Doug Brunk

SAN DIEGO — Primary care physicians use the nonspecific ICD-9 code 496.xx to indicate chronic obstructive pulmonary disease more frequently than specific ICD-9 codes for the disease, Vijay N. Joish, Ph.D., reported in a poster session at the 100th International Conference of the American Thoracic Society.

Most COPD diagnoses in primary care offices are being made without pulmonary function test results or any recorded history of risk factors, said Dr. Joish of the pharmacotherapy outcomes research center at the University of Utah, Salt Lake City.

The findings, part of what he said is the largest study of its kind, confirm previous studies suggesting that patients with COPD continue to be undiagnosed and undertreated. “There is an underuse of spirometry and lung function tests to diagnose COPD,” he said in an interview. “I'm not sure how physicians would get the most effective treatment if they don't have that kind of information.”

He and his associates used GE Centricity, a national electronic medical records database containing more than 16 million patient charts, to identify adults diagnosed with COPD during or after 1990 in office-based family practice, internal medicine, and general practice settings. They identified 35,752 patients by ICD-9 codes 491.xx (bronchitis type), 492.xx (emphysema type), and 496.xx (not elsewhere specified) but studied only the 14,691 who had at least 6 months of health care resource use prior to their first diagnosis of COPD.

The investigators evaluated pulmonary function tests and diagnoses of specified risk factors in the 14,691 patients before and after the first diagnosis of COPD to determine the progression of the disease. They used the Global Initiative for Chronic Obstructive Lung Disease criteria to measure disease severity and defined risk factors as physician recorded diagnosis of smoking, bronchitis, dyspnea/shortness of breath, and cough or abnormal sputum.

Of the 14,691 patients, 10,494 (71%) had an ICD-9 diagnosis of 496, the nonspecific code to indicate COPD. Only 383 patients (less than 3%) had any pulmonary function test before or on their first day of COPD diagnosis, and 426 (less than 3%) had pulmonary function tests after diagnosis. In addition, 4,612 patients (31%) had a recorded risk factor prior to their COPD diagnosis.

In the poster, Dr. Joish and his associates acknowledged that some of the medical records used in the study might have been incomplete. “For instance,” they wrote, “handheld spirometry tests may not [have been] captured and/or appropriately transcribed electronically into the database.”

Pfizer Inc. funded the study.

SAN DIEGO — Primary care physicians use the nonspecific ICD-9 code 496.xx to indicate chronic obstructive pulmonary disease more frequently than specific ICD-9 codes for the disease, Vijay N. Joish, Ph.D., reported in a poster session at the 100th International Conference of the American Thoracic Society.

Most COPD diagnoses in primary care offices are being made without pulmonary function test results or any recorded history of risk factors, said Dr. Joish of the pharmacotherapy outcomes research center at the University of Utah, Salt Lake City.

The findings, part of what he said is the largest study of its kind, confirm previous studies suggesting that patients with COPD continue to be undiagnosed and undertreated. “There is an underuse of spirometry and lung function tests to diagnose COPD,” he said in an interview. “I'm not sure how physicians would get the most effective treatment if they don't have that kind of information.”

He and his associates used GE Centricity, a national electronic medical records database containing more than 16 million patient charts, to identify adults diagnosed with COPD during or after 1990 in office-based family practice, internal medicine, and general practice settings. They identified 35,752 patients by ICD-9 codes 491.xx (bronchitis type), 492.xx (emphysema type), and 496.xx (not elsewhere specified) but studied only the 14,691 who had at least 6 months of health care resource use prior to their first diagnosis of COPD.

The investigators evaluated pulmonary function tests and diagnoses of specified risk factors in the 14,691 patients before and after the first diagnosis of COPD to determine the progression of the disease. They used the Global Initiative for Chronic Obstructive Lung Disease criteria to measure disease severity and defined risk factors as physician recorded diagnosis of smoking, bronchitis, dyspnea/shortness of breath, and cough or abnormal sputum.

Of the 14,691 patients, 10,494 (71%) had an ICD-9 diagnosis of 496, the nonspecific code to indicate COPD. Only 383 patients (less than 3%) had any pulmonary function test before or on their first day of COPD diagnosis, and 426 (less than 3%) had pulmonary function tests after diagnosis. In addition, 4,612 patients (31%) had a recorded risk factor prior to their COPD diagnosis.

In the poster, Dr. Joish and his associates acknowledged that some of the medical records used in the study might have been incomplete. “For instance,” they wrote, “handheld spirometry tests may not [have been] captured and/or appropriately transcribed electronically into the database.”

Pfizer Inc. funded the study.

SAN DIEGO — Primary care physicians use the nonspecific ICD-9 code 496.xx to indicate chronic obstructive pulmonary disease more frequently than specific ICD-9 codes for the disease, Vijay N. Joish, Ph.D., reported in a poster session at the 100th International Conference of the American Thoracic Society.

Most COPD diagnoses in primary care offices are being made without pulmonary function test results or any recorded history of risk factors, said Dr. Joish of the pharmacotherapy outcomes research center at the University of Utah, Salt Lake City.

The findings, part of what he said is the largest study of its kind, confirm previous studies suggesting that patients with COPD continue to be undiagnosed and undertreated. “There is an underuse of spirometry and lung function tests to diagnose COPD,” he said in an interview. “I'm not sure how physicians would get the most effective treatment if they don't have that kind of information.”

He and his associates used GE Centricity, a national electronic medical records database containing more than 16 million patient charts, to identify adults diagnosed with COPD during or after 1990 in office-based family practice, internal medicine, and general practice settings. They identified 35,752 patients by ICD-9 codes 491.xx (bronchitis type), 492.xx (emphysema type), and 496.xx (not elsewhere specified) but studied only the 14,691 who had at least 6 months of health care resource use prior to their first diagnosis of COPD.

The investigators evaluated pulmonary function tests and diagnoses of specified risk factors in the 14,691 patients before and after the first diagnosis of COPD to determine the progression of the disease. They used the Global Initiative for Chronic Obstructive Lung Disease criteria to measure disease severity and defined risk factors as physician recorded diagnosis of smoking, bronchitis, dyspnea/shortness of breath, and cough or abnormal sputum.

Of the 14,691 patients, 10,494 (71%) had an ICD-9 diagnosis of 496, the nonspecific code to indicate COPD. Only 383 patients (less than 3%) had any pulmonary function test before or on their first day of COPD diagnosis, and 426 (less than 3%) had pulmonary function tests after diagnosis. In addition, 4,612 patients (31%) had a recorded risk factor prior to their COPD diagnosis.

In the poster, Dr. Joish and his associates acknowledged that some of the medical records used in the study might have been incomplete. “For instance,” they wrote, “handheld spirometry tests may not [have been] captured and/or appropriately transcribed electronically into the database.”

Pfizer Inc. funded the study.

LAS VEGAS — Treating acne with 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle once daily for 4 weeks was effective and well-tolerated, results from a large study demonstrated.

The finding underscores urea's role as an effective moisturizing agent, Michael H. Gold, M.D., reported during a poster session at the Fall Clinical Dermatology Conference.

In an open-label study that Dr. Gold led at 133 clinical sites, 1,089 men and women were prescribed 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle cleanser (Zoderm) for use in the morning plus an equivalent strength of either Zoderm gel or cream formulation for use in the evening.

Applications were made over a 4-week period. The investigators allowed patients to use additional acne medicines during the study, except for those that contained benzoyl peroxide.

Of the 1,089 patients, 963 completed the second visit of the study, Dr. Gold, a dermatologist with Tennessee Clinical Research Center, Nashville, noted in the text of the poster.

The investigators assessed inflammatory and noninflammatory lesion counts at baseline and at week 4. They rated dryness and erythema on a 0–8 scale in which 8 was defined as severe or deep.

Of the 963 patients, 551 used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy, 17 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral doxycycline, and 21 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral minocycline.

