VIDEO: Don’t miss reservoirs when treating recurrent onychomycosis

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– Patients attribute every nail problem to nail fungus, but part of the problem with nails is concomitant tinea pedis, tinea corporis, and other reservoirs of infection, according to Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego.

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– Patients attribute every nail problem to nail fungus, but part of the problem with nails is concomitant tinea pedis, tinea corporis, and other reservoirs of infection, according to Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

– Patients attribute every nail problem to nail fungus, but part of the problem with nails is concomitant tinea pedis, tinea corporis, and other reservoirs of infection, according to Neal Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego.

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VIDEO: Consider PPIs as a cause of cutaneous reactions

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– Any proton pump inhibitor (PPI) has the potential to cause skin reactions, so it is important to ask patients about their use, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

If patients are going to react to a PPI, they usually will do so within 3 or 4 months of starting treatment, rather than in the first week or so of treatment, Dr. Jackson said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Skin reactions to PPIs are often maculopapular, with a flat and a raised component that can be nonspecific, Dr. Jackson noted.

Interestingly, he added, many times patients can switch to a different PPI and not get a skin reaction. However, there are some patients who develop a lupuslike reaction on the skin, and in these cases, there tends to be cross reactivity, “so they couldn’t switch to a different PPI and be risk-free” of the same reaction, he noted.

Dr. Jackson disclosed financial relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

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– Any proton pump inhibitor (PPI) has the potential to cause skin reactions, so it is important to ask patients about their use, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

If patients are going to react to a PPI, they usually will do so within 3 or 4 months of starting treatment, rather than in the first week or so of treatment, Dr. Jackson said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Skin reactions to PPIs are often maculopapular, with a flat and a raised component that can be nonspecific, Dr. Jackson noted.

Interestingly, he added, many times patients can switch to a different PPI and not get a skin reaction. However, there are some patients who develop a lupuslike reaction on the skin, and in these cases, there tends to be cross reactivity, “so they couldn’t switch to a different PPI and be risk-free” of the same reaction, he noted.

Dr. Jackson disclosed financial relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 

 

– Any proton pump inhibitor (PPI) has the potential to cause skin reactions, so it is important to ask patients about their use, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

If patients are going to react to a PPI, they usually will do so within 3 or 4 months of starting treatment, rather than in the first week or so of treatment, Dr. Jackson said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Skin reactions to PPIs are often maculopapular, with a flat and a raised component that can be nonspecific, Dr. Jackson noted.

Interestingly, he added, many times patients can switch to a different PPI and not get a skin reaction. However, there are some patients who develop a lupuslike reaction on the skin, and in these cases, there tends to be cross reactivity, “so they couldn’t switch to a different PPI and be risk-free” of the same reaction, he noted.

Dr. Jackson disclosed financial relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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VIDEO: Experts offer patch testing tips for AD patients

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– Many atopic dermatitis patients with refractory disease may have also developed allergic contact dermatitis, according to Jonathan Silverberg, MD, of Northwestern University in Chicago.

Clinically, there is often overlap between AD and allergic contact dermatitis, said Dr. Silverberg, who was involved in the development of recent consensus guidelines on when to do patch testing in the setting of AD.

For many patients with severe disease, “sometimes when we patch test, we can find a relevant allergen for the patient to avoid, [and] within a few months, their disease just goes down a notch, gets much better, and really starts to respond to topical and more conservative approaches,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Or patients may respond well to AD treatment on certain parts of the body, but there may be other areas that don’t respond as well, suggesting a possible component of allergic contact dermatitis, he added

The guidelines sought to sort out scenarios “where it makes sense to patch test” and to provide direction on best practices, noted Dr. Silverberg, who is director of the Northwestern Medicine Multidisciplinary Eczema Center, and director of the patch testing clinic, Northwestern Memorial Hospital, Chicago.

He disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi.SDEF and this news organization are owned by the same parent company.

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– Many atopic dermatitis patients with refractory disease may have also developed allergic contact dermatitis, according to Jonathan Silverberg, MD, of Northwestern University in Chicago.

Clinically, there is often overlap between AD and allergic contact dermatitis, said Dr. Silverberg, who was involved in the development of recent consensus guidelines on when to do patch testing in the setting of AD.

For many patients with severe disease, “sometimes when we patch test, we can find a relevant allergen for the patient to avoid, [and] within a few months, their disease just goes down a notch, gets much better, and really starts to respond to topical and more conservative approaches,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Or patients may respond well to AD treatment on certain parts of the body, but there may be other areas that don’t respond as well, suggesting a possible component of allergic contact dermatitis, he added

The guidelines sought to sort out scenarios “where it makes sense to patch test” and to provide direction on best practices, noted Dr. Silverberg, who is director of the Northwestern Medicine Multidisciplinary Eczema Center, and director of the patch testing clinic, Northwestern Memorial Hospital, Chicago.

He disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi.SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 

 

– Many atopic dermatitis patients with refractory disease may have also developed allergic contact dermatitis, according to Jonathan Silverberg, MD, of Northwestern University in Chicago.

