Doug Brunk

When Jennifer Gunter, MD, learned that Marie Claire magazine published an article suggesting that the recent solar eclipse affected menstrual cycles, she turned to social media to dismantle that assertion.

“If the new moon were associated with menstruation, then all women all over the world would be menstruating at the same time,” Dr. Gunter wrote in an Aug. 21, 2017 entry on her personal blog, which includes the slogan “Wielding the Lasso of Truth.” “Have none of these people ever considered that? Maybe that happens in the “Mists of Avalon,” but it doesn’t happen on Earth.”

• Be HIPAA compliant. “I don’t think I’ve ever used my work day to inform what I write about because there’s so much going on in the news,” she said. “You have to be HIPAA compliant because your patients may be following you online. In many ways, I hope that people I’m going to care for do read some of the things that I put out there because I’m trying to give good health information.”
• Be authentic. “When people meet me and have probably read some of my tweets and have heard me talk, they say they can match the voice with the person,” Dr. Gunter said. “People can tell when you’re not being authentic. That doesn’t work for me. I don’t have time to invent another persona!”
• Share articles you think are worthwhile. “If I have a friend who is in the tech industry, and if he posts an article on that topic, I figure he curated that, so maybe I’ll read it,” she said. “Likewise, if you’re a doctor and you have people following you on Facebook who are not physicians, they might say, ‘My friend who I went to high school with who’s a doctor thinks this New York Times article is worth reading. Maybe I should read it.’ People can lurk and share things, and that helps. I follow lots of doctors on Twitter that I don’t regularly engage with, but they post articles, and I’ll read them.”
• Make it clear who you’re speaking for. Are you speaking for your employer or for yourself? Are you giving medical advice, or is the content your opinion only? Include an appropriate disclaimer in your profile. Dr. Gunter’s Twitter profile reads: “Appropriately Confident OB/GYN, Canadian Spice, Sexpert, Lasso of Truth, Pegasister, Not medical advice, I speak for no one but me.”
• If you post regularly, expect criticism at some point. “If social media is not for you, you shouldn’t do it,” Dr. Gunter said. “But if you have a small Facebook account, why not share some good quality articles that you found interesting? You’d be surprised. What you might think is a throwaway message might be of real help to someone who doesn’t practice medicine. There’s a real hunger for good quality curated information.”

[email protected]

When Jennifer Gunter, MD, learned that Marie Claire magazine published an article suggesting that the recent solar eclipse affected menstrual cycles, she turned to social media to dismantle that assertion.

“If the new moon were associated with menstruation, then all women all over the world would be menstruating at the same time,” Dr. Gunter wrote in an Aug. 21, 2017 entry on her personal blog, which includes the slogan “Wielding the Lasso of Truth.” “Have none of these people ever considered that? Maybe that happens in the “Mists of Avalon,” but it doesn’t happen on Earth.”

• Be HIPAA compliant. “I don’t think I’ve ever used my work day to inform what I write about because there’s so much going on in the news,” she said. “You have to be HIPAA compliant because your patients may be following you online. In many ways, I hope that people I’m going to care for do read some of the things that I put out there because I’m trying to give good health information.”
• Be authentic. “When people meet me and have probably read some of my tweets and have heard me talk, they say they can match the voice with the person,” Dr. Gunter said. “People can tell when you’re not being authentic. That doesn’t work for me. I don’t have time to invent another persona!”
• Share articles you think are worthwhile. “If I have a friend who is in the tech industry, and if he posts an article on that topic, I figure he curated that, so maybe I’ll read it,” she said. “Likewise, if you’re a doctor and you have people following you on Facebook who are not physicians, they might say, ‘My friend who I went to high school with who’s a doctor thinks this New York Times article is worth reading. Maybe I should read it.’ People can lurk and share things, and that helps. I follow lots of doctors on Twitter that I don’t regularly engage with, but they post articles, and I’ll read them.”
• Make it clear who you’re speaking for. Are you speaking for your employer or for yourself? Are you giving medical advice, or is the content your opinion only? Include an appropriate disclaimer in your profile. Dr. Gunter’s Twitter profile reads: “Appropriately Confident OB/GYN, Canadian Spice, Sexpert, Lasso of Truth, Pegasister, Not medical advice, I speak for no one but me.”
• If you post regularly, expect criticism at some point. “If social media is not for you, you shouldn’t do it,” Dr. Gunter said. “But if you have a small Facebook account, why not share some good quality articles that you found interesting? You’d be surprised. What you might think is a throwaway message might be of real help to someone who doesn’t practice medicine. There’s a real hunger for good quality curated information.”

[email protected]

When Jennifer Gunter, MD, learned that Marie Claire magazine published an article suggesting that the recent solar eclipse affected menstrual cycles, she turned to social media to dismantle that assertion.

“If the new moon were associated with menstruation, then all women all over the world would be menstruating at the same time,” Dr. Gunter wrote in an Aug. 21, 2017 entry on her personal blog, which includes the slogan “Wielding the Lasso of Truth.” “Have none of these people ever considered that? Maybe that happens in the “Mists of Avalon,” but it doesn’t happen on Earth.”

• Be HIPAA compliant. “I don’t think I’ve ever used my work day to inform what I write about because there’s so much going on in the news,” she said. “You have to be HIPAA compliant because your patients may be following you online. In many ways, I hope that people I’m going to care for do read some of the things that I put out there because I’m trying to give good health information.”
• Be authentic. “When people meet me and have probably read some of my tweets and have heard me talk, they say they can match the voice with the person,” Dr. Gunter said. “People can tell when you’re not being authentic. That doesn’t work for me. I don’t have time to invent another persona!”
• Share articles you think are worthwhile. “If I have a friend who is in the tech industry, and if he posts an article on that topic, I figure he curated that, so maybe I’ll read it,” she said. “Likewise, if you’re a doctor and you have people following you on Facebook who are not physicians, they might say, ‘My friend who I went to high school with who’s a doctor thinks this New York Times article is worth reading. Maybe I should read it.’ People can lurk and share things, and that helps. I follow lots of doctors on Twitter that I don’t regularly engage with, but they post articles, and I’ll read them.”
• Make it clear who you’re speaking for. Are you speaking for your employer or for yourself? Are you giving medical advice, or is the content your opinion only? Include an appropriate disclaimer in your profile. Dr. Gunter’s Twitter profile reads: “Appropriately Confident OB/GYN, Canadian Spice, Sexpert, Lasso of Truth, Pegasister, Not medical advice, I speak for no one but me.”
• If you post regularly, expect criticism at some point. “If social media is not for you, you shouldn’t do it,” Dr. Gunter said. “But if you have a small Facebook account, why not share some good quality articles that you found interesting? You’d be surprised. What you might think is a throwaway message might be of real help to someone who doesn’t practice medicine. There’s a real hunger for good quality curated information.”