Dr. Gold reported that the 551 patients who used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy achieved a 44% mean reduction in total lesion count at week 4 vs. baseline.

The 17 patients who used this regimen plus oral doxycycline achieved a 52% mean reduction in their total lesion count at week 4 vs. baseline, whereas those patients who used concomitant oral minocycline achieved a 34% mean reduction in total lesion count at week 4 vs. baseline.

According to the poster, patients experienced little or no increase in skin dryness and a decrease in erythema.

The study was funded by a grant from Doak Dermatologics, a subsidiary of Bradley Pharmaceuticals Inc., makers of Zoderm.

The meeting was sponsored by the Center for Bio-Medical Communication Inc.

A female patient is shown here at baseline, before using a urea vehicle cleanser.

Clearance of acne is apparent in the same patient at 4 weeks' follow-up. Photos courtesy Dr. Michael H. Gold

LAS VEGAS — Treating acne with 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle once daily for 4 weeks was effective and well-tolerated, results from a large study demonstrated.

The finding underscores urea's role as an effective moisturizing agent, Michael H. Gold, M.D., reported during a poster session at the Fall Clinical Dermatology Conference.

In an open-label study that Dr. Gold led at 133 clinical sites, 1,089 men and women were prescribed 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle cleanser (Zoderm) for use in the morning plus an equivalent strength of either Zoderm gel or cream formulation for use in the evening.

Applications were made over a 4-week period. The investigators allowed patients to use additional acne medicines during the study, except for those that contained benzoyl peroxide.

Of the 1,089 patients, 963 completed the second visit of the study, Dr. Gold, a dermatologist with Tennessee Clinical Research Center, Nashville, noted in the text of the poster.

The investigators assessed inflammatory and noninflammatory lesion counts at baseline and at week 4. They rated dryness and erythema on a 0–8 scale in which 8 was defined as severe or deep.

Of the 963 patients, 551 used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy, 17 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral doxycycline, and 21 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral minocycline.

Dr. Gold reported that the 551 patients who used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy achieved a 44% mean reduction in total lesion count at week 4 vs. baseline.

The 17 patients who used this regimen plus oral doxycycline achieved a 52% mean reduction in their total lesion count at week 4 vs. baseline, whereas those patients who used concomitant oral minocycline achieved a 34% mean reduction in total lesion count at week 4 vs. baseline.

According to the poster, patients experienced little or no increase in skin dryness and a decrease in erythema.

The study was funded by a grant from Doak Dermatologics, a subsidiary of Bradley Pharmaceuticals Inc., makers of Zoderm.

The meeting was sponsored by the Center for Bio-Medical Communication Inc.

A female patient is shown here at baseline, before using a urea vehicle cleanser.

Clearance of acne is apparent in the same patient at 4 weeks' follow-up. Photos courtesy Dr. Michael H. Gold

LAS VEGAS — Treating acne with 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle once daily for 4 weeks was effective and well-tolerated, results from a large study demonstrated.

The finding underscores urea's role as an effective moisturizing agent, Michael H. Gold, M.D., reported during a poster session at the Fall Clinical Dermatology Conference.

In an open-label study that Dr. Gold led at 133 clinical sites, 1,089 men and women were prescribed 4.5% or 8.5% benzoyl peroxide in a 10% urea vehicle cleanser (Zoderm) for use in the morning plus an equivalent strength of either Zoderm gel or cream formulation for use in the evening.

Applications were made over a 4-week period. The investigators allowed patients to use additional acne medicines during the study, except for those that contained benzoyl peroxide.

Of the 1,089 patients, 963 completed the second visit of the study, Dr. Gold, a dermatologist with Tennessee Clinical Research Center, Nashville, noted in the text of the poster.

The investigators assessed inflammatory and noninflammatory lesion counts at baseline and at week 4. They rated dryness and erythema on a 0–8 scale in which 8 was defined as severe or deep.

Of the 963 patients, 551 used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy, 17 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral doxycycline, and 21 used 4.5% or 8.5% benzoyl peroxide in urea vehicle with oral minocycline.

Dr. Gold reported that the 551 patients who used 4.5% or 8.5% benzoyl peroxide in urea vehicle as monotherapy achieved a 44% mean reduction in total lesion count at week 4 vs. baseline.

The 17 patients who used this regimen plus oral doxycycline achieved a 52% mean reduction in their total lesion count at week 4 vs. baseline, whereas those patients who used concomitant oral minocycline achieved a 34% mean reduction in total lesion count at week 4 vs. baseline.

According to the poster, patients experienced little or no increase in skin dryness and a decrease in erythema.

The study was funded by a grant from Doak Dermatologics, a subsidiary of Bradley Pharmaceuticals Inc., makers of Zoderm.

The meeting was sponsored by the Center for Bio-Medical Communication Inc.

A female patient is shown here at baseline, before using a urea vehicle cleanser.

Clearance of acne is apparent in the same patient at 4 weeks' follow-up. Photos courtesy Dr. Michael H. Gold

SAN DIEGO — Thermal balloon endometrial ablation is a safe and effective option for the treatment of women with idiopathic menorrhagia, results from a 3-year study of 330 women have shown.

“The procedure is simple, does not require additional training in operative hysterectomy, and compares favorably with other ablative techniques,” Stefanos Chandakas, M.D., Ph.D., reported at an international congress of the Society of Laparoendoscopic Surgeons. “These good results, however, need to be confirmed in a randomized, controlled trial.”

He and his associates used a 6-mm diameter Cavaterm Plus thermoablation system in 330 women with a mean age of 42 years. All participants had experienced heavy menstrual bleeding, failed medical treatment for the condition, and otherwise would have required hysterectomy, endometrial laser ablation, or endometrial resection.

The outpatient procedures were performed from January 2001 to June 2004 at Princess Royal University Hospital and Farnborough Hospital, Orpington, England. Contraindications included undiagnosed uterine bleeding, pregnancy or the desire to become pregnant, atypical endometrial cells, cervical length greater than 6 mm, a uterine cavity less than 4 cm or greater than 10 cm, uterine wall weakness, and ongoing infection.

No endometrial preparation was used. Each ablation lasted 10 minutes at a temperature of 78° C. Follow-up occurred at intervals of 3, 6, 12, 24, and 36 months, for a mean of 22 months.

Nearly half of the participants (48%) were amenorrheic after 1 year, while the rates of amenorrhea were 39% and 38% after 2 and 3 years, respectively. (See chart.)

The majority of women (83%) reported a reduction in dysmenorrhea and premenstrual symptoms at 1 year, “which is a recognized and consistent finding following endometrial destructive procedures,” said Dr. Chandakas of the minimal access unit in the department of obstetrics and gynecology at Princess Royal.

At 3 years, 73% of women reported a reduction in dysmenorrhea and premenstrual symptoms. No balloons failed, and no major complications were noted.

Dr. Chandakas disclosed that he has no financial interest in Wallsten Medical, the Swiss manufacturer of Cavaterm Plus.

SAN DIEGO — Thermal balloon endometrial ablation is a safe and effective option for the treatment of women with idiopathic menorrhagia, results from a 3-year study of 330 women have shown.

“The procedure is simple, does not require additional training in operative hysterectomy, and compares favorably with other ablative techniques,” Stefanos Chandakas, M.D., Ph.D., reported at an international congress of the Society of Laparoendoscopic Surgeons. “These good results, however, need to be confirmed in a randomized, controlled trial.”

He and his associates used a 6-mm diameter Cavaterm Plus thermoablation system in 330 women with a mean age of 42 years. All participants had experienced heavy menstrual bleeding, failed medical treatment for the condition, and otherwise would have required hysterectomy, endometrial laser ablation, or endometrial resection.

The outpatient procedures were performed from January 2001 to June 2004 at Princess Royal University Hospital and Farnborough Hospital, Orpington, England. Contraindications included undiagnosed uterine bleeding, pregnancy or the desire to become pregnant, atypical endometrial cells, cervical length greater than 6 mm, a uterine cavity less than 4 cm or greater than 10 cm, uterine wall weakness, and ongoing infection.