Clinically, there is often overlap between AD and allergic contact dermatitis, said Dr. Silverberg, who was involved in the development of recent consensus guidelines on when to do patch testing in the setting of AD.

For many patients with severe disease, “sometimes when we patch test, we can find a relevant allergen for the patient to avoid, [and] within a few months, their disease just goes down a notch, gets much better, and really starts to respond to topical and more conservative approaches,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Or patients may respond well to AD treatment on certain parts of the body, but there may be other areas that don’t respond as well, suggesting a possible component of allergic contact dermatitis, he added

The guidelines sought to sort out scenarios “where it makes sense to patch test” and to provide direction on best practices, noted Dr. Silverberg, who is director of the Northwestern Medicine Multidisciplinary Eczema Center, and director of the patch testing clinic, Northwestern Memorial Hospital, Chicago.

He disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi.SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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VIDEO: Dermatologists often miss adult onset atopic dermatitis

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– Evidence from several recent studies suggests that the prevalence of adult onset atopic dermatitis in the United States may be as high as 7%-10%, said Jonathan I. Silverberg, MD, of the department of dermatology, preventive medicine, and medical social sciences, Northwestern University, Chicago.

Many features are similar to atopic dermatitis (AD) seen in childhood, but in adults the eczema is more likely to affect the hands and the eyelids. “We often have a hard time telling that apart from contact dermatitis,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Some adults may have forgotten they had AD as children and don’t recognize it if it reappears in adulthood, but sometimes AD appears with no childhood history, he noted. “There’s a skepticism that if it is adult onset, it must not be atopic dermatitis,” but he has found that is not always the case.

A take-home message for clinicians: “Don’t be surprised when a patient walks in the door as an adult meeting all criteria for atopic dermatitis. It can be, and you can diagnose them comfortably,” said Dr. Silverberg, who is also director of the Northwestern Medicine Multidisciplinary Eczema Center, Northwestern Memorial Hospital, Chicago.

Most of the treatments for adult AD “cover many different arms of the immune system,” and include topical steroids and immunosuppressants, he added.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi. SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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– Evidence from several recent studies suggests that the prevalence of adult onset atopic dermatitis in the United States may be as high as 7%-10%, said Jonathan I. Silverberg, MD, of the department of dermatology, preventive medicine, and medical social sciences, Northwestern University, Chicago.

Many features are similar to atopic dermatitis (AD) seen in childhood, but in adults the eczema is more likely to affect the hands and the eyelids. “We often have a hard time telling that apart from contact dermatitis,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Some adults may have forgotten they had AD as children and don’t recognize it if it reappears in adulthood, but sometimes AD appears with no childhood history, he noted. “There’s a skepticism that if it is adult onset, it must not be atopic dermatitis,” but he has found that is not always the case.

A take-home message for clinicians: “Don’t be surprised when a patient walks in the door as an adult meeting all criteria for atopic dermatitis. It can be, and you can diagnose them comfortably,” said Dr. Silverberg, who is also director of the Northwestern Medicine Multidisciplinary Eczema Center, Northwestern Memorial Hospital, Chicago.

Most of the treatments for adult AD “cover many different arms of the immune system,” and include topical steroids and immunosuppressants, he added.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi. SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 

 

– Evidence from several recent studies suggests that the prevalence of adult onset atopic dermatitis in the United States may be as high as 7%-10%, said Jonathan I. Silverberg, MD, of the department of dermatology, preventive medicine, and medical social sciences, Northwestern University, Chicago.

Many features are similar to atopic dermatitis (AD) seen in childhood, but in adults the eczema is more likely to affect the hands and the eyelids. “We often have a hard time telling that apart from contact dermatitis,” Dr. Silverberg said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

Some adults may have forgotten they had AD as children and don’t recognize it if it reappears in adulthood, but sometimes AD appears with no childhood history, he noted. “There’s a skepticism that if it is adult onset, it must not be atopic dermatitis,” but he has found that is not always the case.

A take-home message for clinicians: “Don’t be surprised when a patient walks in the door as an adult meeting all criteria for atopic dermatitis. It can be, and you can diagnose them comfortably,” said Dr. Silverberg, who is also director of the Northwestern Medicine Multidisciplinary Eczema Center, Northwestern Memorial Hospital, Chicago.

Most of the treatments for adult AD “cover many different arms of the immune system,” and include topical steroids and immunosuppressants, he added.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, GlaxoSmithKline, Lilly, MedImmune-AstraZeneca, Pfizer, Procter & Gamble, Puricore, and Regeneron-Sanofi. SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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Don’t miss these drug reactions

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WAILEA, HAWAII – New drugs can mean new drug reactions affecting the skin, notably those associated with hepatitis C therapies and new cancer drugs, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

Dr. J. Mark Jackson University of Louisville dermatology
Dr. J. Mark Jackson
Skin reactions from telaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor used in combination with peginterferon alfa and ribavirin, stand out from reactions to other medications in three key ways, Dr. Jackson said. First, the incidence of telaprevir-related dermatitis (50%-60%) is much higher than from other medications, he said. Second, approximately 25% of telaprevir reactions occur within 4 days of starting the drug, and 46% occur after 4 weeks.