[email protected]

Preoperative four-dimensional computed tomography imaging and intraoperative findings for parathyroid disease are not always in agreement, a retrospective study has found.

Among patients with primary hyperparathyroidism who underwent preoperative four-dimensional computed tomography (4-D CT) followed by parathyroidectomy, multigland disease was the most strongly associated with discordance between the scan and the intraoperative findings, according to the study.

“Parathyroid 4-D CTs have emerged as one of the most accurate preoperative imaging modalities to localize abnormal parathyroid glands,” wrote researchers led by Shonan Sho, MD (JAMA Surg. 2017 Aug 9. doi: 10.1001/jamasurg.2017.2649). “Despite this use, missed lesions and incorrect localization still occur.”

In what is believed to be the first study of its kind, Dr. Sho of the section of endocrine surgery at the University of California, Los Angeles, and his associates prospectively evaluated factors associated with discordance between preoperative four-dimensional computed tomographic scans and intraoperative findings. They examined data from 411 patients with primary hyperparathyroidism who underwent 4-D CTs followed by parathyroidectomy at UCLA from Sept. 1, 2011, through Oct. 31, 2016. The mean age of patients was 59, 79% were female, and 30% had discordance between preoperative 4-D CTs and intraoperative findings.

When the researchers compared concordant cases with discordant cases, they found that discordant cases had higher frequencies of multigland disease (24.3% vs. 66.7%, respectively; P less than .001) and multinodular goiter or thyroid nodule (29.2% vs. 40.7%; P = .02). “Thyroid nodules can mimic parathyroid adenomas because they can occur in similar locations and appear oval or round, and they can have enhancement characteristics similar to those of parathyroid adenomas,” Dr. Sho and his associates wrote. “The addition of ultrasound may enable correct identification of abnormal parathyroid glands in a patient with thyroid nodules.”

The investigators also found that missed parathyroid lesions tended to be smaller than 10 mm in size and were more likely to be in the inferior position.

Multivariable analysis revealed the analysis risk factors for discordant 4-D CT findings: multigland disease (odds ratio, 7.63), parathyroid lesion in the inferior position (OR, 6.82), parathyroid lesion size of 10 mm or less (OR, 4.37), and multinodular goiter or thyroid nodule (OR, 1.82). The researchers concluded, “In the case of a negative 4-D CT, the surgeon may elect to allot additional operative time for what may be a more difficult case. Or, after considering the likelihood of MGD [multigland disease] based on biochemical values and the 4-D CT result, the surgeon may consider having a more detailed discussion with the patient regarding the potential need for subtotal parathyroidectomy. During surgery, if the surgeon is not finding the culprit glands or if the PTH [parathyroid hormone] level is not dropping, he or she should recall that discordance between intraoperative findings and the 4-D CT results is likely to be explained by MGD, an inferior gland that is flattened against the surface of the thyroid gland, or, less commonly, an intrathyroidal gland.”

They acknowledged certain limitations of the study, including its single-center, retrospective design; the fact that calcium levels were not available in all patients; and the fact that the 4-D CT technique remains novel.

The investigators reported having no relevant financial disclosures.

[email protected]

Preoperative four-dimensional computed tomography imaging and intraoperative findings for parathyroid disease are not always in agreement, a retrospective study has found.

Among patients with primary hyperparathyroidism who underwent preoperative four-dimensional computed tomography (4-D CT) followed by parathyroidectomy, multigland disease was the most strongly associated with discordance between the scan and the intraoperative findings, according to the study.

“Parathyroid 4-D CTs have emerged as one of the most accurate preoperative imaging modalities to localize abnormal parathyroid glands,” wrote researchers led by Shonan Sho, MD (JAMA Surg. 2017 Aug 9. doi: 10.1001/jamasurg.2017.2649). “Despite this use, missed lesions and incorrect localization still occur.”

In what is believed to be the first study of its kind, Dr. Sho of the section of endocrine surgery at the University of California, Los Angeles, and his associates prospectively evaluated factors associated with discordance between preoperative four-dimensional computed tomographic scans and intraoperative findings. They examined data from 411 patients with primary hyperparathyroidism who underwent 4-D CTs followed by parathyroidectomy at UCLA from Sept. 1, 2011, through Oct. 31, 2016. The mean age of patients was 59, 79% were female, and 30% had discordance between preoperative 4-D CTs and intraoperative findings.

When the researchers compared concordant cases with discordant cases, they found that discordant cases had higher frequencies of multigland disease (24.3% vs. 66.7%, respectively; P less than .001) and multinodular goiter or thyroid nodule (29.2% vs. 40.7%; P = .02). “Thyroid nodules can mimic parathyroid adenomas because they can occur in similar locations and appear oval or round, and they can have enhancement characteristics similar to those of parathyroid adenomas,” Dr. Sho and his associates wrote. “The addition of ultrasound may enable correct identification of abnormal parathyroid glands in a patient with thyroid nodules.”

The investigators also found that missed parathyroid lesions tended to be smaller than 10 mm in size and were more likely to be in the inferior position.

Multivariable analysis revealed the analysis risk factors for discordant 4-D CT findings: multigland disease (odds ratio, 7.63), parathyroid lesion in the inferior position (OR, 6.82), parathyroid lesion size of 10 mm or less (OR, 4.37), and multinodular goiter or thyroid nodule (OR, 1.82). The researchers concluded, “In the case of a negative 4-D CT, the surgeon may elect to allot additional operative time for what may be a more difficult case. Or, after considering the likelihood of MGD [multigland disease] based on biochemical values and the 4-D CT result, the surgeon may consider having a more detailed discussion with the patient regarding the potential need for subtotal parathyroidectomy. During surgery, if the surgeon is not finding the culprit glands or if the PTH [parathyroid hormone] level is not dropping, he or she should recall that discordance between intraoperative findings and the 4-D CT results is likely to be explained by MGD, an inferior gland that is flattened against the surface of the thyroid gland, or, less commonly, an intrathyroidal gland.”

They acknowledged certain limitations of the study, including its single-center, retrospective design; the fact that calcium levels were not available in all patients; and the fact that the 4-D CT technique remains novel.

The investigators reported having no relevant financial disclosures.

[email protected]

Preoperative four-dimensional computed tomography imaging and intraoperative findings for parathyroid disease are not always in agreement, a retrospective study has found.

Among patients with primary hyperparathyroidism who underwent preoperative four-dimensional computed tomography (4-D CT) followed by parathyroidectomy, multigland disease was the most strongly associated with discordance between the scan and the intraoperative findings, according to the study.

