahead of print]

 

“CONCLUSIONS: LEDs represent an emerging modality to alter skin biology and change the paradigm of managing skin conditions. Acne vulgaris, herpes simplex and zoster, and acute wound healing received grade of recommendation B. Other skin conditions received grade of recommendation C or D. Limitations of some studies include small patient sample sizes (n < 20), absent blinding, no sham placebo, and varied treatment parameters. Due to few incidences of adverse events, affordability, and encouraging clinical results, we recommend that physicians use LEDs in clinical practice and researchers continue to explore the use of LEDs to treat skin conditions.”

 

 

Ablative fractional CO2 laser for facial atrophic acne scars.

Xu Y, Deng Y.

Facial Plast Surg. 2018 Jan 5. doi: 10.1055/s-0037-1606096. [Epub ahead of print]

 

See above under Acne & rosacea

 

 

Systematic review of low-level laser therapy for adult androgenic alopecia.

Delaney SW, Zhang P.

J Cosmet Laser Ther. 2017 Dec 29:1-8. doi: 10.1080/14764172.2017.1400170. [Epub ahead of print]

 

See above under Hair & nail disorders

 

 

Laser treatment of primary axillary hyperhidrosis: a review of the literature.

Cervantes J, Perper M, Eber AE, Fertig RM, Tsatalis JP, Nouri K.

Lasers Med Sci. 2018 Jan 11. doi: 10.1007/s10103-017-2434-0. [Epub ahead of print]

 

See above under Other disorders affecting the skin

 

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Service delivery & management

 

None found this month.

 

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Prescribing and safety alerts

 

 

We acknowledge the NICE Medicines Awareness Service and MHRA Drug Safety Update as sources in compiling this section.

 

 

Medicines and Healthcare Products Regulatory Agency (MHRA) Drug Safety Update - Recombinant human erythropoietins: very rare risk of severe cutaneous adverse reactions (SCARs)

 

“Recombinant human erythropoietin (r-HuEPO) treatment has been associated with very rare cases of life-threatening severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Withdraw r-HuEPOs permanently in patients who develop severe skin reactions such as SJS or TEN.”

 

 

Revised SmPC: YERVOY (ipilimumab) 5 mg/ml concentrate for solution for infusion

 

After European Commission approval, ipilimumab is now licensed for use in paediatric patients 12 years and older with unresectable or metastatic melanoma.

 

 

Revised SmPC: YERVOY (ipilimumab) 5 mg/ml concentrate for solution for infusion

 

The Summary of Product Characteristics (SmPC) for YERVOY (ipilimumab) 5 mg/ml concentrate for solution for infusion has been updated to include pemphigoid and histiocytosis haematophagic as new adverse drug reactions (frequency unknown), with new associated warnings.

 

 

Revised SmPC: Acnecide (benzoyl peroxide) 5% w/w Gel

 

The Summary of Product Characteristics (SmPC) for Acnecide (benzoyl peroxide) 5% w/w Gel has various additions including:
A warning to discontinue use if swelling or blistering occur and to avoid UV radiation;
A caution for use when breastfeeding;
Allergic reactions including hypersensitivity and anaphylaxis included as adverse events;
New advice about applying to sensitive skin.

 

 

Revised SmPC: Zirtek (cetirizine) Allergy 10 mg film-coated tablets

 

The Summary of Product Characteristics (SmPC) for Zirtek (cetirizine) Allergy 10 mg film-coated tablets has had acute generalized exanthematous pustulosis added as a new potential adverse effect of treatment (frequency unknown).

 

 

 

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CEBD publications & news

 

 

Automated multimodal spectral histopathology for quantitative diagnosis of residual tumour during basal cell carcinoma surgery.

Boitor R, Kong K, Shipp D, Varma S, Koloydenko A, Kulkarni K, Elsheikh S, Schut TB, Caspers P, Puppels G, van der Wolf M, Sokolova E, Nijsten TEC, Salence B, Williams H, Notingher I.

Biomed Opt Express. 2017 Nov 22;8(12):5749-5766. doi: 10.1364/BOE.8.005749. eCollection 2017 Dec 1.

