Seboreik Keratoz İçin Yüksek-Doz hidrojen peroksid 

January 16, 2018   By Naissan O. Wesley, MD  Lily Talakoub, MD

 

Formerly known as A-101, Eskata is a novel topical treatment for seborrheic keratoses (SKs) that was approved by the Food and Drug Administration in December 2017. It is a 40% hydrogen peroxide topical solution that is applied to raised SKs as an in-office procedure. As previously reported, SKs are composed of hyperadherent senescent cells that are arrested in the G1 phase of the cell cycle. They exhibit decreased apoptotic cell death, compared with normal skin.

While the mechanism of action of Eskata is unknown, highly reactive oxygen species likely created from application of this concentration of hydrogen peroxide may lead to direct oxidative damage to SK cells. The oxidative damage created can induce local protein, lipid, and membrane peroxidation, and ultimately, necrotic and apoptotic cell death of the SK cells.

 

Current therapies for SKs include cryotherapy, electrodessication, curettage, shave biopsy/removal, and laser therapy. As SKs affect at least 83 million Americans and are bothersome to patients because of cosmetic disfigurement, irritation, unnecessary diagnostic biopsies, or annoyance, this novel therapy provides a noninvasive treatment option with the potential to supersede all prior therapies with less pain and risk of pigmentary alteration and scarring from the procedure. It is expected to be commercially available in the spring of 2018

 

 

Orta yaşlı kadınlarda yapılan ufak bir çalışmada “yüz egzersizleri” görünümü düzeltiyor.

9 Ocak 2018

 

A 20-week regimen of facial exercises done at home improved the appearance of 16 middle-aged women, according to results of a blinded study.

The role of skin laxity and substructural fat and muscle loss in the appearance of facial aging has been recognized already, and there has been interest within the nonmedical community regarding use of facial exercise to improve appearance, Murad Alam, MD, of Northwestern University, Chicago, and his colleagues wrote in a research letter published in JAMA Dermatology.


The researchers recruited healthy women aged 40-65 years with some photodamage to the face and an interest in facial exercises. After two 90-minute, in-person training sessions with a certified instructor, the participants were asked to perform a 30-minute facial exercise session daily for 8 weeks at home, followed by sessions every other day during weeks 9-20. Sixteen patients completed the full 20-week study.

Two blinded physicians used validated assessment scales to compare photographs of the participants taken at the beginning and end of the 20-week period. Facial exercise was associated with an improved mean upper-cheek fullness score, compared with baseline (1.1 vs. 1.8, respectively; P = .003), and an improved mean lower-cheek fullness score, compared with baseline (0.9 vs. 1.6; P = .003).

In addition, blinded physicians’ estimates of the women’s ages decreased significantly: The estimates dropped from an average of 51 years at baseline to an average of 49 years after the women completed the 20 weeks of facial exercises (P = .002), Dr. Alam and his associates reported.

The study was limited by several factors, including its small sample size, the lack of a control group, and a self-selected population that may have been especially motivated to follow the exercise routine, the researchers noted.

However, the results suggest that the cause for improvements in appearance as a result of the exercises “may be exercise-actuated hypertrophy of cheek and other muscles,” they said. “Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings,” Dr. Alam and his associates concluded.

The study was supported by research funds from the department of dermatology at Northwestern University. Dr. Alam disclosed serving as a consultant for Amway and Leo Pharma and has served as an investigator on studies supported in part by Allergan, Medicis Pharmaceutical, BioForm Medical, and Ulthera.

 

 

Raoultella Planticola: Nadir bir yara enfeksiyonu nedeni.

 

Shana S. Kalaria, MD; Kristina Elliott, FNP; Neal Combs, RN; Linda G. Phillips, MD   Wounds. 2017;29(11):E103-E105. 

 

Raoultella planticola is a gram-negative, aerobic, rod bacterium commonly found in the environment, particularly in water, soil, and fish. This organism has been found to cause a variety of infections, such as necrotizing fasciitis, cystitis, cholecystitis, pancreatitis, hepatic disease, and soft tissue infections. The authors report the case of a 73-year-old-woman who presented with a R planticola wound infection of her left lower extremity after a dog scratch.

