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Simple tips optimize toxin treatments
LAS VEGAS – Listening to patients is the “first and most important step” toward using neuromodulators successfully, according to Burt Steffes, MD.
Clinicians armed with a thorough knowledge of anatomy and the available products can use neuromodulators successfully for a range of aging concerns including the glabellar complex, crow’s feet, marionette lines, smoker’s lines, a dimpled chin, and platysmal bands, Dr. Steffes, a dermatologist in Fond du Lac, Wisc., said in a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
When diluting toxins, be consistent for best results, he advised. “Pick a concentration you like and stick with it,” he said. Establishing realistic expectations and taking preprocedure photos are essential for optimizing results, he added.
Dr. Steffes shared the following tips for successful toxin treatments:
• Horizontal forehead rhytids. Check the brow position and stay approximately 2 cm above the eyebrows. Be conservative with the amount of product used to avoid the frozen look. In cases of upper eyelid ptosis, “improvement can be achieved with apraclonidine 0.5% drops,” he said.
• Glabellar complex. Dr. Steffes said he usually uses 10-30 units. Avoid blood vessels to avoid bruising, he said, “and ask patients to scowl” to identify the exact location for injections.
• Crow’s feet. Treatment of crow’s feet means managing an area “of great variability,” Dr. Steffes said. He advised using superficial injections to minimize bruising, while staying 2 cm from the orbital rim and adjusting to match the patient’s rhytid pattern. He recommends 1-2 units placed 1 cm below the lower eyelid margin at the mid-pupillary line to decrease the bunching of the lower eyelid.
• Platysmal bands. Managing volume is the key to successful treatment of platysmal bands, said Dr. Steffes. “Injecting too much product into the neck can lead to asymmetry” he cautioned. Pinch the platysmal band between the fingers and inject intramuscularly, using 2 units per injection. “Use conservative amounts and adjust in two weeks if needed,” he said.
Be sure that all patients make follow-up appointments before they leave the office after a procedure, and schedule new patients for follow-up in 2 weeks, said Dr. Steffes. Instruct all patients to contact your office immediately for any concerns including bruising that may be managed within the first 24-48 hours with a low-fluence 595-nm, 532-nm, or 1,064-nm laser, he added.
Dr. Steffes had no relevant financial conflicts to disclose.
SDEF and this news organization are owned by the same parent company.
LAS VEGAS – Listening to patients is the “first and most important step” toward using neuromodulators successfully, according to Burt Steffes, MD.
Clinicians armed with a thorough knowledge of anatomy and the available products can use neuromodulators successfully for a range of aging concerns including the glabellar complex, crow’s feet, marionette lines, smoker’s lines, a dimpled chin, and platysmal bands, Dr. Steffes, a dermatologist in Fond du Lac, Wisc., said in a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
When diluting toxins, be consistent for best results, he advised. “Pick a concentration you like and stick with it,” he said. Establishing realistic expectations and taking preprocedure photos are essential for optimizing results, he added.
Dr. Steffes shared the following tips for successful toxin treatments:
• Horizontal forehead rhytids. Check the brow position and stay approximately 2 cm above the eyebrows. Be conservative with the amount of product used to avoid the frozen look. In cases of upper eyelid ptosis, “improvement can be achieved with apraclonidine 0.5% drops,” he said.
• Glabellar complex. Dr. Steffes said he usually uses 10-30 units. Avoid blood vessels to avoid bruising, he said, “and ask patients to scowl” to identify the exact location for injections.
• Crow’s feet. Treatment of crow’s feet means managing an area “of great variability,” Dr. Steffes said. He advised using superficial injections to minimize bruising, while staying 2 cm from the orbital rim and adjusting to match the patient’s rhytid pattern. He recommends 1-2 units placed 1 cm below the lower eyelid margin at the mid-pupillary line to decrease the bunching of the lower eyelid.
• Platysmal bands. Managing volume is the key to successful treatment of platysmal bands, said Dr. Steffes. “Injecting too much product into the neck can lead to asymmetry” he cautioned. Pinch the platysmal band between the fingers and inject intramuscularly, using 2 units per injection. “Use conservative amounts and adjust in two weeks if needed,” he said.
Be sure that all patients make follow-up appointments before they leave the office after a procedure, and schedule new patients for follow-up in 2 weeks, said Dr. Steffes. Instruct all patients to contact your office immediately for any concerns including bruising that may be managed within the first 24-48 hours with a low-fluence 595-nm, 532-nm, or 1,064-nm laser, he added.
Dr. Steffes had no relevant financial conflicts to disclose.
SDEF and this news organization are owned by the same parent company.