No endometrial preparation was used. Each ablation lasted 10 minutes at a temperature of 78° C. Follow-up occurred at intervals of 3, 6, 12, 24, and 36 months, for a mean of 22 months.

Nearly half of the participants (48%) were amenorrheic after 1 year, while the rates of amenorrhea were 39% and 38% after 2 and 3 years, respectively. (See chart.)

The majority of women (83%) reported a reduction in dysmenorrhea and premenstrual symptoms at 1 year, “which is a recognized and consistent finding following endometrial destructive procedures,” said Dr. Chandakas of the minimal access unit in the department of obstetrics and gynecology at Princess Royal.

At 3 years, 73% of women reported a reduction in dysmenorrhea and premenstrual symptoms. No balloons failed, and no major complications were noted.

Dr. Chandakas disclosed that he has no financial interest in Wallsten Medical, the Swiss manufacturer of Cavaterm Plus.

SAN DIEGO — Thermal balloon endometrial ablation is a safe and effective option for the treatment of women with idiopathic menorrhagia, results from a 3-year study of 330 women have shown.

“The procedure is simple, does not require additional training in operative hysterectomy, and compares favorably with other ablative techniques,” Stefanos Chandakas, M.D., Ph.D., reported at an international congress of the Society of Laparoendoscopic Surgeons. “These good results, however, need to be confirmed in a randomized, controlled trial.”

He and his associates used a 6-mm diameter Cavaterm Plus thermoablation system in 330 women with a mean age of 42 years. All participants had experienced heavy menstrual bleeding, failed medical treatment for the condition, and otherwise would have required hysterectomy, endometrial laser ablation, or endometrial resection.

The outpatient procedures were performed from January 2001 to June 2004 at Princess Royal University Hospital and Farnborough Hospital, Orpington, England. Contraindications included undiagnosed uterine bleeding, pregnancy or the desire to become pregnant, atypical endometrial cells, cervical length greater than 6 mm, a uterine cavity less than 4 cm or greater than 10 cm, uterine wall weakness, and ongoing infection.

No endometrial preparation was used. Each ablation lasted 10 minutes at a temperature of 78° C. Follow-up occurred at intervals of 3, 6, 12, 24, and 36 months, for a mean of 22 months.

Nearly half of the participants (48%) were amenorrheic after 1 year, while the rates of amenorrhea were 39% and 38% after 2 and 3 years, respectively. (See chart.)

The majority of women (83%) reported a reduction in dysmenorrhea and premenstrual symptoms at 1 year, “which is a recognized and consistent finding following endometrial destructive procedures,” said Dr. Chandakas of the minimal access unit in the department of obstetrics and gynecology at Princess Royal.

At 3 years, 73% of women reported a reduction in dysmenorrhea and premenstrual symptoms. No balloons failed, and no major complications were noted.

Dr. Chandakas disclosed that he has no financial interest in Wallsten Medical, the Swiss manufacturer of Cavaterm Plus.

SAN DIEGO — Children with fetal alcohol spectrum disorders receive a wide variety of psychiatric diagnoses and medications, Julia Murray, M.D., reported in a poster presentation at the American Psychiatric Association's Institute on Psychiatric Services.

“Out in the community, people are trying to address the needs of these kids, but it looks as if [they] are being given all kinds of diagnoses. They have a full spectrum of psychiatric symptoms, and they're receiving a wide range of diagnoses and psychotropic medications,” said Dr. Murray, a psychiatrist at Odessa Brown Children's Clinic, Seattle.

As part of a study funded by the Centers for Disease Control and Prevention, Dr. Murray and associates reviewed medical charts of 50 children with fetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorders and behavioral problems who were enrolled in community-based therapeutic programs. The records covered about 18 months.

“It's been reported that kids with fetal alcohol spectrum disorders do have depression, bipolar syndromes, and psychosis syndromes, but there has been very little quantitative and qualitative description,” Dr. Murray said. “The literature primarily addresses an [attention-deficit hyperactivity disorder]-type behavioral syndrome and the use of stimulants. There's not much about treatment for any other diagnoses.”

The mean baseline age of participants was about 9 years. Of 50 children, 76% had received psychiatric diagnoses. Overall, 23 psychiatric conditions were found, including attention-deficit hyperactivity disorder (74%), learning disorders (26%), cognitive disorders (26%), disruptive behavior disorders (21%), and anxiety disorders (18%).

More than half (56%) had been prescribed a mean of 2.23 simultaneous medications, ranging from stimulants to atypical antipsychotics. Primary care clinicians were the most frequent prescribers (50%), followed by psychiatrists (42%), and both (8%). The study was limited because the investigators “didn't try to verify the diagnoses or look at the efficacy of the medications that we used,” Dr. Murray said.

SAN DIEGO — Children with fetal alcohol spectrum disorders receive a wide variety of psychiatric diagnoses and medications, Julia Murray, M.D., reported in a poster presentation at the American Psychiatric Association's Institute on Psychiatric Services.

“Out in the community, people are trying to address the needs of these kids, but it looks as if [they] are being given all kinds of diagnoses. They have a full spectrum of psychiatric symptoms, and they're receiving a wide range of diagnoses and psychotropic medications,” said Dr. Murray, a psychiatrist at Odessa Brown Children's Clinic, Seattle.

As part of a study funded by the Centers for Disease Control and Prevention, Dr. Murray and associates reviewed medical charts of 50 children with fetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorders and behavioral problems who were enrolled in community-based therapeutic programs. The records covered about 18 months.

“It's been reported that kids with fetal alcohol spectrum disorders do have depression, bipolar syndromes, and psychosis syndromes, but there has been very little quantitative and qualitative description,” Dr. Murray said. “The literature primarily addresses an [attention-deficit hyperactivity disorder]-type behavioral syndrome and the use of stimulants. There's not much about treatment for any other diagnoses.”

The mean baseline age of participants was about 9 years. Of 50 children, 76% had received psychiatric diagnoses. Overall, 23 psychiatric conditions were found, including attention-deficit hyperactivity disorder (74%), learning disorders (26%), cognitive disorders (26%), disruptive behavior disorders (21%), and anxiety disorders (18%).

More than half (56%) had been prescribed a mean of 2.23 simultaneous medications, ranging from stimulants to atypical antipsychotics. Primary care clinicians were the most frequent prescribers (50%), followed by psychiatrists (42%), and both (8%). The study was limited because the investigators “didn't try to verify the diagnoses or look at the efficacy of the medications that we used,” Dr. Murray said.

SAN DIEGO — Children with fetal alcohol spectrum disorders receive a wide variety of psychiatric diagnoses and medications, Julia Murray, M.D., reported in a poster presentation at the American Psychiatric Association's Institute on Psychiatric Services.

“Out in the community, people are trying to address the needs of these kids, but it looks as if [they] are being given all kinds of diagnoses. They have a full spectrum of psychiatric symptoms, and they're receiving a wide range of diagnoses and psychotropic medications,” said Dr. Murray, a psychiatrist at Odessa Brown Children's Clinic, Seattle.

As part of a study funded by the Centers for Disease Control and Prevention, Dr. Murray and associates reviewed medical charts of 50 children with fetal alcohol spectrum disorders or alcohol-related neurodevelopmental disorders and behavioral problems who were enrolled in community-based therapeutic programs. The records covered about 18 months.

“It's been reported that kids with fetal alcohol spectrum disorders do have depression, bipolar syndromes, and psychosis syndromes, but there has been very little quantitative and qualitative description,” Dr. Murray said. “The literature primarily addresses an [attention-deficit hyperactivity disorder]-type behavioral syndrome and the use of stimulants. There's not much about treatment for any other diagnoses.”