“Parathyroid 4-D CTs have emerged as one of the most accurate preoperative imaging modalities to localize abnormal parathyroid glands,” wrote researchers led by Shonan Sho, MD (JAMA Surg. 2017 Aug 9. doi: 10.1001/jamasurg.2017.2649). “Despite this use, missed lesions and incorrect localization still occur.”

In what is believed to be the first study of its kind, Dr. Sho of the section of endocrine surgery at the University of California, Los Angeles, and his associates prospectively evaluated factors associated with discordance between preoperative four-dimensional computed tomographic scans and intraoperative findings. They examined data from 411 patients with primary hyperparathyroidism who underwent 4-D CTs followed by parathyroidectomy at UCLA from Sept. 1, 2011, through Oct. 31, 2016. The mean age of patients was 59, 79% were female, and 30% had discordance between preoperative 4-D CTs and intraoperative findings.

When the researchers compared concordant cases with discordant cases, they found that discordant cases had higher frequencies of multigland disease (24.3% vs. 66.7%, respectively; P less than .001) and multinodular goiter or thyroid nodule (29.2% vs. 40.7%; P = .02). “Thyroid nodules can mimic parathyroid adenomas because they can occur in similar locations and appear oval or round, and they can have enhancement characteristics similar to those of parathyroid adenomas,” Dr. Sho and his associates wrote. “The addition of ultrasound may enable correct identification of abnormal parathyroid glands in a patient with thyroid nodules.”

The investigators also found that missed parathyroid lesions tended to be smaller than 10 mm in size and were more likely to be in the inferior position.

Multivariable analysis revealed the analysis risk factors for discordant 4-D CT findings: multigland disease (odds ratio, 7.63), parathyroid lesion in the inferior position (OR, 6.82), parathyroid lesion size of 10 mm or less (OR, 4.37), and multinodular goiter or thyroid nodule (OR, 1.82). The researchers concluded, “In the case of a negative 4-D CT, the surgeon may elect to allot additional operative time for what may be a more difficult case. Or, after considering the likelihood of MGD [multigland disease] based on biochemical values and the 4-D CT result, the surgeon may consider having a more detailed discussion with the patient regarding the potential need for subtotal parathyroidectomy. During surgery, if the surgeon is not finding the culprit glands or if the PTH [parathyroid hormone] level is not dropping, he or she should recall that discordance between intraoperative findings and the 4-D CT results is likely to be explained by MGD, an inferior gland that is flattened against the surface of the thyroid gland, or, less commonly, an intrathyroidal gland.”

They acknowledged certain limitations of the study, including its single-center, retrospective design; the fact that calcium levels were not available in all patients; and the fact that the 4-D CT technique remains novel.

The investigators reported having no relevant financial disclosures.

[email protected]

CHICAGO – If severe eczema persists in a pediatric patient despite your best treatment efforts, think allergic contact dermatitis.

“Or, if your eczema patients tell you that they have a cream that’s making things worse, you should think about a contact allergen,” Catalina Matiz, MD, said at the World Congress of Pediatric Dermatology.

Allergic contact dermatitis (ACD) is a type IV delayed-type hypersensitivity reaction to haptens that come into contact with the skin. Poison ivy is a common plant-based culprit, while nickel is the most common metal allergen in adults and children. “The skin barrier also plays a role,” said Dr. Matiz of the department of dermatology at Rady Children’s Hospital–San Diego, and the University of California, San Diego. “Compared with adults, children have a thinner stratum corneum, and some haptens can penetrate the skin. Some studies suggest that patients with atopic dermatitis may have increased rates of allergic sensitization, and filaggrin mutations have been found in patients with atopic dermatitis and in patients with ACD to nickel. Filaggrin helps to aggregate the cytoskeletal proteins that form the cornified cell envelope. Without filaggrin, the skin barrier is defective.”

[email protected]

CHICAGO – If severe eczema persists in a pediatric patient despite your best treatment efforts, think allergic contact dermatitis.

“Or, if your eczema patients tell you that they have a cream that’s making things worse, you should think about a contact allergen,” Catalina Matiz, MD, said at the World Congress of Pediatric Dermatology.

Allergic contact dermatitis (ACD) is a type IV delayed-type hypersensitivity reaction to haptens that come into contact with the skin. Poison ivy is a common plant-based culprit, while nickel is the most common metal allergen in adults and children. “The skin barrier also plays a role,” said Dr. Matiz of the department of dermatology at Rady Children’s Hospital–San Diego, and the University of California, San Diego. “Compared with adults, children have a thinner stratum corneum, and some haptens can penetrate the skin. Some studies suggest that patients with atopic dermatitis may have increased rates of allergic sensitization, and filaggrin mutations have been found in patients with atopic dermatitis and in patients with ACD to nickel. Filaggrin helps to aggregate the cytoskeletal proteins that form the cornified cell envelope. Without filaggrin, the skin barrier is defective.”

[email protected]

CHICAGO – If severe eczema persists in a pediatric patient despite your best treatment efforts, think allergic contact dermatitis.

“Or, if your eczema patients tell you that they have a cream that’s making things worse, you should think about a contact allergen,” Catalina Matiz, MD, said at the World Congress of Pediatric Dermatology.

Allergic contact dermatitis (ACD) is a type IV delayed-type hypersensitivity reaction to haptens that come into contact with the skin. Poison ivy is a common plant-based culprit, while nickel is the most common metal allergen in adults and children. “The skin barrier also plays a role,” said Dr. Matiz of the department of dermatology at Rady Children’s Hospital–San Diego, and the University of California, San Diego. “Compared with adults, children have a thinner stratum corneum, and some haptens can penetrate the skin. Some studies suggest that patients with atopic dermatitis may have increased rates of allergic sensitization, and filaggrin mutations have been found in patients with atopic dermatitis and in patients with ACD to nickel. Filaggrin helps to aggregate the cytoskeletal proteins that form the cornified cell envelope. Without filaggrin, the skin barrier is defective.”

[email protected]

Among psoriatic arthritis (PsA) patients who started a systemic disease-modifying antirheumatic drug (DMARD) in the United States during 2004-2015, treatment modification rates went up and discontinuation rates decreased over the 11-year period, according to results from a large study of national claims data.

The increased rate of treatment modification may not be surprising given the “significant advancement in PsA treatment and expanding pharmacotherapy options in the past decade,” wrote researchers led by Moa P. Lee, PharmD, of the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, Boston (Arthritis Care Res. 2017 Aug 13. doi: 10.1002/acr.23337).