LAS VEGAS – Listening to patients is the “first and most important step” toward using neuromodulators successfully, according to Burt Steffes, MD.
Clinicians armed with a thorough knowledge of anatomy and the available products can use neuromodulators successfully for a range of aging concerns including the glabellar complex, crow’s feet, marionette lines, smoker’s lines, a dimpled chin, and platysmal bands, Dr. Steffes, a dermatologist in Fond du Lac, Wisc., said in a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
When diluting toxins, be consistent for best results, he advised. “Pick a concentration you like and stick with it,” he said. Establishing realistic expectations and taking preprocedure photos are essential for optimizing results, he added.
Dr. Steffes shared the following tips for successful toxin treatments:
• Horizontal forehead rhytids. Check the brow position and stay approximately 2 cm above the eyebrows. Be conservative with the amount of product used to avoid the frozen look. In cases of upper eyelid ptosis, “improvement can be achieved with apraclonidine 0.5% drops,” he said.
• Glabellar complex. Dr. Steffes said he usually uses 10-30 units. Avoid blood vessels to avoid bruising, he said, “and ask patients to scowl” to identify the exact location for injections.
• Crow’s feet. Treatment of crow’s feet means managing an area “of great variability,” Dr. Steffes said. He advised using superficial injections to minimize bruising, while staying 2 cm from the orbital rim and adjusting to match the patient’s rhytid pattern. He recommends 1-2 units placed 1 cm below the lower eyelid margin at the mid-pupillary line to decrease the bunching of the lower eyelid.
• Platysmal bands. Managing volume is the key to successful treatment of platysmal bands, said Dr. Steffes. “Injecting too much product into the neck can lead to asymmetry” he cautioned. Pinch the platysmal band between the fingers and inject intramuscularly, using 2 units per injection. “Use conservative amounts and adjust in two weeks if needed,” he said.
Be sure that all patients make follow-up appointments before they leave the office after a procedure, and schedule new patients for follow-up in 2 weeks, said Dr. Steffes. Instruct all patients to contact your office immediately for any concerns including bruising that may be managed within the first 24-48 hours with a low-fluence 595-nm, 532-nm, or 1,064-nm laser, he added.
Dr. Steffes had no relevant financial conflicts to disclose.
SDEF and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM SDEF LAS VEGAS DERMATOLOGY SEMINAR
First trimester exposure raises risk of Zika-related birth defects
Birth defects associated with the Zika virus occurred in 11% of completed pregnancies of mothers infected with the virus during the first trimester, based on data from the U.S. Zika Pregnancy Registry. The findings were published online in JAMA.
Based on preliminary findings from 442 completed pregnancies, 6% of fetuses or infants of women with possible Zika infections at any point during pregnancy had evidence of Zika-associated birth defects, as did 11% of infants or fetuses of women with possible Zika infections during the first trimester only, or during the first trimester and periconceptual period (JAMA. 2016 Dec 13. doi: 10.1001/jama.2016.19006).
The researchers reviewed data from completed pregnancies in the continental U.S. and Hawaii from Jan. 15, 2016, to Sept. 22, 2016. The data were collected from state and local health departments through the U.S. Zika Pregnancy Registry.
Birth defects were reported in 26 cases; 16 of 271 asymptomatic women and 10 of 167 symptomatic women (approximately 6% of each group). The most common birth defects potentially associated with Zika were microcephaly and brain abnormalities (14 cases), 4 brain abnormalities without microcephaly, and 4 cases of microcephaly and no reported neuroimaging. Overall, microcephaly was present in 4% of completed pregnancies.
Other potentially Zika-related complications included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities, the researchers wrote.
The women ranged in age from 15 to 50 years, and the population included 395 live births (21 infants with birth defects) and 47 pregnancy losses (5 fetuses with birth defects).
“No birth defects were reported among the pregnancies with maternal symptoms or exposure only in the second trimester or third trimester,” the researchers noted, “but there are insufficient data to adequately estimate the proportion affected during these trimesters,” they wrote.
Long-term monitoring of infants with possible congenital Zika virus is essential, the researchers wrote, as some normocephalic infants develop adverse effects of the virus not present at birth.
“In addition, future observations can elucidate the possible role of Zika virus infection in other outcomes, including spontaneous abortions and stillbirths as well as other structural birth defects that are not currently part of the inclusion criteria for Zika-associated birth defects surveillance,” they noted.
The researchers reported having no financial disclosures.
Birth defects associated with the Zika virus occurred in 11% of completed pregnancies of mothers infected with the virus during the first trimester, based on data from the U.S. Zika Pregnancy Registry. The findings were published online in JAMA.