The mean baseline age of participants was about 9 years. Of 50 children, 76% had received psychiatric diagnoses. Overall, 23 psychiatric conditions were found, including attention-deficit hyperactivity disorder (74%), learning disorders (26%), cognitive disorders (26%), disruptive behavior disorders (21%), and anxiety disorders (18%).

More than half (56%) had been prescribed a mean of 2.23 simultaneous medications, ranging from stimulants to atypical antipsychotics. Primary care clinicians were the most frequent prescribers (50%), followed by psychiatrists (42%), and both (8%). The study was limited because the investigators “didn't try to verify the diagnoses or look at the efficacy of the medications that we used,” Dr. Murray said.

YOSEMITE, CALIF. — Some parents of children with Tourette's syndrome hesitate to put them on a class II stimulant for attention deficit disorder.

Speaking at a pediatric conference sponsored by Symposia Medicus, Robert S. McKelvey, M.D., noted: “When I was in training, if you had tics, you had a history of tics, or even a family history of tics, we didn't start you on stimulant medication,” he said.

“Now there are a couple of studies that show that if you have tics and you take stimulants, it's probably OK as long as the tics don't worsen. In many cases, the tics seem to [decrease in severity].”

Drug preparations in the stimulant class are derived from methylphenidate or dextroamphetamine. Methylphenidate is more widely used in the United States, but Dr. McKelvey noted that both agents are equally effective.

A key point to remember about both agents is that they have very short half-lives. Maximal benefit on behavior occurs in 1–2 hours for agents derived from methylphenidate and 3–4 hours for agents derived from dextroamphetamine.

The sustained-release formulations appear to be as effective as the standard short-term formulations. The doses vary with the individual. There is some thought that academic performance (such as that associated with inattention) may respond to a lower dose than do restlessness and impulsivity, he said.

New, long-acting preparations enable once-daily dosing. These include Concerta, Metadate CD, Adderall XR, MethyPatch, and Focalin.

The most common adverse effect of stimulants is decreased appetite, which occurs in about 80% of children who take them. “The decreased appetite and weight loss can be stunning in some kids,” he remarked. “I've seen some very skeletal-looking little boys, and it can make you quite nervous.”

Long-term stimulant use may result in about a 1-cm decrease in height per year during the first 3 years of use, “but some of that is caught up,” Dr. McKelvey said. “More recent studies suggest there is perhaps a 1-cm decrease [in height] overall if you take stimulants long term.”

Insomnia is another common side effect, “so you tend to give it earlier in the day. You have to monitor heart and blood pressure.

“The things you're monitoring are height, weight, and blood pressure. It's pretty straightforward, but yearly, I usually check the white blood cell count,” Dr. McKelvey said.

YOSEMITE, CALIF. — Some parents of children with Tourette's syndrome hesitate to put them on a class II stimulant for attention deficit disorder.

Speaking at a pediatric conference sponsored by Symposia Medicus, Robert S. McKelvey, M.D., noted: “When I was in training, if you had tics, you had a history of tics, or even a family history of tics, we didn't start you on stimulant medication,” he said.

“Now there are a couple of studies that show that if you have tics and you take stimulants, it's probably OK as long as the tics don't worsen. In many cases, the tics seem to [decrease in severity].”

Drug preparations in the stimulant class are derived from methylphenidate or dextroamphetamine. Methylphenidate is more widely used in the United States, but Dr. McKelvey noted that both agents are equally effective.

A key point to remember about both agents is that they have very short half-lives. Maximal benefit on behavior occurs in 1–2 hours for agents derived from methylphenidate and 3–4 hours for agents derived from dextroamphetamine.

The sustained-release formulations appear to be as effective as the standard short-term formulations. The doses vary with the individual. There is some thought that academic performance (such as that associated with inattention) may respond to a lower dose than do restlessness and impulsivity, he said.

New, long-acting preparations enable once-daily dosing. These include Concerta, Metadate CD, Adderall XR, MethyPatch, and Focalin.

The most common adverse effect of stimulants is decreased appetite, which occurs in about 80% of children who take them. “The decreased appetite and weight loss can be stunning in some kids,” he remarked. “I've seen some very skeletal-looking little boys, and it can make you quite nervous.”

Long-term stimulant use may result in about a 1-cm decrease in height per year during the first 3 years of use, “but some of that is caught up,” Dr. McKelvey said. “More recent studies suggest there is perhaps a 1-cm decrease [in height] overall if you take stimulants long term.”

Insomnia is another common side effect, “so you tend to give it earlier in the day. You have to monitor heart and blood pressure.

“The things you're monitoring are height, weight, and blood pressure. It's pretty straightforward, but yearly, I usually check the white blood cell count,” Dr. McKelvey said.

YOSEMITE, CALIF. — Some parents of children with Tourette's syndrome hesitate to put them on a class II stimulant for attention deficit disorder.

Speaking at a pediatric conference sponsored by Symposia Medicus, Robert S. McKelvey, M.D., noted: “When I was in training, if you had tics, you had a history of tics, or even a family history of tics, we didn't start you on stimulant medication,” he said.

“Now there are a couple of studies that show that if you have tics and you take stimulants, it's probably OK as long as the tics don't worsen. In many cases, the tics seem to [decrease in severity].”

Drug preparations in the stimulant class are derived from methylphenidate or dextroamphetamine. Methylphenidate is more widely used in the United States, but Dr. McKelvey noted that both agents are equally effective.

A key point to remember about both agents is that they have very short half-lives. Maximal benefit on behavior occurs in 1–2 hours for agents derived from methylphenidate and 3–4 hours for agents derived from dextroamphetamine.

The sustained-release formulations appear to be as effective as the standard short-term formulations. The doses vary with the individual. There is some thought that academic performance (such as that associated with inattention) may respond to a lower dose than do restlessness and impulsivity, he said.

New, long-acting preparations enable once-daily dosing. These include Concerta, Metadate CD, Adderall XR, MethyPatch, and Focalin.

The most common adverse effect of stimulants is decreased appetite, which occurs in about 80% of children who take them. “The decreased appetite and weight loss can be stunning in some kids,” he remarked. “I've seen some very skeletal-looking little boys, and it can make you quite nervous.”

Long-term stimulant use may result in about a 1-cm decrease in height per year during the first 3 years of use, “but some of that is caught up,” Dr. McKelvey said. “More recent studies suggest there is perhaps a 1-cm decrease [in height] overall if you take stimulants long term.”

Insomnia is another common side effect, “so you tend to give it earlier in the day. You have to monitor heart and blood pressure.

“The things you're monitoring are height, weight, and blood pressure. It's pretty straightforward, but yearly, I usually check the white blood cell count,” Dr. McKelvey said.

A 900-mg daily dose of gabapentin was associated with significant decreases in hot flash severity and frequency, but a 300-mg daily dose of the drug was not, results from a randomized, double-blind, placebo-controlled trial have found.

“We believe gabapentin can be added to the list of nonhormonal agents for the control of hot flashes in women with breast cancer, and the effects of doses higher than 900 mg/day merit further study,” wrote the investigators, led by Kishan J. Pandya, M.D., of the University of Rochester (N.Y.).

In a study funded by the National Cancer Institute, he and his associates randomized 420 women with a mean age of 55 years to receive placebo, 300 mg/day of gabapentin, or 900 mg/day of gabapentin.

The women, the majority of whom were white, were enrolled at 18 different sites of the university's community clinical oncology program. They recorded the severity level of hot flashes and 10 other symptoms in a 1-week self-report diary at baseline and during the fourth and eighth weeks of treatment (Lancet 2005;366:818–24).

Posttreatment analysis revealed that the reduction in hot flash severity score was only 15% for those in the placebo group, compared with 31% for those in the 300-mg/day gabapentin group and 46% for those in the 900-mg/day gabapentin group. The differences between groups were statistically significant, but only the 900- mg/day dose of gabapentin was associated with significant decreases in hot flash frequency and severity.