Finally, “telaprevir-related dermatitis, which accounts for 95% of skin events in telaprevir-treated patients, is clinically and histologically eczematous and different from the classic ‘maculopapular’ drug-induced eruptions,” he explained. Some patients develop DRESS syndrome or drug rash with eosinophilia and systemic symptoms, he added.

In addition, four approved hepatitis C antivirals – simeprevir, telaprevir, boceprevir, and sofosbuvir – may cause photosensitivity, Dr. Jackson said. He cited a case of a patient who took simeprevir and developed photodistributed lichenoid eruptions (J Cutan Pathol. 2015 Oct;42[10]:769-73).

New cancer treatments have brought new side effects as well, Dr. Jackson said. Epidermal growth factor receptor inhibitors cause papulopustular and follicular eruptions in many cancer patients, and some of these patients also experience conditions including xerosis cutis, changes to the hair and nails, skin hyperpigmentation, and enhanced radiation dermatitis, he said. Multikinase inhibitors, a common cause of hand-foot syndrome (HFS), are also associated with facial erythema, subungual splinter hemorrhages, and other skin changes, he added.

Capecitabine-induced HFS, while not life-threatening, can affect a patient’s quality of life, Dr. Jackson pointed out. “Dose modification of the inciting agent serves as the most effective management of HFS, although a variety of anecdotal reports suggest that other agents may also be efficacious,” he explained.

Dr. Jackson noted one extreme case of a 61-year-old woman with metastatic breast cancer who was treated with capecitabine and developed HFS that led to a pseudomonal superinfection, followed by bacterial sepsis and rapid death. The case suggests that “early adjustment of therapy may prevent adverse outcomes from secondary cutaneous infections while maintaining tumor response,” he noted.

Dr. Jackson disclosed relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

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WAILEA, HAWAII – New drugs can mean new drug reactions affecting the skin, notably those associated with hepatitis C therapies and new cancer drugs, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

Dr. J. Mark Jackson University of Louisville dermatology
Dr. J. Mark Jackson
Skin reactions from telaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor used in combination with peginterferon alfa and ribavirin, stand out from reactions to other medications in three key ways, Dr. Jackson said. First, the incidence of telaprevir-related dermatitis (50%-60%) is much higher than from other medications, he said. Second, approximately 25% of telaprevir reactions occur within 4 days of starting the drug, and 46% occur after 4 weeks.

Finally, “telaprevir-related dermatitis, which accounts for 95% of skin events in telaprevir-treated patients, is clinically and histologically eczematous and different from the classic ‘maculopapular’ drug-induced eruptions,” he explained. Some patients develop DRESS syndrome or drug rash with eosinophilia and systemic symptoms, he added.

In addition, four approved hepatitis C antivirals – simeprevir, telaprevir, boceprevir, and sofosbuvir – may cause photosensitivity, Dr. Jackson said. He cited a case of a patient who took simeprevir and developed photodistributed lichenoid eruptions (J Cutan Pathol. 2015 Oct;42[10]:769-73).

New cancer treatments have brought new side effects as well, Dr. Jackson said. Epidermal growth factor receptor inhibitors cause papulopustular and follicular eruptions in many cancer patients, and some of these patients also experience conditions including xerosis cutis, changes to the hair and nails, skin hyperpigmentation, and enhanced radiation dermatitis, he said. Multikinase inhibitors, a common cause of hand-foot syndrome (HFS), are also associated with facial erythema, subungual splinter hemorrhages, and other skin changes, he added.

Capecitabine-induced HFS, while not life-threatening, can affect a patient’s quality of life, Dr. Jackson pointed out. “Dose modification of the inciting agent serves as the most effective management of HFS, although a variety of anecdotal reports suggest that other agents may also be efficacious,” he explained.

Dr. Jackson noted one extreme case of a 61-year-old woman with metastatic breast cancer who was treated with capecitabine and developed HFS that led to a pseudomonal superinfection, followed by bacterial sepsis and rapid death. The case suggests that “early adjustment of therapy may prevent adverse outcomes from secondary cutaneous infections while maintaining tumor response,” he noted.

Dr. Jackson disclosed relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

 

WAILEA, HAWAII – New drugs can mean new drug reactions affecting the skin, notably those associated with hepatitis C therapies and new cancer drugs, according to J. Mark Jackson, MD, of the University of Louisville (Ky.).

Dr. J. Mark Jackson University of Louisville dermatology
Dr. J. Mark Jackson
Skin reactions from telaprevir, a hepatitis C virus (HCV) NS3/4A protease inhibitor used in combination with peginterferon alfa and ribavirin, stand out from reactions to other medications in three key ways, Dr. Jackson said. First, the incidence of telaprevir-related dermatitis (50%-60%) is much higher than from other medications, he said. Second, approximately 25% of telaprevir reactions occur within 4 days of starting the drug, and 46% occur after 4 weeks.