The researchers reviewed records between July 1, 2004, and Sept. 30, 2015, from the Clinformatics Datamart data set, which contains demographic and longitudinal claims information for all United Healthcare beneficiaries. They observed an increasing trend in treatment modifications over the 11-year study period (P = .03) and found that 5% of all patients discontinued treatment, with the discontinuation rates decreasing over time (P less than .001).

Of the 9,222 PsA patients who initiated DMARDs, 43% received a biologic agent (bDMARD) and 57% received a conventional synthetic agent (csDMARD). Patients who were initiated on bDMARDs had an average age of 48 years, compared with 52 years in csDMARD initiators. Biologic DMARD initiators also had generally fewer comorbidities.

The most frequently used DMARD overall was methotrexate, which constituted 81% of csDMARD initiations. The most commonly prescribed bDMARDs were etanercept and adalimumab (49% vs. 34%, respectively).

When the researchers evaluated 12-month follow-up data after the first DMARD initiation, they found that 20% of bDMARD initiators had their initial DMARD regimen modified, compared with 31% of csDMARD initiators. Treatment modifications occurred more quickly after starting a csDMARD (median of 102 days) when compared against bDMARD initiators (148 days), and the rate of modification was also higher for patients who first started a csDMARD (adjusted incidence rate of 39.3 cases per 100 patient-years vs. 21.1 cases per 100 person-years for bDMARDs).

The most common modification made by csDMARD initiators was the addition of a bDMARD to methotrexate, particularly etanercept or adalimumab, in 16%. For bDMARD initiators, the most common modification was adding methotrexate in 7%, followed by switches between etanercept and adalimumab in 6%.

“In a rapidly evolving field of PsA treatment, further studies that elucidate more comprehensive real-world trends in the use of available treatment, including more recent novel therapies for PsA, may be needed,” the researchers concluded.

There was no specific funding source for the study. The researchers reported having no financial disclosures relevant to the study.

[email protected]

Among psoriatic arthritis (PsA) patients who started a systemic disease-modifying antirheumatic drug (DMARD) in the United States during 2004-2015, treatment modification rates went up and discontinuation rates decreased over the 11-year period, according to results from a large study of national claims data.

The increased rate of treatment modification may not be surprising given the “significant advancement in PsA treatment and expanding pharmacotherapy options in the past decade,” wrote researchers led by Moa P. Lee, PharmD, of the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, Boston (Arthritis Care Res. 2017 Aug 13. doi: 10.1002/acr.23337).

The researchers reviewed records between July 1, 2004, and Sept. 30, 2015, from the Clinformatics Datamart data set, which contains demographic and longitudinal claims information for all United Healthcare beneficiaries. They observed an increasing trend in treatment modifications over the 11-year study period (P = .03) and found that 5% of all patients discontinued treatment, with the discontinuation rates decreasing over time (P less than .001).

Of the 9,222 PsA patients who initiated DMARDs, 43% received a biologic agent (bDMARD) and 57% received a conventional synthetic agent (csDMARD). Patients who were initiated on bDMARDs had an average age of 48 years, compared with 52 years in csDMARD initiators. Biologic DMARD initiators also had generally fewer comorbidities.

The most frequently used DMARD overall was methotrexate, which constituted 81% of csDMARD initiations. The most commonly prescribed bDMARDs were etanercept and adalimumab (49% vs. 34%, respectively).

When the researchers evaluated 12-month follow-up data after the first DMARD initiation, they found that 20% of bDMARD initiators had their initial DMARD regimen modified, compared with 31% of csDMARD initiators. Treatment modifications occurred more quickly after starting a csDMARD (median of 102 days) when compared against bDMARD initiators (148 days), and the rate of modification was also higher for patients who first started a csDMARD (adjusted incidence rate of 39.3 cases per 100 patient-years vs. 21.1 cases per 100 person-years for bDMARDs).

The most common modification made by csDMARD initiators was the addition of a bDMARD to methotrexate, particularly etanercept or adalimumab, in 16%. For bDMARD initiators, the most common modification was adding methotrexate in 7%, followed by switches between etanercept and adalimumab in 6%.

“In a rapidly evolving field of PsA treatment, further studies that elucidate more comprehensive real-world trends in the use of available treatment, including more recent novel therapies for PsA, may be needed,” the researchers concluded.

There was no specific funding source for the study. The researchers reported having no financial disclosures relevant to the study.

[email protected]

Among psoriatic arthritis (PsA) patients who started a systemic disease-modifying antirheumatic drug (DMARD) in the United States during 2004-2015, treatment modification rates went up and discontinuation rates decreased over the 11-year period, according to results from a large study of national claims data.

The increased rate of treatment modification may not be surprising given the “significant advancement in PsA treatment and expanding pharmacotherapy options in the past decade,” wrote researchers led by Moa P. Lee, PharmD, of the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, Boston (Arthritis Care Res. 2017 Aug 13. doi: 10.1002/acr.23337).

The researchers reviewed records between July 1, 2004, and Sept. 30, 2015, from the Clinformatics Datamart data set, which contains demographic and longitudinal claims information for all United Healthcare beneficiaries. They observed an increasing trend in treatment modifications over the 11-year study period (P = .03) and found that 5% of all patients discontinued treatment, with the discontinuation rates decreasing over time (P less than .001).

Of the 9,222 PsA patients who initiated DMARDs, 43% received a biologic agent (bDMARD) and 57% received a conventional synthetic agent (csDMARD). Patients who were initiated on bDMARDs had an average age of 48 years, compared with 52 years in csDMARD initiators. Biologic DMARD initiators also had generally fewer comorbidities.

The most frequently used DMARD overall was methotrexate, which constituted 81% of csDMARD initiations. The most commonly prescribed bDMARDs were etanercept and adalimumab (49% vs. 34%, respectively).

When the researchers evaluated 12-month follow-up data after the first DMARD initiation, they found that 20% of bDMARD initiators had their initial DMARD regimen modified, compared with 31% of csDMARD initiators. Treatment modifications occurred more quickly after starting a csDMARD (median of 102 days) when compared against bDMARD initiators (148 days), and the rate of modification was also higher for patients who first started a csDMARD (adjusted incidence rate of 39.3 cases per 100 patient-years vs. 21.1 cases per 100 person-years for bDMARDs).

The most common modification made by csDMARD initiators was the addition of a bDMARD to methotrexate, particularly etanercept or adalimumab, in 16%. For bDMARD initiators, the most common modification was adding methotrexate in 7%, followed by switches between etanercept and adalimumab in 6%.

“In a rapidly evolving field of PsA treatment, further studies that elucidate more comprehensive real-world trends in the use of available treatment, including more recent novel therapies for PsA, may be needed,” the researchers concluded.