Based on preliminary findings from 442 completed pregnancies, 6% of fetuses or infants of women with possible Zika infections at any point during pregnancy had evidence of Zika-associated birth defects, as did 11% of infants or fetuses of women with possible Zika infections during the first trimester only, or during the first trimester and periconceptual period (JAMA. 2016 Dec 13. doi: 10.1001/jama.2016.19006).
The researchers reviewed data from completed pregnancies in the continental U.S. and Hawaii from Jan. 15, 2016, to Sept. 22, 2016. The data were collected from state and local health departments through the U.S. Zika Pregnancy Registry.
Birth defects were reported in 26 cases; 16 of 271 asymptomatic women and 10 of 167 symptomatic women (approximately 6% of each group). The most common birth defects potentially associated with Zika were microcephaly and brain abnormalities (14 cases), 4 brain abnormalities without microcephaly, and 4 cases of microcephaly and no reported neuroimaging. Overall, microcephaly was present in 4% of completed pregnancies.
Other potentially Zika-related complications included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities, the researchers wrote.
The women ranged in age from 15 to 50 years, and the population included 395 live births (21 infants with birth defects) and 47 pregnancy losses (5 fetuses with birth defects).
“No birth defects were reported among the pregnancies with maternal symptoms or exposure only in the second trimester or third trimester,” the researchers noted, “but there are insufficient data to adequately estimate the proportion affected during these trimesters,” they wrote.
Long-term monitoring of infants with possible congenital Zika virus is essential, the researchers wrote, as some normocephalic infants develop adverse effects of the virus not present at birth.
“In addition, future observations can elucidate the possible role of Zika virus infection in other outcomes, including spontaneous abortions and stillbirths as well as other structural birth defects that are not currently part of the inclusion criteria for Zika-associated birth defects surveillance,” they noted.
The researchers reported having no financial disclosures.
Birth defects associated with the Zika virus occurred in 11% of completed pregnancies of mothers infected with the virus during the first trimester, based on data from the U.S. Zika Pregnancy Registry. The findings were published online in JAMA.
Based on preliminary findings from 442 completed pregnancies, 6% of fetuses or infants of women with possible Zika infections at any point during pregnancy had evidence of Zika-associated birth defects, as did 11% of infants or fetuses of women with possible Zika infections during the first trimester only, or during the first trimester and periconceptual period (JAMA. 2016 Dec 13. doi: 10.1001/jama.2016.19006).
The researchers reviewed data from completed pregnancies in the continental U.S. and Hawaii from Jan. 15, 2016, to Sept. 22, 2016. The data were collected from state and local health departments through the U.S. Zika Pregnancy Registry.
Birth defects were reported in 26 cases; 16 of 271 asymptomatic women and 10 of 167 symptomatic women (approximately 6% of each group). The most common birth defects potentially associated with Zika were microcephaly and brain abnormalities (14 cases), 4 brain abnormalities without microcephaly, and 4 cases of microcephaly and no reported neuroimaging. Overall, microcephaly was present in 4% of completed pregnancies.
Other potentially Zika-related complications included intracranial calcifications, corpus callosum abnormalities, abnormal cortical formation, cerebral atrophy, ventriculomegaly, hydrocephaly, and cerebellar abnormalities, the researchers wrote.
The women ranged in age from 15 to 50 years, and the population included 395 live births (21 infants with birth defects) and 47 pregnancy losses (5 fetuses with birth defects).
“No birth defects were reported among the pregnancies with maternal symptoms or exposure only in the second trimester or third trimester,” the researchers noted, “but there are insufficient data to adequately estimate the proportion affected during these trimesters,” they wrote.
Long-term monitoring of infants with possible congenital Zika virus is essential, the researchers wrote, as some normocephalic infants develop adverse effects of the virus not present at birth.
“In addition, future observations can elucidate the possible role of Zika virus infection in other outcomes, including spontaneous abortions and stillbirths as well as other structural birth defects that are not currently part of the inclusion criteria for Zika-associated birth defects surveillance,” they noted.
The researchers reported having no financial disclosures.
FROM JAMA
Key clinical point:
Major finding: Approximately 6% of fetuses or infants of women with possible Zika virus infections at any point during pregnancy showed signs of Zika-related birth defects, but the number increased to 11% among women with Zika infections during the first trimester.
Data source: A review of data from 442 completed pregnancies collected via the U.S. Zika Pregnancy Registry.
Disclosures: The researchers reported having no financial disclosures.
Teen drug use hits lowest levels in decades
, with the exception of marijuana, according to results of the 2016 Monitoring the Future survey released on Dec. 13 by the National Institute on Drug Abuse.