No differences were observed among the three treatment groups with respect to the 10 other symptoms, suggesting that gabapentin was well tolerated.

“Our study was designed to test the intervention for 8 weeks; therefore, we cannot comment on long-term use of gabapentin,” the investigators wrote.

While the drug's mechanism of action in the reduction of hot flashes in women with breast cancer remains unclear, the investigators speculate that “upregulation of the gabapentin binding site could be involved in the hypothalamus as a result of estrogen withdrawal, leading to increased activity of the neurotransmitters in the hypothalamus.”

Gabapentin is approved for the treatment of epileptic seizures but it is also used for the treatment of migraines, restless legs syndrome, and bipolar disorder.

Pfizer Inc. provided the gabapentin and placebo used in the study.

A 900-mg daily dose of gabapentin was associated with significant decreases in hot flash severity and frequency, but a 300-mg daily dose of the drug was not, results from a randomized, double-blind, placebo-controlled trial have found.

“We believe gabapentin can be added to the list of nonhormonal agents for the control of hot flashes in women with breast cancer, and the effects of doses higher than 900 mg/day merit further study,” wrote the investigators, led by Kishan J. Pandya, M.D., of the University of Rochester (N.Y.).

In a study funded by the National Cancer Institute, he and his associates randomized 420 women with a mean age of 55 years to receive placebo, 300 mg/day of gabapentin, or 900 mg/day of gabapentin.

The women, the majority of whom were white, were enrolled at 18 different sites of the university's community clinical oncology program. They recorded the severity level of hot flashes and 10 other symptoms in a 1-week self-report diary at baseline and during the fourth and eighth weeks of treatment (Lancet 2005;366:818–24).

Posttreatment analysis revealed that the reduction in hot flash severity score was only 15% for those in the placebo group, compared with 31% for those in the 300-mg/day gabapentin group and 46% for those in the 900-mg/day gabapentin group. The differences between groups were statistically significant, but only the 900- mg/day dose of gabapentin was associated with significant decreases in hot flash frequency and severity.

No differences were observed among the three treatment groups with respect to the 10 other symptoms, suggesting that gabapentin was well tolerated.

“Our study was designed to test the intervention for 8 weeks; therefore, we cannot comment on long-term use of gabapentin,” the investigators wrote.

While the drug's mechanism of action in the reduction of hot flashes in women with breast cancer remains unclear, the investigators speculate that “upregulation of the gabapentin binding site could be involved in the hypothalamus as a result of estrogen withdrawal, leading to increased activity of the neurotransmitters in the hypothalamus.”

Gabapentin is approved for the treatment of epileptic seizures but it is also used for the treatment of migraines, restless legs syndrome, and bipolar disorder.

Pfizer Inc. provided the gabapentin and placebo used in the study.

A 900-mg daily dose of gabapentin was associated with significant decreases in hot flash severity and frequency, but a 300-mg daily dose of the drug was not, results from a randomized, double-blind, placebo-controlled trial have found.

“We believe gabapentin can be added to the list of nonhormonal agents for the control of hot flashes in women with breast cancer, and the effects of doses higher than 900 mg/day merit further study,” wrote the investigators, led by Kishan J. Pandya, M.D., of the University of Rochester (N.Y.).

In a study funded by the National Cancer Institute, he and his associates randomized 420 women with a mean age of 55 years to receive placebo, 300 mg/day of gabapentin, or 900 mg/day of gabapentin.

The women, the majority of whom were white, were enrolled at 18 different sites of the university's community clinical oncology program. They recorded the severity level of hot flashes and 10 other symptoms in a 1-week self-report diary at baseline and during the fourth and eighth weeks of treatment (Lancet 2005;366:818–24).

Posttreatment analysis revealed that the reduction in hot flash severity score was only 15% for those in the placebo group, compared with 31% for those in the 300-mg/day gabapentin group and 46% for those in the 900-mg/day gabapentin group. The differences between groups were statistically significant, but only the 900- mg/day dose of gabapentin was associated with significant decreases in hot flash frequency and severity.

No differences were observed among the three treatment groups with respect to the 10 other symptoms, suggesting that gabapentin was well tolerated.

“Our study was designed to test the intervention for 8 weeks; therefore, we cannot comment on long-term use of gabapentin,” the investigators wrote.

While the drug's mechanism of action in the reduction of hot flashes in women with breast cancer remains unclear, the investigators speculate that “upregulation of the gabapentin binding site could be involved in the hypothalamus as a result of estrogen withdrawal, leading to increased activity of the neurotransmitters in the hypothalamus.”

Gabapentin is approved for the treatment of epileptic seizures but it is also used for the treatment of migraines, restless legs syndrome, and bipolar disorder.

Pfizer Inc. provided the gabapentin and placebo used in the study.

SAN DIEGO — There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones, of the M.I.N.D. Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” she said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups.

“We are also going to measure parent head circumference so we can see correlation with child head circumference,” she said.

SAN DIEGO — There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones, of the M.I.N.D. Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” she said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups.

“We are also going to measure parent head circumference so we can see correlation with child head circumference,” she said.

SAN DIEGO — There appear to be no differences in the mean head circumference between children with and without autism, results from a population-based case-control study show.

The finding differs from other smaller studies that have reported increased rates of macrocephaly in autistic children, Carrie Jones, M.D., said at the annual meeting of the Society for Developmental and Behavioral Pediatrics.

Those studies have proposed that accelerated brain growth in the first years of life is an early biologic marker for a subgroup of children with autism, “but the results are based on very small groups of children, and they may or may not be representative of the general population of kids with autism,” said Dr. Jones, of the M.I.N.D. Institute at the University of California, Davis. “Also, they have rarely been correlated with other growth parameters such as weight and height, [and] they rarely have been paired with children from the same population.”

For the study, known as Childhood Autism Risks from Genetics and the Environment (CHARGE), Dr. Jones and her associates recruited 175 children with autism aged 2–5 years through six centers that provide developmental disability services to children and adults in Northern and Southern California. Diagnoses were confirmed with the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observational Schedule.

The investigators used birth records to identify 43 control children from the general population who were matched to the case population for age, gender, and geographic location.

All study participants received a medical exam that included measurement of head circumference, weight, and height. All parameters were plotted by age and gender on National Health and Nutrition Examination Survey III growth charts.

Dr. Jones and her associates found that the mean head circumference of both cases and controls was at the 59th percentile. About 12% of both cases and controls were at or above the 95th percentile, which was higher than expected.

“In linear regression models, the strongest predictor of head circumference was weight,” she said. “The heavier kids tended to have bigger heads, but autism vs. general population group membership did not predict head circumference.”

The next steps in the study are to examine earlier growth parameters from medical records for trajectories over time in both groups.

“We are also going to measure parent head circumference so we can see correlation with child head circumference,” she said.

SAN DIEGO — A specific warning issued in June 2003 by the United Kingdom Committee on Safety of Medicines that advised physicians not to use paroxetine in patients younger than 18 years of age significantly influenced how the drug was prescribed in young patients in Ontario.

Yet subsequent, more generalized warnings about selective serotonin reuptake inhibitors (SSRIs) issued in the United States and Canada did not influence antidepressant prescription trends in any age group of Ontario residents, Paul A. Kurdyak, M.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“From a policy perspective, vague warnings don't do anything in Ontario,” Dr. Kurdyak, a research fellow in the department of psychiatry at the University of Toronto, said in an interview. “I don't know about the United States. It might be different there because you're more litigious here than we [in Canada] are.”

In a study supported by AstraZeneca Pharmaceuticals and the Canadian Institute of Health Research, Dr. Kurdyak and his associates analyzed new antidepressant prescriptions dispensed by the Ontario Drug Benefits Program between April 1998 and March 2005. Three age groups were studied: younger than 20 years, 20–65 years, and 66 years and older.

The investigators conducted a time-series analysis to assess the impact of five advisory dates on the prescription of antidepressants. Those dates were:

▸ June 10, 2003. The UK Committee on the Safety of Medicine advises against the use of paroxetine in patients with depression younger than 18 years of age.