There was no specific funding source for the study. The researchers reported having no financial disclosures relevant to the study.

[email protected]

Compared with adults who underwent off-pump coronary-artery bypass grafting surgery, those who underwent on-pump CABG had significantly lower rates of mortality and major adverse cardiovascular events at 5 years, results from a large randomized trial demonstrated.

“Given the results, it appears that innovative surgical approaches – such as the more technically demanding off-pump procedure – may not always provide superior clinical outcomes,” researchers led by A. Laurie Shroyer, PhD, wrote (N Engl J Med. 2017 Aug 17;377:623-32). “Additional long-term follow-up, evaluating these same outcomes rigorously at 10 years after CABG, appears to be warranted. Future research may identify the risk factors of the patients and the cardiac surgical processes of care that affect longer-term outcomes of coronary revascularization procedures, with the goal of increasing the rate of long-term event-free survival.”

Dr. Shroyer, of the Northport (N.Y.) VA Medical Center, and her associates conduced a 5-year follow-up study of patients who had participated in the original Randomized On/Off Bypass (ROOBY) trial, which compared the effectiveness of the two surgical approaches (N Engl J Med 2009 Nov 5;361:1827-37). During February 2002–June 2007, 2,203 patients at 18 medical centers were randomly assigned to either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The primary outcomes were the rates mortality and major adverse cardiovascular events at 5 years, while the secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction.

The mean age of patients was 63 years, nearly all were male, 46% were between the ages of 55 and 64, and about 21% had chronic obstructive pulmonary disease. The researchers found that at 5 years, the rate of death was 15.2% in the off-pump group, compared with 11.9% in the on-pump group, which translated into a relative risk of 1.28 (P = .02). In addition, the rate of major cardiovascular events at 5 years was 31% in the off-pump group, compared with 27.1% in the on-pump group, which translated into a relative risk of 1.14 (P = .046). None of the secondary outcomes at 5 years met the prespecified threshold of a P value of .01 or less for statistical significance, when the off-pump and on-pump groups were compared. This included the rates of nonfatal myocardial infarction (12.1% vs. 9.6%, respectively; P = .05); death from cardiac causes (6.3% vs. 5.3%; P = .29); repeat vascularization (13.1% vs. 11.9%; P = .39), and repeat CABG (1.4% vs. 0.5%; P = .02).

“In combination with findings from other randomized trials and a 2012 Cochrane systematic review [Cochrane Database Syst Rev. 2012;14:CD007224], the 5-year outcomes in our study support the conclusion that off-pump CABG does not offer any substantial advantages over on-pump CABG except possibly in unusual situations such as, for example, in patients with an extensively calcified (porcelain) aorta, in whom the off-pump technique may result in less manipulation of the aorta, potentially decreasing the risk of aortic emboli or stroke,” the researchers wrote. “In light of the low rates of use of off-pump CABG in the United States, the findings in our trial may provide more of a real-world experience than those in the CORONARY and GOPCABE trials, which required surgeons with a very high volume of experience with off-pump procedures, as compared with the ROOBY trial and with most other surgeons who are based in the United States.”

They acknowledged certain limitations of the study, including the fact that the study population comprised mostly males who had multiple coexisting conditions, “so the findings may not be applicable to female patients or to patients who are not veterans.”

The study was supported by a grant from the Department of Veterans Affairs. Dr. Shroyer reported having received grants from the VA Cooperative Studies Program during the conduct of the study. Her coauthors reported having no financial disclosures.

[email protected]

Compared with adults who underwent off-pump coronary-artery bypass grafting surgery, those who underwent on-pump CABG had significantly lower rates of mortality and major adverse cardiovascular events at 5 years, results from a large randomized trial demonstrated.

“Given the results, it appears that innovative surgical approaches – such as the more technically demanding off-pump procedure – may not always provide superior clinical outcomes,” researchers led by A. Laurie Shroyer, PhD, wrote (N Engl J Med. 2017 Aug 17;377:623-32). “Additional long-term follow-up, evaluating these same outcomes rigorously at 10 years after CABG, appears to be warranted. Future research may identify the risk factors of the patients and the cardiac surgical processes of care that affect longer-term outcomes of coronary revascularization procedures, with the goal of increasing the rate of long-term event-free survival.”

Dr. Shroyer, of the Northport (N.Y.) VA Medical Center, and her associates conduced a 5-year follow-up study of patients who had participated in the original Randomized On/Off Bypass (ROOBY) trial, which compared the effectiveness of the two surgical approaches (N Engl J Med 2009 Nov 5;361:1827-37). During February 2002–June 2007, 2,203 patients at 18 medical centers were randomly assigned to either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The primary outcomes were the rates mortality and major adverse cardiovascular events at 5 years, while the secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction.

The mean age of patients was 63 years, nearly all were male, 46% were between the ages of 55 and 64, and about 21% had chronic obstructive pulmonary disease. The researchers found that at 5 years, the rate of death was 15.2% in the off-pump group, compared with 11.9% in the on-pump group, which translated into a relative risk of 1.28 (P = .02). In addition, the rate of major cardiovascular events at 5 years was 31% in the off-pump group, compared with 27.1% in the on-pump group, which translated into a relative risk of 1.14 (P = .046). None of the secondary outcomes at 5 years met the prespecified threshold of a P value of .01 or less for statistical significance, when the off-pump and on-pump groups were compared. This included the rates of nonfatal myocardial infarction (12.1% vs. 9.6%, respectively; P = .05); death from cardiac causes (6.3% vs. 5.3%; P = .29); repeat vascularization (13.1% vs. 11.9%; P = .39), and repeat CABG (1.4% vs. 0.5%; P = .02).

“In combination with findings from other randomized trials and a 2012 Cochrane systematic review [Cochrane Database Syst Rev. 2012;14:CD007224], the 5-year outcomes in our study support the conclusion that off-pump CABG does not offer any substantial advantages over on-pump CABG except possibly in unusual situations such as, for example, in patients with an extensively calcified (porcelain) aorta, in whom the off-pump technique may result in less manipulation of the aorta, potentially decreasing the risk of aortic emboli or stroke,” the researchers wrote. “In light of the low rates of use of off-pump CABG in the United States, the findings in our trial may provide more of a real-world experience than those in the CORONARY and GOPCABE trials, which required surgeons with a very high volume of experience with off-pump procedures, as compared with the ROOBY trial and with most other surgeons who are based in the United States.”

They acknowledged certain limitations of the study, including the fact that the study population comprised mostly males who had multiple coexisting conditions, “so the findings may not be applicable to female patients or to patients who are not veterans.”