Overall, 14% of 12th graders reported using an illicit drug (other than marijuana), compared with 18% in 2013 (the highest rate in the history of the survey).
The Monitoring the Future survey is a national analysis of 8th, 10th, and 12th graders about drug use and attitudes. The 2016 survey included 45,473 students in 372 schools nationwide. The survey has been conducted since 1975.
The 2016 results showed the lowest levels of use of heroin, methamphetamines, inhalants, and ecstasy across all age groups since the inception of the survey, Dr. Volkow said. The next step is “to try to understand what is driving the decreases so we can strengthen them and sustain them,” she said.
Marijuana use remains high among 12th graders (6%), making it a continuing area of concern, and the notion that marijuana is harmless is becoming more common, she added.
Past-year marijuana use among 8th graders dropped significantly from 12% in 2015 to 9% in 2016. However, past-year marijuana use was stable from last year for 10th and 12th graders, at 24% and 36%, respectively. Daily marijuana use for 10th and 12th graders also remained stable, at 3% and 6%, respectively.
Use of synthetic cannabinoids dropped significantly from last year among 12th graders, according to the survey; from 5% in 2015 to 4% in 2016, and a significant drop from a peak of 11% in 2011. Use of synthetic marijuana declined among 10th graders as well.
Nonmedical use of opioid pain relievers such as Vicodin continued to drop (from 10% to 3% among 12th graders over the past 10 years) and the rate of Vicodin misuse is now lower than that of Oxycontin. Nonmedical use of Adderall remained stable at approximately 6% among 12th graders but misuse of other ADHD medications and tranquilizers declined.
“We all have a role to play in the community” to continue to reduce availability and access of illicit substances for teenagers, said National Drug Control Policy Director Michael Botticelli.
Healthcare providers in particular can drive down the overprescribing of pain medication that can contribute to opioid abuse through excess medicine and the diversion of unused medicine, he said. According to the survey results, most teens say they get their prescription opioids from friends and family.
All physicians should have some education about appropriate opioid prescribing, and should themselves educate patients and families about removing unused medicine from the home, Mr. Botticelli emphasized. In addition, healthcare providers continue to play an important role in identifying teens at increased risk for substance abuse, such as those with diagnosed or undiagnosed mental health issues, to help prevent problems before they start, Dr. Volkow noted.
Factors driving the downward trend in illicit drug use likely include the declines in alcohol and tobacco use, said Lloyd D. Johnston, PhD, principal investigator at the Institute for Social Research, University of Michigan, Ann Arbor, who was involved in the creation of the Monitoring the Future survey in 1975.
Alcohol and tobacco use “are at the lowest levels we have ever recorded,” he said. “What we are seeing is a real decline” that is contributing to fewer teens moving on to other substances; “there’s a connection,” he noted.
Approximately 56% of 12th graders reported past-year alcohol use, compared with a peak of 75% in 1997. Past-year alcohol use was 38% in 10th graders and 18% of 8th graders, also down from past peaks of 65% and 47%, respectively.
Binge drinking continued to decrease among 8th, 10th, and 12th graders, and 37%, 21%, and 6% of 12th, 10th, and 8th graders respectively reported having been drunk, all significant declines.
Smoking both regular cigarettes and e-cigarettes declined across all three age groups, continuing a long-term decrease from peak use 2 decades ago, according to the report. Past-month rates were 12% for e-cigarettes and 11% for regular cigarettes. Approximately 60% of those surveyed said they use e-cigarettes for flavor rather than nicotine, Dr. Volkow noted in a video interview discussing the findings.
Find more details about the 2016 Monitoring the Future survey at the NIDA website, drugabuse.gov.
, with the exception of marijuana, according to results of the 2016 Monitoring the Future survey released on Dec. 13 by the National Institute on Drug Abuse.
Overall, 14% of 12th graders reported using an illicit drug (other than marijuana), compared with 18% in 2013 (the highest rate in the history of the survey).
The Monitoring the Future survey is a national analysis of 8th, 10th, and 12th graders about drug use and attitudes. The 2016 survey included 45,473 students in 372 schools nationwide. The survey has been conducted since 1975.
The 2016 results showed the lowest levels of use of heroin, methamphetamines, inhalants, and ecstasy across all age groups since the inception of the survey, Dr. Volkow said. The next step is “to try to understand what is driving the decreases so we can strengthen them and sustain them,” she said.
Marijuana use remains high among 12th graders (6%), making it a continuing area of concern, and the notion that marijuana is harmless is becoming more common, she added.
