Interpreting Medical Literature
Featuring Dr. Jennie Clarke and Dr. Joslyn Kirby
This morning Dr. Jennie Clarke and Dr. Joslyn Kirby gave a wonderful presentation reviewing pertinent medical literature from the last year applicable to current dermatology practice. Confirming what most in the dermatology field already believed, a recent JAMA Dermatology article revealed total unprotected sun exposure is significantly associated with increased melanoma risk. JAMA Dermatology also published a study in which patients with moderately dysplastic nevi with positive histological margins were monitored for several years. They did not find any melanoma growth within the site of the previously biopsied dysplastic nevi. Of interest, however, 22.8% of these patients did develop melanoma elsewhere on their body reiterating dysplastic nevi patients have increased rates of melanoma. Dr. Clarke and Dr. Kirby emphasized the importance of knowing the dermatopathologist with whom you work.
Next, field treatment of actinic keratoses was discussed. Dr. Kirby mentioned her goal in the treatment of patients with numerous actinic keratoses is to get the most effect, with the least difficulty for patients and with the lowest cost to the patient. The study Dr. Kirby cited revealed 5% 5-FU applied twice daily for 4 weeks was most effective for field treatment of actinic keratoses. The next discussion centered around cosmetic outcomes of face and neck surgeries and suture type and spacing. No difference in cosmetic outcome or adverse events was found in regards to width of suture spacing or size of fast gut used in head and neck surgeries.
The study Dr. Kirby cited revealed 5% 5-FU applied twice daily for 4 weeks was most effective for field treatment of actinic keratoses.
Dr. Clarke went on to discuss urticaria. The literature reveals routine screening with extensive labs and/or malignancy screening is not recommended in the patient who presents with urticaria. First line therapy of urticaria should be with 2nd generation antihistamines given up to four times the usual dose. Second line therapies may include omalizumab or dapsone. Next, Dr. Kirby reviewed the data on lidocaine allergy. In one study, only 0.5% of 402 patients who reported an allergy to lidocaine were truly allergic.
The incidence of bullous pemphigoid (BP) has been increasing with the aging population, better diagnostics as well as better recognition of atypical clinical feature. Additionally, Dr. Clarke reported new drugs have been identified to induce BP , specifically the diabetes medication class of dipeptidyl peptidase-4 (DDP-4) inhibitors. Dr. Kirby went on to discuss atopic dermatitis. Dupilumab induced conjunctivitis was reviewed as well as the sleep cycle disruption in children with atopic dermatitis. Itch plays the main role in these children with atopic dermatitis who have sleep disturbances. This results in lower cognitive and motor function. Melatonin has been found to improve sleep in these children. Dr. Clarke and Dr. Kirby concluded the lecture with the current data on diagnosis and management of hidradenitis and cellulitus.
The incidence of bullous pemphigoid (BP) has been increasing with the aging population, better diagnostics as well as better recognition of atypical clinical feature.