The study was supported by a grant from the Department of Veterans Affairs. Dr. Shroyer reported having received grants from the VA Cooperative Studies Program during the conduct of the study. Her coauthors reported having no financial disclosures.

[email protected]

Compared with adults who underwent off-pump coronary-artery bypass grafting surgery, those who underwent on-pump CABG had significantly lower rates of mortality and major adverse cardiovascular events at 5 years, results from a large randomized trial demonstrated.

“Given the results, it appears that innovative surgical approaches – such as the more technically demanding off-pump procedure – may not always provide superior clinical outcomes,” researchers led by A. Laurie Shroyer, PhD, wrote (N Engl J Med. 2017 Aug 17;377:623-32). “Additional long-term follow-up, evaluating these same outcomes rigorously at 10 years after CABG, appears to be warranted. Future research may identify the risk factors of the patients and the cardiac surgical processes of care that affect longer-term outcomes of coronary revascularization procedures, with the goal of increasing the rate of long-term event-free survival.”

Dr. Shroyer, of the Northport (N.Y.) VA Medical Center, and her associates conduced a 5-year follow-up study of patients who had participated in the original Randomized On/Off Bypass (ROOBY) trial, which compared the effectiveness of the two surgical approaches (N Engl J Med 2009 Nov 5;361:1827-37). During February 2002–June 2007, 2,203 patients at 18 medical centers were randomly assigned to either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The primary outcomes were the rates mortality and major adverse cardiovascular events at 5 years, while the secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction.

The mean age of patients was 63 years, nearly all were male, 46% were between the ages of 55 and 64, and about 21% had chronic obstructive pulmonary disease. The researchers found that at 5 years, the rate of death was 15.2% in the off-pump group, compared with 11.9% in the on-pump group, which translated into a relative risk of 1.28 (P = .02). In addition, the rate of major cardiovascular events at 5 years was 31% in the off-pump group, compared with 27.1% in the on-pump group, which translated into a relative risk of 1.14 (P = .046). None of the secondary outcomes at 5 years met the prespecified threshold of a P value of .01 or less for statistical significance, when the off-pump and on-pump groups were compared. This included the rates of nonfatal myocardial infarction (12.1% vs. 9.6%, respectively; P = .05); death from cardiac causes (6.3% vs. 5.3%; P = .29); repeat vascularization (13.1% vs. 11.9%; P = .39), and repeat CABG (1.4% vs. 0.5%; P = .02).

“In combination with findings from other randomized trials and a 2012 Cochrane systematic review [Cochrane Database Syst Rev. 2012;14:CD007224], the 5-year outcomes in our study support the conclusion that off-pump CABG does not offer any substantial advantages over on-pump CABG except possibly in unusual situations such as, for example, in patients with an extensively calcified (porcelain) aorta, in whom the off-pump technique may result in less manipulation of the aorta, potentially decreasing the risk of aortic emboli or stroke,” the researchers wrote. “In light of the low rates of use of off-pump CABG in the United States, the findings in our trial may provide more of a real-world experience than those in the CORONARY and GOPCABE trials, which required surgeons with a very high volume of experience with off-pump procedures, as compared with the ROOBY trial and with most other surgeons who are based in the United States.”

They acknowledged certain limitations of the study, including the fact that the study population comprised mostly males who had multiple coexisting conditions, “so the findings may not be applicable to female patients or to patients who are not veterans.”

The study was supported by a grant from the Department of Veterans Affairs. Dr. Shroyer reported having received grants from the VA Cooperative Studies Program during the conduct of the study. Her coauthors reported having no financial disclosures.

[email protected]

SAN FRANCISCO– The role of fidaxomicin for treating mild to moderate Clostridium difficile infection is still finding its way, according to Sarah Doernberg, MD.

For now, fidaxomicin, a narrow spectrum macrocyclic antibiotic, may be appropriate for those at high risk for relapse and/or those requiring concomitant antibiotics – but its high price tag may be prohibitive.

“I think a lot of centers have taken the fidaxomicin data, which were based on patients with initial infection or a single relapse, and extrapolated it to patients with multiple relapses,” Dr. Doernberg, medical director of adult antimicrobial stewardship at UCSF Medical Center, said at the UCSF Annual Advances in Internal Medicine meeting.

In a recent analysis, researchers collected real-world data on implementation of fidaxomicin for CDI patients at seven hospitals in the United Kingdom (Eur J Clin Microbiol Infect Dis. 2016 Feb;35[2]:251-9). In two hospitals where fidaxomicin was used as the first-line treatment for all primary and recurrent episodes, the recurrence rate reduced from 10.6% to 3.1% and from 16.3% to 3.1%, with a significant difference in 28-day mortality, from 18.2% to 3.1%; (P less than .05) and 17.3% to 6.3% (P less than .05). In the remaining five hospitals that used fidaxomicin in selected patients only, the changes in recurrence rates and mortality were less marked.

Other studies have found that fidaxomicin has a similar cure rate, compared with vancomycin (around 88%) but a lower recurrence rate (13%-15%, compared with 25%-27%, respectively; see N Engl J Med. 2011 Feb 3;364[5]:422-31). However, the general cost for a course is significantly more, compared with metronidazole and vancomycin, making fidaxomicin less cost effective as a first-line agent in most cases (Clin Infect Dis. 2013 Aug 15; 57[4]:555-61).

“Our guidelines recommend it in patients who have a very high risk for relapse who would not be candidates for fecal transplant down the line, which generally means immunocompromised patients,” Dr. Doernberg said.

Additional considerations when treating CDI include stopping unnecessary antibiotics, shortening the antibiotic course, narrowing the antibiotic spectrum, and stopping acid-suppressive medication when possible, especially proton pump inhibitors. “Do no use anti-peristaltic agents until acute symptoms of CDI improve,” she said.

Dr. Doernberg disclosed that she is a consultant for Actelion. She has also conducted prior research studies with Cerexa, Cubist, and Merck.

[email protected]

SAN FRANCISCO– The role of fidaxomicin for treating mild to moderate Clostridium difficile infection is still finding its way, according to Sarah Doernberg, MD.

For now, fidaxomicin, a narrow spectrum macrocyclic antibiotic, may be appropriate for those at high risk for relapse and/or those requiring concomitant antibiotics – but its high price tag may be prohibitive.

“I think a lot of centers have taken the fidaxomicin data, which were based on patients with initial infection or a single relapse, and extrapolated it to patients with multiple relapses,” Dr. Doernberg, medical director of adult antimicrobial stewardship at UCSF Medical Center, said at the UCSF Annual Advances in Internal Medicine meeting.