 

“Multimodal spectral histopathology (MSH), an optical technique combining tissue auto-fluorescence (AF) imaging and Raman micro-spectroscopy (RMS), was previously proposed for detection of residual basal cell carcinoma (BCC) at the surface of surgically-resected skin tissue. Here we report the development of a fully-automated prototype instrument based on MSH designed to be used in the clinic and operated by a non-specialist spectroscopy user. The algorithms for the AF image processing and Raman spectroscopy classification had been first optimised on a manually-operated laboratory instrument and then validated on the automated prototype using skin samples from independent patients. We present results on a range of skin samples excised during Mohs micrographic surgery, and demonstrate consistent diagnosis obtained in repeat test measurement, in agreement with the reference histopathology diagnosis. We also show that the prototype instrument can be operated by clinical users (a skin surgeon and a core medical trainee, after only 1-8 hours of training) to obtain consistent results in agreement with histopathology. The development of the new automated prototype and demonstration of inter-instrument transferability of the diagnosis models are important steps on the clinical translation path: it allows the testing of the MSH technology in a relevant clinical environment in order to evaluate its performance on a sufficiently large number of patients.”

 

 

How should minimally important change (MIC) scores for the Patient Oriented Eczema Measure (POEM) be interpreted? A validation using varied methods.

Howells L, Ratib S, Chalmers JR, Bradshaw L, Thomas KS; CLOTHES trial team.

Br J Dermatol. 2018 Jan 21. doi: 10.1111/bjd.16367. [Epub ahead of print]

 

“RESULTS: Data was collected from 300 children. The smallest detectable change was 2.12. The MIC estimates were 1.07 (0.2 SD) and 2.68 (0.5 SD) based on distribution-based methods, were 3.09 to 6.13 based on patient-reported anchor-based methods, and were 3.23 to 5.38 based on investigator-reported anchor-based methods.

CONCLUSIONS: We recommend the following thresholds are used to interpret changes in POEM scores: ≤ 2, unlikely to be a change beyond measurement error; 2.1 to 2.9, a small change detected that is likely to be beyond measurement error but may not be clinically important; 3 to 3.9, probably a clinically important change; 4+, very likely to be a clinically important change.”

 

 

What's new in atopic eczema? An analysis of systematic reviews published in 2015. Part 1: epidemiology and methodology.

Davies E, Rogers NK, Lloyd-Lavery A, Grindlay DJC, Thomas KS.

Clin Exp Dermatol. 2018 Jan 4. doi: 10.1111/ced.13377. [Epub ahead of print]

 

“The worldwide prevalence of AE during childhood has been calculated to be 7.89% (95% CI 7.88-7.89), based on studies of 1 430 329 children from 102 countries. Children with AE are four times more likely than controls to have allergic rhinitis and asthma [relative risk (RR) = 4.24, 95% CI 3.75-4.79]. Twin studies show the heritability of AE to be about 75%. AE is more prevalent in patients with vitiligo and alopecia, and is positively associated with a high body mass index in America and Asia but not in Europe. Possible relationships between AE and exercise, maternal folate supplementation, maternal stress and autism spectrum disorder (ASD) have been assessed, but more high-quality studies are needed for definitive conclusions. The Harmonising Outcomes Measures for Eczema (HOME) Initiative is developing a core set of outcome measures for AE trials. Suitable instruments for measuring quality of life are yet to be agreed, and use of Investigator Global Assessment in trials requires standardization. Transparent reporting of AE trials remains problematic.”

 

 

Views and experiences of seeking information and help for vitiligo: a qualitative study of written accounts.

Teasdale E, Muller I, Abdullah Sani A, Thomas KS, Stuart B, Santer M.

BMJ Open. 2018 Jan 11;8(1):e018652. doi: 10.1136/bmjopen-2017-018652.

 

“PARTICIPANTS: A survey link was emailed to 675 members of The Vitiligo Society, a UK-based charity providing information and support for people with vitiligo. One hundred and sixty-one members responded to the survey (24%).

RESULTS: Many participants wrote extensive free text, often reporting frustration with help-seeking. They perceived general practitioners (GP) as their primary source of advice but felt that GPs had low awareness of available treatments. Where GPs appeared sympathetic or signposted towards further information this was appreciated, even where people felt their GP had not seemed knowledgeable. Many felt that vitiligo was dismissed by health professionals including GPs and dermatologists as 'cosmetic', which upset those who experienced substantial impact. Participants expressed concerns about the credibility of online information on vitiligo and the need for reliable, detailed information, as well as a desire for support with managing its psychosocial impact.