▸ Oct. 27, 2003. The U.S. Food and Drug Administration issues a more general public health advisory emphasizing that newer antidepressants should be used with caution in pediatric patients.

▸ March 22, 2004. The FDA issues a public health advisory about the need to closely monitor patients of all ages for worsening depression or suicidality after initiation of antidepressant therapy.

▸ June 3, 2004. Health Care Canada follows suit with a similar warning.

▸ Oct. 15, 2004. The FDA issues a black box warning for the use of antidepressants in pediatric patients.

Analysis revealed that the mean number of monthly new prescriptions for any SSRI per 10,000 individuals was 5.5 for patients younger than 20 years; 29.7 for patients aged 20–65 years, and 16.4 for patients aged 66 years and older.

“The number of new prescriptions for SSRIs as a group did not change after any antidepressant warning in any age group,” the investigators wrote in the text of their poster.

“However, the rate of new paroxetine prescriptions in patients younger than 20 years of age declined by 54% immediately following the first UK warning for paroxetine in June 2003.”

That particular warning “had no effect on new paroxetine prescriptions in the other age categories, [and] no warnings influenced new prescription rates for any other antidepressants in any other age group,” they added.

SAN DIEGO — A specific warning issued in June 2003 by the United Kingdom Committee on Safety of Medicines that advised physicians not to use paroxetine in patients younger than 18 years of age significantly influenced how the drug was prescribed in young patients in Ontario.

Yet subsequent, more generalized warnings about selective serotonin reuptake inhibitors (SSRIs) issued in the United States and Canada did not influence antidepressant prescription trends in any age group of Ontario residents, Paul A. Kurdyak, M.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“From a policy perspective, vague warnings don't do anything in Ontario,” Dr. Kurdyak, a research fellow in the department of psychiatry at the University of Toronto, said in an interview. “I don't know about the United States. It might be different there because you're more litigious here than we [in Canada] are.”

In a study supported by AstraZeneca Pharmaceuticals and the Canadian Institute of Health Research, Dr. Kurdyak and his associates analyzed new antidepressant prescriptions dispensed by the Ontario Drug Benefits Program between April 1998 and March 2005. Three age groups were studied: younger than 20 years, 20–65 years, and 66 years and older.

The investigators conducted a time-series analysis to assess the impact of five advisory dates on the prescription of antidepressants. Those dates were:

▸ June 10, 2003. The UK Committee on the Safety of Medicine advises against the use of paroxetine in patients with depression younger than 18 years of age.

▸ Oct. 27, 2003. The U.S. Food and Drug Administration issues a more general public health advisory emphasizing that newer antidepressants should be used with caution in pediatric patients.

▸ March 22, 2004. The FDA issues a public health advisory about the need to closely monitor patients of all ages for worsening depression or suicidality after initiation of antidepressant therapy.

▸ June 3, 2004. Health Care Canada follows suit with a similar warning.

▸ Oct. 15, 2004. The FDA issues a black box warning for the use of antidepressants in pediatric patients.

Analysis revealed that the mean number of monthly new prescriptions for any SSRI per 10,000 individuals was 5.5 for patients younger than 20 years; 29.7 for patients aged 20–65 years, and 16.4 for patients aged 66 years and older.

“The number of new prescriptions for SSRIs as a group did not change after any antidepressant warning in any age group,” the investigators wrote in the text of their poster.

“However, the rate of new paroxetine prescriptions in patients younger than 20 years of age declined by 54% immediately following the first UK warning for paroxetine in June 2003.”

That particular warning “had no effect on new paroxetine prescriptions in the other age categories, [and] no warnings influenced new prescription rates for any other antidepressants in any other age group,” they added.

SAN DIEGO — A specific warning issued in June 2003 by the United Kingdom Committee on Safety of Medicines that advised physicians not to use paroxetine in patients younger than 18 years of age significantly influenced how the drug was prescribed in young patients in Ontario.

Yet subsequent, more generalized warnings about selective serotonin reuptake inhibitors (SSRIs) issued in the United States and Canada did not influence antidepressant prescription trends in any age group of Ontario residents, Paul A. Kurdyak, M.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“From a policy perspective, vague warnings don't do anything in Ontario,” Dr. Kurdyak, a research fellow in the department of psychiatry at the University of Toronto, said in an interview. “I don't know about the United States. It might be different there because you're more litigious here than we [in Canada] are.”

In a study supported by AstraZeneca Pharmaceuticals and the Canadian Institute of Health Research, Dr. Kurdyak and his associates analyzed new antidepressant prescriptions dispensed by the Ontario Drug Benefits Program between April 1998 and March 2005. Three age groups were studied: younger than 20 years, 20–65 years, and 66 years and older.

The investigators conducted a time-series analysis to assess the impact of five advisory dates on the prescription of antidepressants. Those dates were:

▸ June 10, 2003. The UK Committee on the Safety of Medicine advises against the use of paroxetine in patients with depression younger than 18 years of age.

▸ Oct. 27, 2003. The U.S. Food and Drug Administration issues a more general public health advisory emphasizing that newer antidepressants should be used with caution in pediatric patients.

▸ March 22, 2004. The FDA issues a public health advisory about the need to closely monitor patients of all ages for worsening depression or suicidality after initiation of antidepressant therapy.

▸ June 3, 2004. Health Care Canada follows suit with a similar warning.

▸ Oct. 15, 2004. The FDA issues a black box warning for the use of antidepressants in pediatric patients.

Analysis revealed that the mean number of monthly new prescriptions for any SSRI per 10,000 individuals was 5.5 for patients younger than 20 years; 29.7 for patients aged 20–65 years, and 16.4 for patients aged 66 years and older.

“The number of new prescriptions for SSRIs as a group did not change after any antidepressant warning in any age group,” the investigators wrote in the text of their poster.

“However, the rate of new paroxetine prescriptions in patients younger than 20 years of age declined by 54% immediately following the first UK warning for paroxetine in June 2003.”

That particular warning “had no effect on new paroxetine prescriptions in the other age categories, [and] no warnings influenced new prescription rates for any other antidepressants in any other age group,” they added.

SAN DIEGO — Two previous baclofen pumps had performed in the young patient without incident, Jonathan Dyer, M.D., reported at the annual meeting of the Society for Pediatric Dermatology.

The rash that developed after the implantation of the third pump was nontender and nonpruritic.

Histopathology showed peri-vascular inflammatory infiltrate of lymphocytes, histiocytes, and a few sparse neutrophils. The initial interpretation suggested resolving cellulitis.

“However, when we brought up the possibility of reticular telangiectatic erythema, we thought it was very consistent if not identical to the histopathology report of this condition in the literature,” said Dr. Dyer of the department of dermatology at the University of Missouri-Columbia.

He and his associate, Stacia Miles, M.D., patch-tested all of the pump's components; the tests came out negative. They also performed two 4-mm punch biopsies that were also negative.

However, a previous culture from the access port of the pump was positive for methicillin-resistant Staphylococcus epidermis (MRSE), so the boy was treated with 3 weeks of intravenous vancomycin. The rash gradually faded over a 6-week period.

Dr. Dyer said that reticular telangiectatic erythema was first described in 1981 overlying an implanted pacemaker.

“There have been about 14 cases described since,” he said. “It was thought to be innate to implantable cardioverter defibrillators or pacemakers. However, this year there was a description of the condition developing after implantation of a similar intrathecal pump” (Arch. Dermatol. 2005;141:106–7).

The exact cause of reticular telangiectatic erythema remains unclear. Possible etiologies suggested over the years include abnormal microcirculation in the area of the implanted pump, allergic contact dermatitis to pump components, irritation, electromagnetic radiation, and infection.

The favored hypothesis attributes the rash to alterations in the normal cutaneous anatomy induced by the implanted devices.

