DermHelpCentral

WMTM Supplemental Material

Here is the data from the What Matters To Me Paper.

Appendix 1. Questionnaire: Download What Matters To Me Questionnaire

 

Table. Demographic Data: Download What Matters To Me Demographics 11.17

 

Appendix 2. Graphs to Question Answers: Link to Google-Doc File.

 

Appendix 3.  Comments on the Questionnaire. Link to Google-Doc File.

What Matters To Me Questionnaire

This instrument is designed to help you communicate with your physicians and other care providers about what really matters to you in your relationships with the health care system.

Although one may not always get everything one wishes for, this is a chance to share your preferences and values with regards to the healthcare you receive.

When answering the questions it may be helpful to think of times you felt that your medical care needs were not met.

Please download and print out the questionnaire:
Download What Matters To Me Questionnaire 8.26.18

 

 

Marius Rademaker's Talks on Isotretinoin and Atopic Dermatitis

Marius Rademaker practices dermatology in Hamilton, New Zealand.
He has been at the forefront of research into the use of isotretinoin for acne and other disorders as well as the treatment of atopic dermatitis with methotrexate.

Here are notes from his presentations at Hot Spots in Dermatology
August 17 - 19, 2018, Kahuku, Hawaii

1. Isotretinoin:  Download Notes from Marius Rademaker’s Talks on Isotretinoin
2. Methotrexate: for Atopic Dermatitis : Download Marius Rademaker on Atopic Dermatitis

Key References:

1. Download Isotretinoin- Dose Duration Relapse

2.We do not have a pdf.  Here is the citation + the abstract:

Methotrexate for treatment of atopic dermatitis in children and adolescents

Marius Rademaker et. al.

Int. J. Dermatoil 2014 https://doi.org/10.1111/ijd.12314 (06 March 2014)

Abstract: Low‐dose methotrexate is becoming established as a second‐line treatment for atopic eczema in the adult population, but there has been a paucity of data to support its use for this indication in the pediatric population.

Methods A retrospective review was undertaken of patients aged 18 years and under started on methotrexate between January 2005 and April 2010, at a hospital‐based dermatology department in New Zealand.

Results: Thirty‐one patients (17 females, mean age 10 years, range 3–18 years) were reviewed. Methotrexate was found to be effective or very effective in 75% and ineffective in 25%. The mean duration of treatment for those who responded to methotrexate was 14 months (range 2–38 months), 74% of patients were still on treatment at the time of last review. The most common adverse effect was minor nausea in four patients (14%) and non‐significant elevation of liver enzymes (four patients). No serious adverse effects were noted.

Conclusion: In our experience, methotrexate has a good safety/tolerability profile when used in low dose for the treatment of atopic dermatitis in children and adolescents and appears to be effective. Formal comparative studies are needed.

 

Isotretinoin: Dose, Duration and Relapse

Article by Marius Rademaker, Hamilton, NZ

Abstract below...  Download Isotretinoin- Dose Duration Relapse

With 30 years of clinical use, it is appropriate to review the use of isotretinoin. While the standard dose of 0.5 to 1 mg/kg per day for 4 months to acumulative dose of 120–140 mg/kg per day has servedus well in the management of acne vulgaris, there is emerging evidence that much lower dosages (as low as 5 mg/day) are just as effective but have significantly fewer adverse effects.
Relapse of acne vulgaris continues to be a problem but we are beginning to recognise that this is related less to the cumulative dose and more to the length of sebaceous gland suppression.
Other factors important for relapse include
1. a macrocomedonal pattern of acne, smoking and age,
 2.both younger (under 14 years) and older ( women over 25 years).

After 30 years of use, we now understand why isotretinoin is such an effective drug. Not only does it clear acne in almost all patients, long-term remission can be achieved in 70–80% of patients with a single course. Important changes in the use of isotretinoin include using a lower daily dose for a longer period of time. New indications continue to emerge, particularly as a potential treatment for both intrinsic and extrinsic (photo) aging. Teratogenicity however, remains a very significant concern.

Key words: acne vulgaris, adverse effects, dose, isotretinoin, relapse, retinoid.

Low Dose Isotretinoin - Rademaker

Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us?

Rademaker M. Australas J Dermatol. 2013 Aug;54(3):157-62  Download Low Dose Isotretinoin Rademaker

Abstract: With 30 years of clinical use, it is appropriate to review the use of isotretinoin. We now understand that retinoids influence cellular growth, differentiation, morphogenesis and apoptosis, inhibit tumour promotion and malignant cell growth, exert immuno-modulatory actions and alter cellular cohesiveness. This has expanded the indications of isotretinoin from just acne and rosacea to a wide range of inflammatory and malignant skin disorders. While the standard dose of 0.5 to 1 mg/kg per day for 4 months to a cumulative dose of 120-140 mg/kg per day has served us well in the management of acne vulgaris, there is emerging evidence that much lower dosages (as low as 5 mg/day) are just as effective but have significantly fewer adverse effects. Relapse of acne vulgaris continues to be a problem but we are beginning to recognise that this is related less to the cumulative dose and more to the length of sebaceous gland suppression. Other factors important for relapse include a macrocomedonal pattern of acne, smoking and age, both younger (under 14 years) and older (over 25 years). After 30 years of use, we now understand why isotretinoin is such an effective drug. Not only does it clear acne in almost all patients, long-term remission can be achieved in 70-80% of patients with a single course. Important changes in the use of isotretinoin include using a lower daily dose for a longer period of time. New indications continue to emerge, particularly as a potential treatment for both intrinsic and extrinsic (photo) aging. Teratogenicity however, remains a very significant concern.

PTSD Following Emergency Caesarian Section

Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study

 

Abstract: Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game ‘Tetris’ via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: −0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention “rather” to “extremely” acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child.

This is a long, but important article.  Full Text Link.

Melanoma: Work-up

This is a very helpful review:

Kauffmann RM, Chen SL. Workup and staging of malignant melanoma.

Surg Clin North Am. 2014 Oct;94(5):963-72

Abstract: Melanoma continues to be one of the fastest growing cancers in terms of incidence. The workup of melanoma focuses on risk factors based on the visual aspects of a skin lesion. Risk factors including sun exposure increase the risk of melanoma. Staging is based on depth of invasion, mitotic rate, and spread into lymph nodes and other sites. Once diagnosed, wide excision is indicated for the primary lesion, and sentinel node biopsy for all but the thinnest of melanomas. Routine imaging workup for most thinner melanomas should be minimized, and is questionable in the asymptomatic patients even with thicker melanomas.

Full article: Download Kauffmann2014