In a recent analysis, researchers collected real-world data on implementation of fidaxomicin for CDI patients at seven hospitals in the United Kingdom (Eur J Clin Microbiol Infect Dis. 2016 Feb;35[2]:251-9). In two hospitals where fidaxomicin was used as the first-line treatment for all primary and recurrent episodes, the recurrence rate reduced from 10.6% to 3.1% and from 16.3% to 3.1%, with a significant difference in 28-day mortality, from 18.2% to 3.1%; (P less than .05) and 17.3% to 6.3% (P less than .05). In the remaining five hospitals that used fidaxomicin in selected patients only, the changes in recurrence rates and mortality were less marked.

Other studies have found that fidaxomicin has a similar cure rate, compared with vancomycin (around 88%) but a lower recurrence rate (13%-15%, compared with 25%-27%, respectively; see N Engl J Med. 2011 Feb 3;364[5]:422-31). However, the general cost for a course is significantly more, compared with metronidazole and vancomycin, making fidaxomicin less cost effective as a first-line agent in most cases (Clin Infect Dis. 2013 Aug 15; 57[4]:555-61).

“Our guidelines recommend it in patients who have a very high risk for relapse who would not be candidates for fecal transplant down the line, which generally means immunocompromised patients,” Dr. Doernberg said.

Additional considerations when treating CDI include stopping unnecessary antibiotics, shortening the antibiotic course, narrowing the antibiotic spectrum, and stopping acid-suppressive medication when possible, especially proton pump inhibitors. “Do no use anti-peristaltic agents until acute symptoms of CDI improve,” she said.

Dr. Doernberg disclosed that she is a consultant for Actelion. She has also conducted prior research studies with Cerexa, Cubist, and Merck.

[email protected]

SAN FRANCISCO– The role of fidaxomicin for treating mild to moderate Clostridium difficile infection is still finding its way, according to Sarah Doernberg, MD.

For now, fidaxomicin, a narrow spectrum macrocyclic antibiotic, may be appropriate for those at high risk for relapse and/or those requiring concomitant antibiotics – but its high price tag may be prohibitive.

“I think a lot of centers have taken the fidaxomicin data, which were based on patients with initial infection or a single relapse, and extrapolated it to patients with multiple relapses,” Dr. Doernberg, medical director of adult antimicrobial stewardship at UCSF Medical Center, said at the UCSF Annual Advances in Internal Medicine meeting.

In a recent analysis, researchers collected real-world data on implementation of fidaxomicin for CDI patients at seven hospitals in the United Kingdom (Eur J Clin Microbiol Infect Dis. 2016 Feb;35[2]:251-9). In two hospitals where fidaxomicin was used as the first-line treatment for all primary and recurrent episodes, the recurrence rate reduced from 10.6% to 3.1% and from 16.3% to 3.1%, with a significant difference in 28-day mortality, from 18.2% to 3.1%; (P less than .05) and 17.3% to 6.3% (P less than .05). In the remaining five hospitals that used fidaxomicin in selected patients only, the changes in recurrence rates and mortality were less marked.

Other studies have found that fidaxomicin has a similar cure rate, compared with vancomycin (around 88%) but a lower recurrence rate (13%-15%, compared with 25%-27%, respectively; see N Engl J Med. 2011 Feb 3;364[5]:422-31). However, the general cost for a course is significantly more, compared with metronidazole and vancomycin, making fidaxomicin less cost effective as a first-line agent in most cases (Clin Infect Dis. 2013 Aug 15; 57[4]:555-61).

“Our guidelines recommend it in patients who have a very high risk for relapse who would not be candidates for fecal transplant down the line, which generally means immunocompromised patients,” Dr. Doernberg said.

Additional considerations when treating CDI include stopping unnecessary antibiotics, shortening the antibiotic course, narrowing the antibiotic spectrum, and stopping acid-suppressive medication when possible, especially proton pump inhibitors. “Do no use anti-peristaltic agents until acute symptoms of CDI improve,” she said.

Dr. Doernberg disclosed that she is a consultant for Actelion. She has also conducted prior research studies with Cerexa, Cubist, and Merck.

[email protected]

CHICAGO– The way Keith Choate, MD, PhD, sees it, he and other clinicians are only beginning to scratch the surface on their understanding of the genetic causes of ichthyosis and ichthyosis syndromes.

“Despite the fact that we now understand that there are about 21,000 genes in the genome, we have very superficial understanding and functions known for only about 4,000 genes,” Dr. Choate of the departments of dermatology and genetics at Yale University, New Haven, Conn., said at the World Congress of Pediatric Dermatology. “Clinical insight is what’s driving all of the discovery. We continue to find new disorders, and these next-generation technologies really permit us to find the genetic basis for those disorders. I like to say that it’s the disorders that we don’t read about in the textbook that end up being the ones that are most interesting.”

Ichthyoses are cardinal disorders that occur when the normal pattern of epidermal differentiation is disrupted and leads to compensatory hyperproliferation. Clinically, ichthyoses present in a variety of ways, and more than 50 genes can cause them.

[email protected]

CHICAGO– The way Keith Choate, MD, PhD, sees it, he and other clinicians are only beginning to scratch the surface on their understanding of the genetic causes of ichthyosis and ichthyosis syndromes.

“Despite the fact that we now understand that there are about 21,000 genes in the genome, we have very superficial understanding and functions known for only about 4,000 genes,” Dr. Choate of the departments of dermatology and genetics at Yale University, New Haven, Conn., said at the World Congress of Pediatric Dermatology. “Clinical insight is what’s driving all of the discovery. We continue to find new disorders, and these next-generation technologies really permit us to find the genetic basis for those disorders. I like to say that it’s the disorders that we don’t read about in the textbook that end up being the ones that are most interesting.”

Ichthyoses are cardinal disorders that occur when the normal pattern of epidermal differentiation is disrupted and leads to compensatory hyperproliferation. Clinically, ichthyoses present in a variety of ways, and more than 50 genes can cause them.

[email protected]

CHICAGO– The way Keith Choate, MD, PhD, sees it, he and other clinicians are only beginning to scratch the surface on their understanding of the genetic causes of ichthyosis and ichthyosis syndromes.

“Despite the fact that we now understand that there are about 21,000 genes in the genome, we have very superficial understanding and functions known for only about 4,000 genes,” Dr. Choate of the departments of dermatology and genetics at Yale University, New Haven, Conn., said at the World Congress of Pediatric Dermatology. “Clinical insight is what’s driving all of the discovery. We continue to find new disorders, and these next-generation technologies really permit us to find the genetic basis for those disorders. I like to say that it’s the disorders that we don’t read about in the textbook that end up being the ones that are most interesting.”