“Current thinking on reticular telangiectatic erythema is that it is not necessary to remove these pumps, but I think the issue of infection requires some consideration,” Dr. Dyer noted.

“In our case [the rash] did seem to get better after treatment for MRSE. While reticular telangiectatic erythema does not necessarily require removal of the device, I think you have to make sure that there's not some type of infection going on in these cases,” he reported.

SAN DIEGO — Two previous baclofen pumps had performed in the young patient without incident, Jonathan Dyer, M.D., reported at the annual meeting of the Society for Pediatric Dermatology.

The rash that developed after the implantation of the third pump was nontender and nonpruritic.

Histopathology showed peri-vascular inflammatory infiltrate of lymphocytes, histiocytes, and a few sparse neutrophils. The initial interpretation suggested resolving cellulitis.

“However, when we brought up the possibility of reticular telangiectatic erythema, we thought it was very consistent if not identical to the histopathology report of this condition in the literature,” said Dr. Dyer of the department of dermatology at the University of Missouri-Columbia.

He and his associate, Stacia Miles, M.D., patch-tested all of the pump's components; the tests came out negative. They also performed two 4-mm punch biopsies that were also negative.

However, a previous culture from the access port of the pump was positive for methicillin-resistant Staphylococcus epidermis (MRSE), so the boy was treated with 3 weeks of intravenous vancomycin. The rash gradually faded over a 6-week period.

Dr. Dyer said that reticular telangiectatic erythema was first described in 1981 overlying an implanted pacemaker.

“There have been about 14 cases described since,” he said. “It was thought to be innate to implantable cardioverter defibrillators or pacemakers. However, this year there was a description of the condition developing after implantation of a similar intrathecal pump” (Arch. Dermatol. 2005;141:106–7).

The exact cause of reticular telangiectatic erythema remains unclear. Possible etiologies suggested over the years include abnormal microcirculation in the area of the implanted pump, allergic contact dermatitis to pump components, irritation, electromagnetic radiation, and infection.

The favored hypothesis attributes the rash to alterations in the normal cutaneous anatomy induced by the implanted devices.

“Current thinking on reticular telangiectatic erythema is that it is not necessary to remove these pumps, but I think the issue of infection requires some consideration,” Dr. Dyer noted.

“In our case [the rash] did seem to get better after treatment for MRSE. While reticular telangiectatic erythema does not necessarily require removal of the device, I think you have to make sure that there's not some type of infection going on in these cases,” he reported.

SAN DIEGO — Two previous baclofen pumps had performed in the young patient without incident, Jonathan Dyer, M.D., reported at the annual meeting of the Society for Pediatric Dermatology.

The rash that developed after the implantation of the third pump was nontender and nonpruritic.

Histopathology showed peri-vascular inflammatory infiltrate of lymphocytes, histiocytes, and a few sparse neutrophils. The initial interpretation suggested resolving cellulitis.

“However, when we brought up the possibility of reticular telangiectatic erythema, we thought it was very consistent if not identical to the histopathology report of this condition in the literature,” said Dr. Dyer of the department of dermatology at the University of Missouri-Columbia.

He and his associate, Stacia Miles, M.D., patch-tested all of the pump's components; the tests came out negative. They also performed two 4-mm punch biopsies that were also negative.

However, a previous culture from the access port of the pump was positive for methicillin-resistant Staphylococcus epidermis (MRSE), so the boy was treated with 3 weeks of intravenous vancomycin. The rash gradually faded over a 6-week period.

Dr. Dyer said that reticular telangiectatic erythema was first described in 1981 overlying an implanted pacemaker.

“There have been about 14 cases described since,” he said. “It was thought to be innate to implantable cardioverter defibrillators or pacemakers. However, this year there was a description of the condition developing after implantation of a similar intrathecal pump” (Arch. Dermatol. 2005;141:106–7).

The exact cause of reticular telangiectatic erythema remains unclear. Possible etiologies suggested over the years include abnormal microcirculation in the area of the implanted pump, allergic contact dermatitis to pump components, irritation, electromagnetic radiation, and infection.

The favored hypothesis attributes the rash to alterations in the normal cutaneous anatomy induced by the implanted devices.

“Current thinking on reticular telangiectatic erythema is that it is not necessary to remove these pumps, but I think the issue of infection requires some consideration,” Dr. Dyer noted.

“In our case [the rash] did seem to get better after treatment for MRSE. While reticular telangiectatic erythema does not necessarily require removal of the device, I think you have to make sure that there's not some type of infection going on in these cases,” he reported.

LAS VEGAS — When rosacea overlaps with another skin disease, certain topical treatments are better than others, Guy F. Webster, M.D., said at the Fall Clinical Dermatology Conference.

“I'm finding there are subsets of topical treatments that are good for subsets of disease,” said Dr. Webster of the department of dermatology at Jefferson Medical College, Philadelphia. “There's a new 1% metronidazole out that's a little stronger, and the topical immunomodulators are useful when someone has rosacea plus seborrheic dermatitis, or [for] someone with atopic dermatitis plus seborrheic dermatitis.”

Another subset of rosacea patients he described are those who had severe acne as teenagers. “They've often been through Accutane [isotretinoin], and then they're in their mid to late 20s, and they start getting rosacea,” he explained at the conference, sponsored by the Center for Bio-Medical Communication Inc. “With them I find the benzoyl peroxide/clindamycin mixtures are often very effective.”

Azelaic acid and sodium sulfacetamide/sulfur have a role in rosacea treatment, he noted, but sodium sulfacetamide/sulfur “isn't quite as strong as the other topicals.”

He added that evidence to support the use of tretinoin for rosacea is in the realm of speculation. Studies of fair-skinned people who live in areas of high sun exposure make him wonder if what the investigators really observed were improvements in sun damage and not rosacea. “But it's clear that if you're patient enough in a person like that, you can get some aspects of their rosacea to improve with tretinoin,” Dr. Webster said.

He credited the efficacy of metronidazole 1% to not only a boost in drug concentration from the 0.75% form, but to the fact that the agent is contained in a modern vehicle.

“Many of the drugs we have are [contained in] old-fashioned vehicles that were formulated 15–20 years ago, even though maybe they've only been approved for 5–10 years,” Dr. Webster said at the conference.

“A lot has gone on in vehicle technology since then. This is a new, modern vehicle, and it optimizes the health of the skin.”

As for oral rosacea therapy, effective options include tetracycline, doxycycline, and minocycline, which are antibacterial and anti-inflammatory.

Cipro (ciprofloxacin) and Bactrim (trimethoprim/sulfamethoxazole) both work, “but there's a worry with giving people long-term antibiotic treatment for a disease that is chronic,” he noted.

“You worry about generating resistance to bacteria and making other infections harder to treat. We should get patients as clear as we can with an oral antibiotic and then try to get them onto something that's either nonantibiotic or topical.”

Dr. Webster said that isotretinoin is not as “magic” for rosacea as it is for acne. “It's better for nodules than a lot of other drugs for rosacea, but it doesn't work as quickly as you would expect. I'd save it for a situation where all else fails.”

Other drugs that he finds “occasionally effective” include β-blockers and selective serotonin reuptake inhibitors. β-Blockers “will sometime make a patient who is 'flushy' and 'blushy' and a little bit agitated have less flushing and blushing, but it's not as magical as you'd hope,” he remarked.

“Sometimes patients who are anxious in general benefit from an SSRI. They're a fairly big part of my practice. I use them for acne patients and agitated rosacea folks, and eczema patients.”

One promising new treatment for rosacea is topical dapsone gel. “I think it will probably be better for rosacea than it will be for acne, but there's a problem,” he said.

“The [Food and Drug Administration] is insistent on having blood tests because they're worried about the risk of hemolysis. I'm wondering at this point if we'll ever see the product. But if it comes out I think it will be useful effects for rosacea because of its anti-inflammatory activity.”