Finally, “telaprevir-related dermatitis, which accounts for 95% of skin events in telaprevir-treated patients, is clinically and histologically eczematous and different from the classic ‘maculopapular’ drug-induced eruptions,” he explained. Some patients develop DRESS syndrome or drug rash with eosinophilia and systemic symptoms, he added.

In addition, four approved hepatitis C antivirals – simeprevir, telaprevir, boceprevir, and sofosbuvir – may cause photosensitivity, Dr. Jackson said. He cited a case of a patient who took simeprevir and developed photodistributed lichenoid eruptions (J Cutan Pathol. 2015 Oct;42[10]:769-73).

New cancer treatments have brought new side effects as well, Dr. Jackson said. Epidermal growth factor receptor inhibitors cause papulopustular and follicular eruptions in many cancer patients, and some of these patients also experience conditions including xerosis cutis, changes to the hair and nails, skin hyperpigmentation, and enhanced radiation dermatitis, he said. Multikinase inhibitors, a common cause of hand-foot syndrome (HFS), are also associated with facial erythema, subungual splinter hemorrhages, and other skin changes, he added.

Capecitabine-induced HFS, while not life-threatening, can affect a patient’s quality of life, Dr. Jackson pointed out. “Dose modification of the inciting agent serves as the most effective management of HFS, although a variety of anecdotal reports suggest that other agents may also be efficacious,” he explained.

Dr. Jackson noted one extreme case of a 61-year-old woman with metastatic breast cancer who was treated with capecitabine and developed HFS that led to a pseudomonal superinfection, followed by bacterial sepsis and rapid death. The case suggests that “early adjustment of therapy may prevent adverse outcomes from secondary cutaneous infections while maintaining tumor response,” he noted.

Dr. Jackson disclosed relationships with companies including AbbVie, Amgen, Celgene, Dermira, Galderma, Genentech, Janssen, Lilly, Medimetriks, Merck, Novartis, Pfizer, Promius, and Top MD.

SDEF and this news organization are owned by the same parent company.

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VIDEO: Pattern recognition provides clues to rheumatologic diagnoses

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Several patterns can provide clues to diagnoses of rheumatologic diseases, according to Daniel E. Furst, MD, professor of rheumatology, University of Washington, Seattle.

Dermatology and rheumatology share the use of pattern recognition when making a diagnosis, he said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. An important pattern is the idea of polyarticular versus monoarticular disease. Rheumatoid arthritis, osteoarthritis, autoimmune diseases, and gout and crystalline diseases, he said, encompass “about 80% of the cases with polyarticular arthritis.”

Another pattern to consider is symmetry versus asymmetry. Osteoarthritis and gout will be asymmetric, while autoimmune diseases and RA will be symmetrical, Dr. Furst pointed out. Also consider areas of involvement, such as upper and lower parts of the body. “Lower tends to be more gout and more OA,” while upper-extremity involvement is more likely to be autoimmune diseases and RA, he said.

“You don’t have to be Einstein to be a rheumatologist; just remember some simple stuff,” added Dr. Furst, who also discusses the use of lab tests in the interview.

Dr. Furst is also professor emeritus, University of California, Los Angeles, and is affiliated with the University of Florence (Italy) Medical School.

He disclosed financial relationships with companies including AbbVie, Actelion, Amgen, BMS, Cytori, Genentech/Roche, Novartis, and Pfizer.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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Several patterns can provide clues to diagnoses of rheumatologic diseases, according to Daniel E. Furst, MD, professor of rheumatology, University of Washington, Seattle.

Dermatology and rheumatology share the use of pattern recognition when making a diagnosis, he said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. An important pattern is the idea of polyarticular versus monoarticular disease. Rheumatoid arthritis, osteoarthritis, autoimmune diseases, and gout and crystalline diseases, he said, encompass “about 80% of the cases with polyarticular arthritis.”

Another pattern to consider is symmetry versus asymmetry. Osteoarthritis and gout will be asymmetric, while autoimmune diseases and RA will be symmetrical, Dr. Furst pointed out. Also consider areas of involvement, such as upper and lower parts of the body. “Lower tends to be more gout and more OA,” while upper-extremity involvement is more likely to be autoimmune diseases and RA, he said.

“You don’t have to be Einstein to be a rheumatologist; just remember some simple stuff,” added Dr. Furst, who also discusses the use of lab tests in the interview.

Dr. Furst is also professor emeritus, University of California, Los Angeles, and is affiliated with the University of Florence (Italy) Medical School.

He disclosed financial relationships with companies including AbbVie, Actelion, Amgen, BMS, Cytori, Genentech/Roche, Novartis, and Pfizer.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 

 

Several patterns can provide clues to diagnoses of rheumatologic diseases, according to Daniel E. Furst, MD, professor of rheumatology, University of Washington, Seattle.