She was treated successfully with local wound care using dehydrated human amnion/chorion and oral levofloxacin. Her wound healed completely in 4 months but may have been delayed due to her comorbidities. Her chronic proton pump inhibitor use and trial of antibiotics prior to diagnosis of this infection may have selected for this particular organism. Although not commonly reported as a cause of wound infections, practitioners should consider R planticola as a differential diagnosis for a nonhealing wound as prompt identification can allow for timely treatment and decreased morbidity of this serious pathogen.

 

Düşük Dozda Reçetelenen Metotreksatın Yan Etki Durumları İçin Rölatif Risk ve Belirleyiciler

A Systematic Review and Meta-analysis of Randomized Placebo-controlled Trials

 

The British Journal of Dermatology. 2017;177(4):978-986.   C. Mazaud; L. Fardet

 

Low-dose (i.e. ≤ 30 mg per week) methotrexate is widely prescribed by dermatologists. However, there is limited evidence-based information regarding the relative risk of and determinants for adverse events associated with this treatment. The aims of this review were to assess the relative risk of and the determinants for adverse events associated with low-dose methotrexate exposure. A systematic review was undertaken using the MEDLINE, Embase and CENTRAL databases. Randomized controlled trials comparing low-dose methotrexate with placebo were eligible. Random effect meta-analyses were conducted to assess the risk ratios (RRs) of adverse events associated with methotrexate exposure. Subgroup analyses and random effect meta-regressions were performed to examine the determinants of adverse events. In total, 68 trials (6938 participants) were included. Compared with placebo, low-dose methotrexate slightly increased the risk of adverse events (mean number per individual: 1·78 ± 2·00 in the methotrexate group, 1·53 ± 1·89 in the placebo group; P < 0·001), including nausea/vomiting, elevated transaminase levels, mucosal ulcerations, leucopenia, thrombopenia and infectious events, but not the risk of serious adverse events or death. Low-dose methotrexate also increased the number of withdrawals from studies because of adverse events [RR 1·32 (1·13–1·53)]. The concomitant prescription of folic/folinic acid was associated with a significant lower risk of any adverse events, and methotrexate prescribed orally was associated with a higher risk of abdominal pain than when prescribed subcutaneously or by intramuscular injection. On the other hand, the risk of adverse events did not increase with the weekly dose or with duration of exposure. Similar studies comparing methotrexate with other systemic/biological treatments are needed.

 

 

Genetik Retiküler Pigment Bozuklukların Güncellenmiş Gözden Geçirilmesi

The British Journal of Dermatology. 2017;177(4):945-959.      J. Zhang; M. Li; Z. Yao

 

Reticulate pigmentary disorders are a group of disorders characterized by hyper- and/or hypopigmented macules with varying sizes and amounts of pigment. Some of the disorders are heritable, such as Dowling-Degos disease, dyschromatosis universalis hereditaria, dyschromatosis symmetrica hereditaria, reticulate acropigmentation of Kitamura and X-linked reticulate pigmentary disorder. Although each condition possesses unique phenotypic characteristics and the prognosis for each is somewhat different, there is a large degree of overlap between the disorders and therefore they are difficult to differentiate in the clinical setting. This updated review provides a clinical and molecular delineation of these genetic reticulate pigmentary disorders and aims to establish a concise diagnostic strategy to allow clinical dermatologists to make an accurate diagnosis, as well as to provide useful information for clinical and genetic counselling.