CONCLUSIONS: Information and help-seeking needs of people with vitiligo currently appear to be poorly met, even among members of The Vitiligo Society, who are likely to have received more information than others. People with vitiligo would welcome greater health professional awareness of available vitiligo treatments. Acknowledging the psychosocial impacts of vitiligo and signposting towards credible information are also welcomed.”

 

 

The Vitiligo Extent Score (VES) and the VESplus are responsive instruments to assess global and regional treatment response in patients with vitiligo.

van Geel N, Bekkenk M, Lommerts JE, Ezzedine K, Harris J, Hamzavi I, Eleftheriadou V, Picardo M, Taieb A, Prinsen CA, Wolkerstorfer A, Speeckaert R.

J Am Acad Dermatol. 2018 Jan 4. pii: S0190-9622(18)30013-6. doi: 10.1016/j.jaad.2017.12.070. [Epub ahead of print] No abstract available.

 

“In conclusion, both VES [Vitiligo Extent Score] and VESplus appeared to be responsive instruments. However, further studies are required to make final conclusions on the most preferred tool as limitation in our included patient population (e.g. perifollicular repigmentation absent in ±2/3 of cases, mean BSA<5% in 93% and photo skin type ≤4 in 84%) may have influenced the results. Furthermore, future studies will be needed to compare these scoring systems directly to existing scoring systems like the VETF and VASI.”

 

 

Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal.

Thomson J, Wernham AGH, Williams HC.

Br J Dermatol. 2018 Jan 6. doi: 10.1111/bjd.16317. [Epub ahead of print]

 

“RESULTS: 740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.

CONCLUSIONS: Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.”

 

 

Survey of practice for bullous pemphigoid

 

In November 2015, the BLISTER trial team conducted a survey of dermatologists to establish current practice for the initial treatment of bullous pemphigoid, prior to the publication of the BLISTER trial results. Now that the findings of the BLISTER study have been published in The Lancet, the team are conducting a second survey to assess what impact this UK Dermatology Clinical Trials Network study has had. You can link to the online survey at https://www.surveymonkey.co.uk/r/Post-BLISTER.

 

 

Vacancy in the CEBD for Associate Professor of Applied Health Services Research

 

Applications are invited for a non-clinical academic post as Associate Professor of Applied Health Services Research at the Centre of Evidence-Based Dermatology (CEBD). Candidates must have a PhD in a relevant area and extensive experience of applied health services research with an established and growing reputation in the field. We are particularly interested in candidates with demonstrable experience in qualitative research, knowledge mobilisation and / or process evaluation as applied in a health research setting. For more details, please see the job advertisement. The closing date for applications is Thursday, 15th February 2018.

 

 

Vacancy in the CEBD for Research Associate/Fellow (fixed term, part time)

 

Applications are invited for a Research Fellow/Associate (fixed term, part time) at the Centre of Evidence-Based Dermatology (CEBD). The successful applicant will work alongside a Cochrane review methodologist and have responsibility for helping to deliver two systematic reviews related to the treatment of eczema as part of our National Institute for Health Programme Grant, Eczema Care Online. For more details, please see the job advertisement. The closing date for applications is Tuesday, 13th February 2018.

 

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Other key publications that have caught our eye

 

 

GPs' experiences of diagnosing and managing childhood eczema: a qualitative study in primary care.

Le Roux E, Powell K, Banks JP, Ridd MJ.

Br J Gen Pract. 2018 Jan 15. pii: bjgp18X694529. doi: 10.3399/bjgp18X694529. [Epub ahead of print]

 

“RESULTS: GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy.

CONCLUSION: GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.”

 

 

Developing a written action plan for children with eczema: a qualitative study.

Powell K, Le Roux E, Banks JP, Ridd MJ.

Br J Gen Pract. 2018 Feb;68(667):e81-e89. doi: 10.3399/bjgp17X693617. Epub 2017 Dec 4.

 

“RESULTS: Reported challenges of managing eczema included: parental confusion about treatment application; lack of verbal and written advice from GPs; differing beliefs about the cause and management of eczema; re-prescribing of failed treatments; and parents feeling unsupported by their GP. An eczema WAP [written action plan] was viewed as an educational tool that could help address these problems. Participants expressed a preference for a WAP that gives clear, individualised guidance on treatment use, presented in a step-up/step-down approach. Participants also wanted more general information about eczema, its potential triggers, and how to manage problem symptoms.

CONCLUSION: An eczema WAP may help overcome some of the difficulties of managing eczema, and support families and clinicians in the management of the condition. Further evaluation is needed to determine if the eczema WAP the authors have developed is both acceptable and improves the outcomes for affected children and their families.”