Dermatology and rheumatology share the use of pattern recognition when making a diagnosis, he said in a video interview at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. An important pattern is the idea of polyarticular versus monoarticular disease. Rheumatoid arthritis, osteoarthritis, autoimmune diseases, and gout and crystalline diseases, he said, encompass “about 80% of the cases with polyarticular arthritis.”

Another pattern to consider is symmetry versus asymmetry. Osteoarthritis and gout will be asymmetric, while autoimmune diseases and RA will be symmetrical, Dr. Furst pointed out. Also consider areas of involvement, such as upper and lower parts of the body. “Lower tends to be more gout and more OA,” while upper-extremity involvement is more likely to be autoimmune diseases and RA, he said.

“You don’t have to be Einstein to be a rheumatologist; just remember some simple stuff,” added Dr. Furst, who also discusses the use of lab tests in the interview.

Dr. Furst is also professor emeritus, University of California, Los Angeles, and is affiliated with the University of Florence (Italy) Medical School.

He disclosed financial relationships with companies including AbbVie, Actelion, Amgen, BMS, Cytori, Genentech/Roche, Novartis, and Pfizer.

SDEF and this news organization are owned by the same parent company.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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Contact dermatitis gets personal

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Parabens have been eliminated from many personal care products because of health concerns, but from a contact dermatitis standpoint, they have “very low rates of irritancy and allergenicity” and are considered safe and well tolerated, according to Jonathan I. Silverberg, MD, of Northwestern University, Chicago.

“I almost never see a positive reaction to parabens,” Dr. Silverberg said in a presentation on contact dermatitis at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

However, the confirmation of estrogenic activity associated with parabens has led to their replacement in many products – especially personal care products – with other

Dr. Jonathan Silverberg of Northwestern University, Chicago
Dr. Jonathan Silverberg
preservatives that may cause skin reactions, he said. One of these is methylisothiazolinone, which was named the Contact Allergen of the Year by the American Contact Dermatitis Society in 2013. Methylisothiazoline/methylisothiazolinone (MCI/MI) is active against bacteria, yeast, fungi, and algae, and is used in a range of products, especially shampoos, but is also found in hair gels, cosmetics, sunscreens, baby wipes, antibacterial washes, and household cleaning products.

“MCI/MI is now a common cause of contact dermatitis and can cause severe reactions,” said Dr. Silverberg, director of the Northwestern Medicine Multidisciplinary Eczema Center in Chicago.

An alternative to MCI/MI – methyldibromoglutaronitrile/phenoxyethanol (Euxyl K 400) – also appears in personal care products, such as soaps and shampoos, as well as industrial products such as paints, glues, wood preservatives, and metal-working fluids, Dr. Silverberg noted. This preservative is relatively uncommon in the United States, and in Europe it has been banned from leave-on products since 2005 and from rinse-off products since 2007, he said.

Another paraben alternative, iodopropynyl butylcarbamate, is a relatively uncommon preservative, but it frequently occurs as a positive patch test reaction, Dr. Silverberg said.

Lanolin, a natural ingredient used in topical skin emollients and cosmetics, also has been associated with skin reactions, he added. In addition to personal care products, the increasing range of personal technology products can be sources of contact dermatitis, Dr. Silverberg pointed out. Consider nickel exposure not only from jewelry, but from items such as iPads, iPhones, laptops, and Xbox controllers, when evaluating contact dermatitis in adults and children, he said.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, Galderma, GlaxoSmithKline, Lilly, Puricore, Medimmune-AstraZeneca, Pfizer, Proctor & Gamble, Puricore, Hoffmann-La Roche, and Regeneron-Sanofi.

SDEF and this news organization are owned by the same parent company.

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Parabens have been eliminated from many personal care products because of health concerns, but from a contact dermatitis standpoint, they have “very low rates of irritancy and allergenicity” and are considered safe and well tolerated, according to Jonathan I. Silverberg, MD, of Northwestern University, Chicago.

“I almost never see a positive reaction to parabens,” Dr. Silverberg said in a presentation on contact dermatitis at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

However, the confirmation of estrogenic activity associated with parabens has led to their replacement in many products – especially personal care products – with other

Dr. Jonathan Silverberg of Northwestern University, Chicago
Dr. Jonathan Silverberg
preservatives that may cause skin reactions, he said. One of these is methylisothiazolinone, which was named the Contact Allergen of the Year by the American Contact Dermatitis Society in 2013. Methylisothiazoline/methylisothiazolinone (MCI/MI) is active against bacteria, yeast, fungi, and algae, and is used in a range of products, especially shampoos, but is also found in hair gels, cosmetics, sunscreens, baby wipes, antibacterial washes, and household cleaning products.

“MCI/MI is now a common cause of contact dermatitis and can cause severe reactions,” said Dr. Silverberg, director of the Northwestern Medicine Multidisciplinary Eczema Center in Chicago.

An alternative to MCI/MI – methyldibromoglutaronitrile/phenoxyethanol (Euxyl K 400) – also appears in personal care products, such as soaps and shampoos, as well as industrial products such as paints, glues, wood preservatives, and metal-working fluids, Dr. Silverberg noted. This preservative is relatively uncommon in the United States, and in Europe it has been banned from leave-on products since 2005 and from rinse-off products since 2007, he said.