 

 

Egzama İçin Yumuşatıcılar ve Nemlendiriciler

The British Journal of Dermatology. 2017;177(5):1256-1271.  E.J. van Zuuren; Z. Fedorowicz; B.W.M. Arents  

 

Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturizers are widely recommended, but are these effective and safe? We searched for randomized controlled trials (RCTs) in the Cochrane Skin Group Specialised Skin Register, CENTRAL in The Cochrane Library, MEDLINE, Embase, LILACS, the GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9%) were at low risk of bias, 34 (44%) had unclear risk and 36 (47%) were at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison, 'moisturizer vs. no moisturizer', showed improved Scoring Atopic Dermatitis values in the moisturizer group compared with no moisturizer [mean difference −2·42, 95% confidence interval (CI) −4·55 to −0·28], but did not meet the minimal important difference of 8·7. Fewer flares were seen (risk ratio 0·40, 95% CI 0·23–0·70) and the rate of flares was reduced (hazard ratio 3·74, 95% CI 1·86–7·50). The groups applying moisturizer used less topical corticosteroids over 6–8 weeks (mean difference −9·30 g, 95% CI 15·3 to −3·27). Glycyrrhetinic acid-, urea- and glycerol-containing creams worked better than their controls (vehicle, placebo or no moisturizer) according to both participants and physicians. More flares were reported with moisturizer alone than when combined with twice-weekly fluticasone propionate (risk ratio 2·17, 95% CI 1·55–3·11). Adding moisturizers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and resulted in fewer flares.

 

Gençlik, Çekicilik, Başarı ve Sağlık Açısından Gözlemci Derecelendirmeleri ve Yüz Gençleştirme Arasındaki İlişki.

JAMA Facial Plast Surg. 2017 Sep 1;19(5):360-367. doi: 10.1001/jamafacial.2017.0126. Bater KL, et al.    

 

Surgical procedures for the aging face-including face-lift, blepharoplasty, and brow-lift-consistently rank among the most popular cosmetic services sought by patients. Although these surgical procedures are broadly classified as procedures that restore a youthful appearance, they may improve societal perceptions of attractiveness, success, and health, conferring an even larger social benefit than just restoring a youthful appearance to the face.

The data presented in this study demonstrate that patients are perceived as younger and more attractive by the casual observer after undergoing face-lift and upper facial rejuvenation surgery. These procedures also improved ratings of perceived success and health in our patient population. These findings suggest that facial rejuvenation surgery conveys an even larger societal benefit than merely restoring a youthful appearance to the face.

 

Melanom 2018: 28. Yıllık Kütanöz Malignite Güncellemesi

CME

During this course nationally recognized experts will present information on prevention, risk assessment, early detection, genetic factors, and current and future treatment choices for melanoma patients. Issues concerning surgical management, adjuvant therapy, advanced disease therapy, and personalizing the course of treatment for individual patients will also be discussed. This course is designed to provide information that will help clinicians in their decision making regarding these difficult patient problems. The course will be taught by a wide range of experts as this most serious of skin cancers will require multidisciplinary efforts to conquer.
Venue: Hilton San Diego Resort Mission Bay

January 20-21, 2018 

San Diego, California 92109, United States

 

Gebelikte Melanom: Melanom ile komplike olmuş 60 gebelik raporu

Melanoma Research  May 05, 2017  de Haan J, et al.

 

The target of this study was to analyze the incidence, the demographic and clinical features and the treatment modalities related to melanoma during pregnancy. It was inferred that new systemic therapies were advantageous for metastatic melanoma patients. However, these were possibly not pregnancy compatible. In these patients, preterm induction of labour had to be assessed, despite the short–term and long–term negative impact on the child.

Methods

Results

 

Gastrointestinal melanom metastazlarının görüntülenmesi: Rezeke Edilen Örneğin Histopatolojisi ve Cerrahinin Korelasyonu

European Radiology   May 03, 2017  Othman AE, et al.

 

This study sought to evaluate the appearance of gastrointestinal melanoma metastases on CT and PET/CT and evaluate the diagnostic value of CT and PET/CT compared with surgery and histopathology. It was considered that most gastrointestinal melanoma metastases were located in the small bowel. They observed that large and polypoid metastases were correlated with higher complication rates. PET/CT was superior for detection of gastrointestinal melanoma metastases and should be considered in patients with limited disease undergoing surgery.