DermHelpCentral

Programs Expand Schizophrenic Patients’ Role in Their Own Care

by Benedict Carey, NY Times, December 28, 2015

"Over the past several years, a number of states have set up programs emphasizing supportive services, like sustained one-on-one therapy, school and work assistance, and family education, as well as medication. The therapists work to engage each patient as an equal partner in decisions — including about medication dosage, to make it as tolerable as possible.

In a landmark study published this fall, government-backed researchers reported that after two years, people who had this combined package were doing better on a variety of measures than those who received treatment as usual. The difference was modest but notable. And, significantly, the participants continued to receive care for six months longer on average."

One wonders if this approach would work as well for patients with other delusions such as parasitophobia, body dysmorphic disorder and eating disorders.

Oral Itraconazole for Seborrheic Dermatitis

Efficacy of Oral Itraconazole in the Treatment and Relapse Prevention of Moderate to Severe Seborrheic Dermatitis: A Randomized, Placebo-Controlled Trial.
Ghodsi SZ, Abbas Z, Abedeni R. Am J Clin Dermatol. 2015 Oct;16(5):431-
Abstract
BACKGROUND: Seborrheic dermatitis (SD) is a chronic and relapsing disease and topical therapy may be associated with failure, particularly in severe disease. Itraconazole has been suggested as an effective treatment for severe SD. Previous studies have been open clinical trials with variable results.
OBJECTIVE: The aim of this study was to determine the efficacy of oral itraconazole in the treatment of patients with moderate to severe SD.
CONCLUSION: Itraconazole is not only an effective and safe therapy for controlling exacerbations of SD but may also be used as maintenance therapy to prevent disease recurrence.

Discussion in NEJM Journal Watch. If you can'topen link:
Download Seb Derm Itraconazole Journal Watch

Risk of Stroke and Heart Attack After Shingles

Shingles infections are very painful. They may also increase the risk of heart attacks and strokes in the weeks after an outbreak, a new study reports.

Researchers analyzed the records of 61,191 Medicare recipients with a shingles (herpes zoster) diagnosis and either a heart attack or a stroke from 2006 through 2011, comparing rates of cardiovascular events before and after a shingles attack.

They found that in the first week after diagnosis, there was a 2.4-fold increase in the rate of stroke and a 1.7-fold increase in the rate of heart attack. The difference gradually faded over six months. The findings were published in PLOS Medicine.

The exact mechanism is unclear, but the authors suggest that inflammation may lead to blood clots in people with hardening of the arteries. A similar link has been noted for respiratory diseases and other infections. Stress from the pain of shingles, the authors acknowledge, could have contributed to the effect, but they lacked the data to assess this.

Herpes zoster vaccination did not appear to change the result, but only 9 percent of people in the group had been vaccinated, not enough to reach firm conclusions about the effect of the vaccine.

Tanning "Parlor" Wars

F.D.A. Proposes Ban on Indoor Tanning for Minors to Fight Skin Cancer (This article appeared in the December 19^th 2015, NY Times)

“The Food and Drug Administration on Friday proposed barring everyone under 18 from using tanning beds, a sweeping move that medical experts say is a major step toward reducing the risk of skin cancer in the United States.”

The incidence of melanoma has been steadily rising over the past two decades. Importantly, as this article states, “death rates [from melanoma] have not gone up, however, a testament to earlier detection and better treatment.” This may not be a result of early detection and treatment, but because pathologists are calling lesions melanoma that would not have been labeled as such in the past (diagnostic drift) or because melanomas that are stimulated by artificial UVL behave less aggressively than melanomas that are caused in other ways.

Demonizing “tanning parlors” may well be attacking a soft target. Still, we agree that regulating the use of artificial tanning facilities, especially for minors (who appear at increased risk) is prudent. Thinking that this is based on good science, may be off the mark.

Cutaneous Collagenous Vasculopathy

IMAGES IN CLINICAL MEDICINE. Cutaneous Collagenous Vasculopathy.

Ma DL, Vano-Galvan S. N Engl J Med. 2015 Sep 17;373  Download Cutaneous Collagenous Vasculopathy - NEJMicm1408473

Radiotherapy Skin Cancers Head and Neck

[Radiotherapy of basal cell carcinoma of the face and head: Importance of low dose per fraction on long-term outcome].

[Article in German]

Olschewski T1, Bajor K, Lang B, Lang E, Seegenschmiedt MH.

J Dtsch Dermatol Ges. 2006 Feb;4(2):124-30.

BACKGROUND:

Radiotherapy plays an important role in the treatment of basal cell carcinoma of the face and head and achieves cure rates of 92-96 %. Different fractionation concepts of radiotherapy have been described. This study investigates the efficacy, as well as acute and chronic toxicity, of a slightly hypo-fractionated radiotherapy schedule.

PATIENTS AND METHODS:

85 patients with 104 tumors underwent radiotherapy for basal cell carcinoma of the face and head. The radiotherapy schedule was 5 x 3 Gray/week up to a total dose of 57 Gray in 95 % of patients. Acute and late radiotherapy toxicity and cosmetic outcome were evaluated in long-term follow-up.

RESULTS:

No recurrence was observed. In 87 % of tumors, only low acute toxicity occurred at the end of radiotherapy. Late toxicity, if observed, was low in most patients. "Excellent" or "good" cosmesis was achieved in 94 % of tumors at last follow-up.

CONCLUSIONS:

Our radiotherapy schedule achieves a very high local control rate and very good cosmetic and functional results. This fractionation can be recommended as a standardized radiotherapy treatment for basal cell carcinoma of the face and head.

Basal Cell Radiotherapy

Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: our experience in 671 lesions.

Caccialanza M et.al Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9

J Eur Acad Dermatol Venereol. 2009 Sep;23(9):1044-9.

Abstract

BACKGROUND: The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result.

OBJECTIVE: To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose.

METHODS: A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007.

RESULTS: The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed.

CONCLUSION: Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.

Comment: I think Moh's surgeons would say that their cure rates are higher, but then, this group may include very complex lesions that were not amenable to Moh's or that would have left significant defects.  One would need to review this article carefully. DJE

Cancer Screening and Easly Diagnosis

The mantra “early diagnosis” is a bit like “free money”—it sounds great, but there’s a complicated catch. Patients will be short changed unless it’s fairly explained. Why are we so reluctant to be upfront about downsides?

Margaret McCartney's editorial in the British Medical Journal is a short, readable introduction in the epidemic of cancer screening: Download Margaret McCartney: Early cancer diagnosis: how low should we go? - bmj.h6442.full