 

 

Stemming the tide of antimicrobial resistance: implications for management of acne vulgaris.

Santer M, Francis NA, Platt D, Eady EA, Layton AM.

Br J Gen Pract. 2018 Feb;68(667):64-65. doi: 10.3399/bjgp18X694457. No abstract available.

 

This review discusses the implications of increasing antimicrobial resistance for the management of acne vulgaris in primary case, where a case has been made for reducing antibiotic prescribing. Skin conditions account for 8% of primary care antibiotic prescribing, and data from the Clinical Practice Research Datalink (CPRD) indicate that GPs prescribe oral antibiotics at 31% of first consultations for acne.

 

 

A systematic review of comparisons between protocols or registrations and full reports in primary biomedical research.

Li G, Abbade LPF, Nwosu I, Jin Y, Leenus A, Maaz M, Wang M, Bhatt M, Zielinski L, Sanger N, Bantoto B, Luo C, Shams I, Shahid H, Chang Y, Sun G, Mbuagbaw L, Samaan Z, Levine MAH, Adachi JD, Thabane L.

BMC Med Res Methodol. 2018 Jan 11;18(1):9. doi: 10.1186/s12874-017-0465-7.

 

“RESULTS: There were 37 studies (33 surveys and 4 systematic reviews) included in our analyses. Most studies (n = 36) compared protocols or registrations with full reports in clinical trials, while a single survey focused on primary studies of clinical trials and observational research. High inconsistency levels were found in outcome reporting (ranging from 14% to 100%), subgroup reporting (from 12% to 100%), statistical analyses (from 9% to 47%), and other measure comparisons. Some factors, such as outcomes with significant results, sponsorship, type of outcome and disease speciality were reported to be significantly related to inconsistent reporting.

CONCLUSIONS: We found that inconsistent reporting between protocols or registrations and full reports of primary biomedical research is frequent, prevalent and suboptimal. We also identified methodological issues such as the need for consensus on measuring inconsistency across sources for trial reports, and more studies evaluating transparency and reproducibility in reporting all aspects of study design and analysis. A joint effort involving authors, journals, sponsors, regulators and research ethics committees is required to solve this problem.”

 

 

Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care.

Christie J, Gray TA, Dumville JC, Cullum NA.

PLoS One. 2018 Jan 10;13(1):e0190045. doi: 10.1371/journal.pone.0190045. eCollection 2018.

 

“CONCLUSIONS: Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research addresses important clinical uncertainties and is of sufficient rigour to inform practice.”

 

 

NIHR Signal: Biological therapies for psoriasis do not increase serious infection risk

 

This NIHR Signal is a commentary on a review of patient data from the British Association of Dermatologists Biological Interventions Register (BADBIR) which found that treatment with etanercept, adalimumab or ustekinumab did not lead to an increased risk of serious infection compared to non-biologic oral treatments. The commentary concludes:

“The risk of serious infection should not be a deciding factor between biological and non-biological oral treatments for psoriasis. Neither should it influence which biological therapy to choose as none was shown to have a different risk from the others.

The findings back the rationale for the British Association of Dermatologists’ guidelines on use of biological therapies in psoriasis, which suggest that treatment should be tailored to the individual, but that adalimumab, ustekinumab and secukinumab should be considered first-line.

There were low rates of tuberculosis in this UK based study and so results may not apply to populations with greater lifetime exposure to tuberculosis.”

 

 

Chinese translation of 3rd edition of “Evidence-Based Dermatology” textbook

 

Yuping Ran, Professor of Dermatology in Chengdu, China has undertaken a massive project to translate the 3rd edition of Evidence-Based Dermatology (Editor-in-Chief Hywel Williams) into Chinese, in agreement with the publishers. The link is here.

 

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Notes

 

 

The provision of a link to an item in this e-mail shall not be taken as an endorsement of any kind. Whilst reasonable efforts have been made to ensure the accuracy of the information in this newsletter, we cannot guarantee its correctness or completeness.

 

 

Many more useful resources can be found on the CEBD Website. Do take a look

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Dr Douglas Grindlay
Information Specialist

Centre of Evidence Based Dermatology
University of Nottingham

King’s Meadow Campus
Nottingham, NG7 2NR

+44 (0) 115 8468624 nottingham.ac.uk

http://www.nottingham.ac.uk/research/groups/cebd



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