Another paraben alternative, iodopropynyl butylcarbamate, is a relatively uncommon preservative, but it frequently occurs as a positive patch test reaction, Dr. Silverberg said.

Lanolin, a natural ingredient used in topical skin emollients and cosmetics, also has been associated with skin reactions, he added. In addition to personal care products, the increasing range of personal technology products can be sources of contact dermatitis, Dr. Silverberg pointed out. Consider nickel exposure not only from jewelry, but from items such as iPads, iPhones, laptops, and Xbox controllers, when evaluating contact dermatitis in adults and children, he said.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, Galderma, GlaxoSmithKline, Lilly, Puricore, Medimmune-AstraZeneca, Pfizer, Proctor & Gamble, Puricore, Hoffmann-La Roche, and Regeneron-Sanofi.

SDEF and this news organization are owned by the same parent company.

 

Parabens have been eliminated from many personal care products because of health concerns, but from a contact dermatitis standpoint, they have “very low rates of irritancy and allergenicity” and are considered safe and well tolerated, according to Jonathan I. Silverberg, MD, of Northwestern University, Chicago.

“I almost never see a positive reaction to parabens,” Dr. Silverberg said in a presentation on contact dermatitis at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

However, the confirmation of estrogenic activity associated with parabens has led to their replacement in many products – especially personal care products – with other

Dr. Jonathan Silverberg of Northwestern University, Chicago
Dr. Jonathan Silverberg
preservatives that may cause skin reactions, he said. One of these is methylisothiazolinone, which was named the Contact Allergen of the Year by the American Contact Dermatitis Society in 2013. Methylisothiazoline/methylisothiazolinone (MCI/MI) is active against bacteria, yeast, fungi, and algae, and is used in a range of products, especially shampoos, but is also found in hair gels, cosmetics, sunscreens, baby wipes, antibacterial washes, and household cleaning products.

“MCI/MI is now a common cause of contact dermatitis and can cause severe reactions,” said Dr. Silverberg, director of the Northwestern Medicine Multidisciplinary Eczema Center in Chicago.

An alternative to MCI/MI – methyldibromoglutaronitrile/phenoxyethanol (Euxyl K 400) – also appears in personal care products, such as soaps and shampoos, as well as industrial products such as paints, glues, wood preservatives, and metal-working fluids, Dr. Silverberg noted. This preservative is relatively uncommon in the United States, and in Europe it has been banned from leave-on products since 2005 and from rinse-off products since 2007, he said.

Another paraben alternative, iodopropynyl butylcarbamate, is a relatively uncommon preservative, but it frequently occurs as a positive patch test reaction, Dr. Silverberg said.

Lanolin, a natural ingredient used in topical skin emollients and cosmetics, also has been associated with skin reactions, he added. In addition to personal care products, the increasing range of personal technology products can be sources of contact dermatitis, Dr. Silverberg pointed out. Consider nickel exposure not only from jewelry, but from items such as iPads, iPhones, laptops, and Xbox controllers, when evaluating contact dermatitis in adults and children, he said.

Dr. Silverberg disclosed relationships with companies including AbbVie, Anacor, Celgene, Chugai, Galderma, GlaxoSmithKline, Lilly, Puricore, Medimmune-AstraZeneca, Pfizer, Proctor & Gamble, Puricore, Hoffmann-La Roche, and Regeneron-Sanofi.

SDEF and this news organization are owned by the same parent company.

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Improving sunscreen use entails patient counseling

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WAILEA, HAWAII – When sunscreens are tested for their SPF, testers apply 2 mg/cm2, but most people use only 20%-50% of that amount, which significantly reduces their protection, according to Dr. Julie C. Harper, director of the Dermatology & Skin Care Center of Birmingham, Ala.

The correct amount is 1 teaspoon of sunscreen on the face/head/neck, 1 teaspoon on each arm, 2 teaspoons on the torso, and 2 teaspoons on each leg, Dr. Harper said in a presentation at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Reapplication every 90 minutes to 2 hours is key to effective protection, Dr. Harper said.

However, “most people use less than one bottle of sunscreen per year,” she noted.

Prompting patients to improve their sunscreen use involves disproving some myths, Dr. Harper pointed out. When patients cite concerns about low vitamin D as a reason to avoid sunscreens, she recommended that they be counseled that there are three sources of vitamin D: foods such as fatty fish, vitamin D fortified foods, cheese, and egg yolks; vitamin D supplements; and skin synthesis through UVB exposure; and that only one of these – UVB exposure – is a known carcinogen.

Dr. Julie C. Harper
Dr. Julie C. Harper


Also, some patients express concern that sunscreen itself may be a carcinogen. Oxybenzone, a common sunscreen ingredient, has demonstrated some estrogenic effects in vitro and in vivo studies. However, the rat studies often cited in support of that finding involved the use of very high doses – approximately the equivalent of 277 years of daily sunscreen application with 6% oxybenzone, a much higher concentration than is found in commercial sunscreens, she said.