Another new therapy is anti-inflammatory-dose doxycycline. Doxycycline can be given in a dose so low “that it doesn't change the oral flora or GI flora, but it still has a lot of the anti-inflammatory activity,” Dr. Webster said.

Even more promising in the future, he added, is a drug called incyclinide, “which is a chemically modified doxycycline that has no antibiotic activity but whopping anti-inflammatory activity. This drug is real promising.”

LAS VEGAS — When rosacea overlaps with another skin disease, certain topical treatments are better than others, Guy F. Webster, M.D., said at the Fall Clinical Dermatology Conference.

“I'm finding there are subsets of topical treatments that are good for subsets of disease,” said Dr. Webster of the department of dermatology at Jefferson Medical College, Philadelphia. “There's a new 1% metronidazole out that's a little stronger, and the topical immunomodulators are useful when someone has rosacea plus seborrheic dermatitis, or [for] someone with atopic dermatitis plus seborrheic dermatitis.”

Another subset of rosacea patients he described are those who had severe acne as teenagers. “They've often been through Accutane [isotretinoin], and then they're in their mid to late 20s, and they start getting rosacea,” he explained at the conference, sponsored by the Center for Bio-Medical Communication Inc. “With them I find the benzoyl peroxide/clindamycin mixtures are often very effective.”

Azelaic acid and sodium sulfacetamide/sulfur have a role in rosacea treatment, he noted, but sodium sulfacetamide/sulfur “isn't quite as strong as the other topicals.”

He added that evidence to support the use of tretinoin for rosacea is in the realm of speculation. Studies of fair-skinned people who live in areas of high sun exposure make him wonder if what the investigators really observed were improvements in sun damage and not rosacea. “But it's clear that if you're patient enough in a person like that, you can get some aspects of their rosacea to improve with tretinoin,” Dr. Webster said.

He credited the efficacy of metronidazole 1% to not only a boost in drug concentration from the 0.75% form, but to the fact that the agent is contained in a modern vehicle.

“Many of the drugs we have are [contained in] old-fashioned vehicles that were formulated 15–20 years ago, even though maybe they've only been approved for 5–10 years,” Dr. Webster said at the conference.

“A lot has gone on in vehicle technology since then. This is a new, modern vehicle, and it optimizes the health of the skin.”

As for oral rosacea therapy, effective options include tetracycline, doxycycline, and minocycline, which are antibacterial and anti-inflammatory.

Cipro (ciprofloxacin) and Bactrim (trimethoprim/sulfamethoxazole) both work, “but there's a worry with giving people long-term antibiotic treatment for a disease that is chronic,” he noted.

“You worry about generating resistance to bacteria and making other infections harder to treat. We should get patients as clear as we can with an oral antibiotic and then try to get them onto something that's either nonantibiotic or topical.”

Dr. Webster said that isotretinoin is not as “magic” for rosacea as it is for acne. “It's better for nodules than a lot of other drugs for rosacea, but it doesn't work as quickly as you would expect. I'd save it for a situation where all else fails.”

Other drugs that he finds “occasionally effective” include β-blockers and selective serotonin reuptake inhibitors. β-Blockers “will sometime make a patient who is 'flushy' and 'blushy' and a little bit agitated have less flushing and blushing, but it's not as magical as you'd hope,” he remarked.

“Sometimes patients who are anxious in general benefit from an SSRI. They're a fairly big part of my practice. I use them for acne patients and agitated rosacea folks, and eczema patients.”

One promising new treatment for rosacea is topical dapsone gel. “I think it will probably be better for rosacea than it will be for acne, but there's a problem,” he said.

“The [Food and Drug Administration] is insistent on having blood tests because they're worried about the risk of hemolysis. I'm wondering at this point if we'll ever see the product. But if it comes out I think it will be useful effects for rosacea because of its anti-inflammatory activity.”

Another new therapy is anti-inflammatory-dose doxycycline. Doxycycline can be given in a dose so low “that it doesn't change the oral flora or GI flora, but it still has a lot of the anti-inflammatory activity,” Dr. Webster said.

Even more promising in the future, he added, is a drug called incyclinide, “which is a chemically modified doxycycline that has no antibiotic activity but whopping anti-inflammatory activity. This drug is real promising.”

LAS VEGAS — When rosacea overlaps with another skin disease, certain topical treatments are better than others, Guy F. Webster, M.D., said at the Fall Clinical Dermatology Conference.

“I'm finding there are subsets of topical treatments that are good for subsets of disease,” said Dr. Webster of the department of dermatology at Jefferson Medical College, Philadelphia. “There's a new 1% metronidazole out that's a little stronger, and the topical immunomodulators are useful when someone has rosacea plus seborrheic dermatitis, or [for] someone with atopic dermatitis plus seborrheic dermatitis.”

Another subset of rosacea patients he described are those who had severe acne as teenagers. “They've often been through Accutane [isotretinoin], and then they're in their mid to late 20s, and they start getting rosacea,” he explained at the conference, sponsored by the Center for Bio-Medical Communication Inc. “With them I find the benzoyl peroxide/clindamycin mixtures are often very effective.”

Azelaic acid and sodium sulfacetamide/sulfur have a role in rosacea treatment, he noted, but sodium sulfacetamide/sulfur “isn't quite as strong as the other topicals.”

He added that evidence to support the use of tretinoin for rosacea is in the realm of speculation. Studies of fair-skinned people who live in areas of high sun exposure make him wonder if what the investigators really observed were improvements in sun damage and not rosacea. “But it's clear that if you're patient enough in a person like that, you can get some aspects of their rosacea to improve with tretinoin,” Dr. Webster said.

He credited the efficacy of metronidazole 1% to not only a boost in drug concentration from the 0.75% form, but to the fact that the agent is contained in a modern vehicle.

“Many of the drugs we have are [contained in] old-fashioned vehicles that were formulated 15–20 years ago, even though maybe they've only been approved for 5–10 years,” Dr. Webster said at the conference.

“A lot has gone on in vehicle technology since then. This is a new, modern vehicle, and it optimizes the health of the skin.”

As for oral rosacea therapy, effective options include tetracycline, doxycycline, and minocycline, which are antibacterial and anti-inflammatory.

Cipro (ciprofloxacin) and Bactrim (trimethoprim/sulfamethoxazole) both work, “but there's a worry with giving people long-term antibiotic treatment for a disease that is chronic,” he noted.

“You worry about generating resistance to bacteria and making other infections harder to treat. We should get patients as clear as we can with an oral antibiotic and then try to get them onto something that's either nonantibiotic or topical.”

Dr. Webster said that isotretinoin is not as “magic” for rosacea as it is for acne. “It's better for nodules than a lot of other drugs for rosacea, but it doesn't work as quickly as you would expect. I'd save it for a situation where all else fails.”

Other drugs that he finds “occasionally effective” include β-blockers and selective serotonin reuptake inhibitors. β-Blockers “will sometime make a patient who is 'flushy' and 'blushy' and a little bit agitated have less flushing and blushing, but it's not as magical as you'd hope,” he remarked.

“Sometimes patients who are anxious in general benefit from an SSRI. They're a fairly big part of my practice. I use them for acne patients and agitated rosacea folks, and eczema patients.”

One promising new treatment for rosacea is topical dapsone gel. “I think it will probably be better for rosacea than it will be for acne, but there's a problem,” he said.

“The [Food and Drug Administration] is insistent on having blood tests because they're worried about the risk of hemolysis. I'm wondering at this point if we'll ever see the product. But if it comes out I think it will be useful effects for rosacea because of its anti-inflammatory activity.”

Another new therapy is anti-inflammatory-dose doxycycline. Doxycycline can be given in a dose so low “that it doesn't change the oral flora or GI flora, but it still has a lot of the anti-inflammatory activity,” Dr. Webster said.

Even more promising in the future, he added, is a drug called incyclinide, “which is a chemically modified doxycycline that has no antibiotic activity but whopping anti-inflammatory activity. This drug is real promising.”