Ichthyoses are cardinal disorders that occur when the normal pattern of epidermal differentiation is disrupted and leads to compensatory hyperproliferation. Clinically, ichthyoses present in a variety of ways, and more than 50 genes can cause them.

[email protected]

CHICAGO – A streamlined set of diagnostic criteria from the American Academy of Dermatology’s most recent consensus criteria for diagnosing atopic dermatitis (AD) produced a specificity of more than 95%, and was also highly sensitive, a prospective analysis found.

“Atopic dermatitis typically presents in childhood and is associated with a worsened quality of life, with severe itch and lack of sleep, and substantial health care costs due to therapeutic management and increased hospitalizations,” study author Jeremy Udkoff said at the World Congress of Pediatric Dermatology. “We also know that in order to treat the disease and to learn more about it, we have to have a good tool for diagnosing it. When it comes to clinical studies and research, we require a systematic and refined set of criteria.”

[email protected]

CHICAGO – A streamlined set of diagnostic criteria from the American Academy of Dermatology’s most recent consensus criteria for diagnosing atopic dermatitis (AD) produced a specificity of more than 95%, and was also highly sensitive, a prospective analysis found.

“Atopic dermatitis typically presents in childhood and is associated with a worsened quality of life, with severe itch and lack of sleep, and substantial health care costs due to therapeutic management and increased hospitalizations,” study author Jeremy Udkoff said at the World Congress of Pediatric Dermatology. “We also know that in order to treat the disease and to learn more about it, we have to have a good tool for diagnosing it. When it comes to clinical studies and research, we require a systematic and refined set of criteria.”

[email protected]

CHICAGO – A streamlined set of diagnostic criteria from the American Academy of Dermatology’s most recent consensus criteria for diagnosing atopic dermatitis (AD) produced a specificity of more than 95%, and was also highly sensitive, a prospective analysis found.

“Atopic dermatitis typically presents in childhood and is associated with a worsened quality of life, with severe itch and lack of sleep, and substantial health care costs due to therapeutic management and increased hospitalizations,” study author Jeremy Udkoff said at the World Congress of Pediatric Dermatology. “We also know that in order to treat the disease and to learn more about it, we have to have a good tool for diagnosing it. When it comes to clinical studies and research, we require a systematic and refined set of criteria.”

[email protected]

CHICAGO – Pityriasis lichenoides chronica (PLC) is a benign, chronic disorder that can last from 1 to 5 years, yet no formal treatment standards exist.

“Topical corticosteroids will not alter the course of the disease, but they provide symptomatic relief when there is pruritus,” Sibel Ersoy-Evans, MD, said at the World Congress of Pediatric Dermatology. “Oral antibiotics, especially erythromycin, and phototherapy are the most common modalities used in children. Systemic immunosuppressants are rarely needed.”

Dr. Ersoy-Evans, a dermatologist at Hacettepe University in Ankara, Turkey, described pityriasis lichenoides (PL) as a spectrum with two polar ends: PLC and pityriasis lichenoides et varioliformis acuta (PLEVA). Its incidence and prevalence are unknown, but age distribution peaks at 2, 5, and 10 years of age. The average age of onset is 6.5 years, it’s slightly more common in boys, and there is no racial or ethnic predilection.

[email protected]

CHICAGO – Pityriasis lichenoides chronica (PLC) is a benign, chronic disorder that can last from 1 to 5 years, yet no formal treatment standards exist.

“Topical corticosteroids will not alter the course of the disease, but they provide symptomatic relief when there is pruritus,” Sibel Ersoy-Evans, MD, said at the World Congress of Pediatric Dermatology. “Oral antibiotics, especially erythromycin, and phototherapy are the most common modalities used in children. Systemic immunosuppressants are rarely needed.”

Dr. Ersoy-Evans, a dermatologist at Hacettepe University in Ankara, Turkey, described pityriasis lichenoides (PL) as a spectrum with two polar ends: PLC and pityriasis lichenoides et varioliformis acuta (PLEVA). Its incidence and prevalence are unknown, but age distribution peaks at 2, 5, and 10 years of age. The average age of onset is 6.5 years, it’s slightly more common in boys, and there is no racial or ethnic predilection.

[email protected]

CHICAGO – Pityriasis lichenoides chronica (PLC) is a benign, chronic disorder that can last from 1 to 5 years, yet no formal treatment standards exist.

“Topical corticosteroids will not alter the course of the disease, but they provide symptomatic relief when there is pruritus,” Sibel Ersoy-Evans, MD, said at the World Congress of Pediatric Dermatology. “Oral antibiotics, especially erythromycin, and phototherapy are the most common modalities used in children. Systemic immunosuppressants are rarely needed.”

Dr. Ersoy-Evans, a dermatologist at Hacettepe University in Ankara, Turkey, described pityriasis lichenoides (PL) as a spectrum with two polar ends: PLC and pityriasis lichenoides et varioliformis acuta (PLEVA). Its incidence and prevalence are unknown, but age distribution peaks at 2, 5, and 10 years of age. The average age of onset is 6.5 years, it’s slightly more common in boys, and there is no racial or ethnic predilection.

[email protected]

CHICAGO – The neonatal period and early infancy are especially critical for patients with ichthyosis, because compromised barrier function increases risk for morbidity and mortality.

“There are minimal data presently to guide management of patients with ichthyosis, making it a time of uncertainty,” Brittany Craiglow, MD, said at the World Congress of Pediatric Dermatology. “You’re going to want to get all hands on deck for the care of these patients. And don’t forget about the family – involve them in the care as much as possible. Reassure them; normalize their feelings, acknowledge them.”

Doug Brunk/Frontline Medical News

[email protected]

CHICAGO – The neonatal period and early infancy are especially critical for patients with ichthyosis, because compromised barrier function increases risk for morbidity and mortality.

“There are minimal data presently to guide management of patients with ichthyosis, making it a time of uncertainty,” Brittany Craiglow, MD, said at the World Congress of Pediatric Dermatology. “You’re going to want to get all hands on deck for the care of these patients. And don’t forget about the family – involve them in the care as much as possible. Reassure them; normalize their feelings, acknowledge them.”

Doug Brunk/Frontline Medical News

[email protected]

CHICAGO – The neonatal period and early infancy are especially critical for patients with ichthyosis, because compromised barrier function increases risk for morbidity and mortality.

“There are minimal data presently to guide management of patients with ichthyosis, making it a time of uncertainty,” Brittany Craiglow, MD, said at the World Congress of Pediatric Dermatology. “You’re going to want to get all hands on deck for the care of these patients. And don’t forget about the family – involve them in the care as much as possible. Reassure them; normalize their feelings, acknowledge them.”

Doug Brunk/Frontline Medical News

[email protected]