For patients interested in nontopical sun protection, polypodium leucotomos extract (PLE) is an option, Dr. Harper said. PLE, an antioxidant extract from a tropical fern, can be part of a skin cancer prevention strategy that also includes good sunscreen and protective clothing. PLE works by counteracting UV-induced immunosuppression, activating the tumor suppressor p53 gene, and inhibiting cyclooxygenase-2, all of which can help protect the skin from burning.

In addition, oral nicotinamide has been shown to help repair DNA damage in human keratinocytes, and in a clinical trial, has been associated with fewer actinic keratoses and squamous cell carcinoma, compared with placebo, she said.

However, more research in these options is needed, and patients should be encouraged to follow consistent sun protection practices, Dr. Harper emphasized.

Dr. Harper disclosed relationships with companies including Allergan, Bayer, Galderma, LaRoche-Posay, Promius, Valeant, and BioPharmX.

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WAILEA, HAWAII – When sunscreens are tested for their SPF, testers apply 2 mg/cm2, but most people use only 20%-50% of that amount, which significantly reduces their protection, according to Dr. Julie C. Harper, director of the Dermatology & Skin Care Center of Birmingham, Ala.

The correct amount is 1 teaspoon of sunscreen on the face/head/neck, 1 teaspoon on each arm, 2 teaspoons on the torso, and 2 teaspoons on each leg, Dr. Harper said in a presentation at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Reapplication every 90 minutes to 2 hours is key to effective protection, Dr. Harper said.

However, “most people use less than one bottle of sunscreen per year,” she noted.

Prompting patients to improve their sunscreen use involves disproving some myths, Dr. Harper pointed out. When patients cite concerns about low vitamin D as a reason to avoid sunscreens, she recommended that they be counseled that there are three sources of vitamin D: foods such as fatty fish, vitamin D fortified foods, cheese, and egg yolks; vitamin D supplements; and skin synthesis through UVB exposure; and that only one of these – UVB exposure – is a known carcinogen.

Dr. Julie C. Harper
Dr. Julie C. Harper


Also, some patients express concern that sunscreen itself may be a carcinogen. Oxybenzone, a common sunscreen ingredient, has demonstrated some estrogenic effects in vitro and in vivo studies. However, the rat studies often cited in support of that finding involved the use of very high doses – approximately the equivalent of 277 years of daily sunscreen application with 6% oxybenzone, a much higher concentration than is found in commercial sunscreens, she said.

For patients interested in nontopical sun protection, polypodium leucotomos extract (PLE) is an option, Dr. Harper said. PLE, an antioxidant extract from a tropical fern, can be part of a skin cancer prevention strategy that also includes good sunscreen and protective clothing. PLE works by counteracting UV-induced immunosuppression, activating the tumor suppressor p53 gene, and inhibiting cyclooxygenase-2, all of which can help protect the skin from burning.

In addition, oral nicotinamide has been shown to help repair DNA damage in human keratinocytes, and in a clinical trial, has been associated with fewer actinic keratoses and squamous cell carcinoma, compared with placebo, she said.

However, more research in these options is needed, and patients should be encouraged to follow consistent sun protection practices, Dr. Harper emphasized.

Dr. Harper disclosed relationships with companies including Allergan, Bayer, Galderma, LaRoche-Posay, Promius, Valeant, and BioPharmX.

SDEF and this news organization are owned by the same parent company.
 

WAILEA, HAWAII – When sunscreens are tested for their SPF, testers apply 2 mg/cm2, but most people use only 20%-50% of that amount, which significantly reduces their protection, according to Dr. Julie C. Harper, director of the Dermatology & Skin Care Center of Birmingham, Ala.

The correct amount is 1 teaspoon of sunscreen on the face/head/neck, 1 teaspoon on each arm, 2 teaspoons on the torso, and 2 teaspoons on each leg, Dr. Harper said in a presentation at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation. Reapplication every 90 minutes to 2 hours is key to effective protection, Dr. Harper said.

However, “most people use less than one bottle of sunscreen per year,” she noted.

Prompting patients to improve their sunscreen use involves disproving some myths, Dr. Harper pointed out. When patients cite concerns about low vitamin D as a reason to avoid sunscreens, she recommended that they be counseled that there are three sources of vitamin D: foods such as fatty fish, vitamin D fortified foods, cheese, and egg yolks; vitamin D supplements; and skin synthesis through UVB exposure; and that only one of these – UVB exposure – is a known carcinogen.

Dr. Julie C. Harper
Dr. Julie C. Harper


Also, some patients express concern that sunscreen itself may be a carcinogen. Oxybenzone, a common sunscreen ingredient, has demonstrated some estrogenic effects in vitro and in vivo studies. However, the rat studies often cited in support of that finding involved the use of very high doses – approximately the equivalent of 277 years of daily sunscreen application with 6% oxybenzone, a much higher concentration than is found in commercial sunscreens, she said.

For patients interested in nontopical sun protection, polypodium leucotomos extract (PLE) is an option, Dr. Harper said. PLE, an antioxidant extract from a tropical fern, can be part of a skin cancer prevention strategy that also includes good sunscreen and protective clothing. PLE works by counteracting UV-induced immunosuppression, activating the tumor suppressor p53 gene, and inhibiting cyclooxygenase-2, all of which can help protect the skin from burning.

In addition, oral nicotinamide has been shown to help repair DNA damage in human keratinocytes, and in a clinical trial, has been associated with fewer actinic keratoses and squamous cell carcinoma, compared with placebo, she said.

However, more research in these options is needed, and patients should be encouraged to follow consistent sun protection practices, Dr. Harper emphasized.

Dr. Harper disclosed relationships with companies including Allergan, Bayer, Galderma, LaRoche-Posay, Promius, Valeant, and BioPharmX.

SDEF and this news organization are owned by the same parent company.
 

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VIDEO: Oxymetazoline approval expands options for rosacea

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Fri, 01/18/2019 - 16:29

 

The Food and Drug Administration approval of oxymetazoline 1% cream for the background erythema of rosacea is big news for dermatologists and patients, according to Linda Stein Gold, MD, director of dermatology research, Henry Ford Health System, Detroit.

In studies, patients showed a two grade improvement in baseline erythema, and erythema reduction that lasted for 9-12 hours in many patients, said Dr. Stein Gold in a video interview, who was involved in the clinical trials.

“We have safety data that lasts up to an entire year, with no new safety signals,” and the incidence of exacerbation of erythema was rare, she added in a video interview at
the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation. Oxymetazoline 1% cream, which will be marketed as Rhofade by Allergan, was approved in January 2017 for the “topical treatment of persistent facial erythema associated with rosacea in adults.”

Dr. Stein Gold disclosed relationships with several companies, including Galderma, Leo, Novan, Valeant, Dermira, Novartis, Celgene, Allergan, Foamix, Anacor, Medimetriks, Sol-Gel, and Promius.


SDEF and this news organization are owned by the same parent organization.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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The Food and Drug Administration approval of oxymetazoline 1% cream for the background erythema of rosacea is big news for dermatologists and patients, according to Linda Stein Gold, MD, director of dermatology research, Henry Ford Health System, Detroit.

In studies, patients showed a two grade improvement in baseline erythema, and erythema reduction that lasted for 9-12 hours in many patients, said Dr. Stein Gold in a video interview, who was involved in the clinical trials.

“We have safety data that lasts up to an entire year, with no new safety signals,” and the incidence of exacerbation of erythema was rare, she added in a video interview at
the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation. Oxymetazoline 1% cream, which will be marketed as Rhofade by Allergan, was approved in January 2017 for the “topical treatment of persistent facial erythema associated with rosacea in adults.”

Dr. Stein Gold disclosed relationships with several companies, including Galderma, Leo, Novan, Valeant, Dermira, Novartis, Celgene, Allergan, Foamix, Anacor, Medimetriks, Sol-Gel, and Promius.


SDEF and this news organization are owned by the same parent organization.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 

 

The Food and Drug Administration approval of oxymetazoline 1% cream for the background erythema of rosacea is big news for dermatologists and patients, according to Linda Stein Gold, MD, director of dermatology research, Henry Ford Health System, Detroit.

In studies, patients showed a two grade improvement in baseline erythema, and erythema reduction that lasted for 9-12 hours in many patients, said Dr. Stein Gold in a video interview, who was involved in the clinical trials.

“We have safety data that lasts up to an entire year, with no new safety signals,” and the incidence of exacerbation of erythema was rare, she added in a video interview at
the meeting provided by Global Academy for Medical Education/Skin Disease Education Foundation. Oxymetazoline 1% cream, which will be marketed as Rhofade by Allergan, was approved in January 2017 for the “topical treatment of persistent facial erythema associated with rosacea in adults.”

Dr. Stein Gold disclosed relationships with several companies, including Galderma, Leo, Novan, Valeant, Dermira, Novartis, Celgene, Allergan, Foamix, Anacor, Medimetriks, Sol-Gel, and Promius.


SDEF and this news organization are owned by the same parent organization.

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
 
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VIDEO: Adding methotrexate to a biologic may help achieve treatment goal

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Mon, 07/01/2019 - 11:14

 

– Combining methotrexate with a biologic is an off-label use for psoriasis patients but is supported by information from the psoriatic arthritis literature, said J. Mark Jackson, MD, of the University of Louisville (Ky.).

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– Combining methotrexate with a biologic is an off-label use for psoriasis patients but is supported by information from the psoriatic arthritis literature, said J. Mark Jackson, MD, of the University of Louisville (Ky.).

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel

 

– Combining methotrexate with a biologic is an off-label use for psoriasis patients but is supported by information from the psoriatic arthritis literature, said J. Mark Jackson, MD, of the University of Louisville (Ky.).

The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
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