Past-year marijuana use among 8th graders dropped significantly from 12% in 2015 to 9% in 2016. However, past-year marijuana use was stable from last year for 10th and 12th graders, at 24% and 36%, respectively. Daily marijuana use for 10th and 12th graders also remained stable, at 3% and 6%, respectively.
Use of synthetic cannabinoids dropped significantly from last year among 12th graders, according to the survey; from 5% in 2015 to 4% in 2016, and a significant drop from a peak of 11% in 2011. Use of synthetic marijuana declined among 10th graders as well.
Nonmedical use of opioid pain relievers such as Vicodin continued to drop (from 10% to 3% among 12th graders over the past 10 years) and the rate of Vicodin misuse is now lower than that of Oxycontin. Nonmedical use of Adderall remained stable at approximately 6% among 12th graders but misuse of other ADHD medications and tranquilizers declined.
“We all have a role to play in the community” to continue to reduce availability and access of illicit substances for teenagers, said National Drug Control Policy Director Michael Botticelli.
Healthcare providers in particular can drive down the overprescribing of pain medication that can contribute to opioid abuse through excess medicine and the diversion of unused medicine, he said. According to the survey results, most teens say they get their prescription opioids from friends and family.
All physicians should have some education about appropriate opioid prescribing, and should themselves educate patients and families about removing unused medicine from the home, Mr. Botticelli emphasized. In addition, healthcare providers continue to play an important role in identifying teens at increased risk for substance abuse, such as those with diagnosed or undiagnosed mental health issues, to help prevent problems before they start, Dr. Volkow noted.
Factors driving the downward trend in illicit drug use likely include the declines in alcohol and tobacco use, said Lloyd D. Johnston, PhD, principal investigator at the Institute for Social Research, University of Michigan, Ann Arbor, who was involved in the creation of the Monitoring the Future survey in 1975.
Alcohol and tobacco use “are at the lowest levels we have ever recorded,” he said. “What we are seeing is a real decline” that is contributing to fewer teens moving on to other substances; “there’s a connection,” he noted.
Approximately 56% of 12th graders reported past-year alcohol use, compared with a peak of 75% in 1997. Past-year alcohol use was 38% in 10th graders and 18% of 8th graders, also down from past peaks of 65% and 47%, respectively.
Binge drinking continued to decrease among 8th, 10th, and 12th graders, and 37%, 21%, and 6% of 12th, 10th, and 8th graders respectively reported having been drunk, all significant declines.
Smoking both regular cigarettes and e-cigarettes declined across all three age groups, continuing a long-term decrease from peak use 2 decades ago, according to the report. Past-month rates were 12% for e-cigarettes and 11% for regular cigarettes. Approximately 60% of those surveyed said they use e-cigarettes for flavor rather than nicotine, Dr. Volkow noted in a video interview discussing the findings.
Find more details about the 2016 Monitoring the Future survey at the NIDA website, drugabuse.gov.
, with the exception of marijuana, according to results of the 2016 Monitoring the Future survey released on Dec. 13 by the National Institute on Drug Abuse.
Overall, 14% of 12th graders reported using an illicit drug (other than marijuana), compared with 18% in 2013 (the highest rate in the history of the survey).
The Monitoring the Future survey is a national analysis of 8th, 10th, and 12th graders about drug use and attitudes. The 2016 survey included 45,473 students in 372 schools nationwide. The survey has been conducted since 1975.
The 2016 results showed the lowest levels of use of heroin, methamphetamines, inhalants, and ecstasy across all age groups since the inception of the survey, Dr. Volkow said. The next step is “to try to understand what is driving the decreases so we can strengthen them and sustain them,” she said.
Marijuana use remains high among 12th graders (6%), making it a continuing area of concern, and the notion that marijuana is harmless is becoming more common, she added.
Past-year marijuana use among 8th graders dropped significantly from 12% in 2015 to 9% in 2016. However, past-year marijuana use was stable from last year for 10th and 12th graders, at 24% and 36%, respectively. Daily marijuana use for 10th and 12th graders also remained stable, at 3% and 6%, respectively.
Use of synthetic cannabinoids dropped significantly from last year among 12th graders, according to the survey; from 5% in 2015 to 4% in 2016, and a significant drop from a peak of 11% in 2011. Use of synthetic marijuana declined among 10th graders as well.
Nonmedical use of opioid pain relievers such as Vicodin continued to drop (from 10% to 3% among 12th graders over the past 10 years) and the rate of Vicodin misuse is now lower than that of Oxycontin. Nonmedical use of Adderall remained stable at approximately 6% among 12th graders but misuse of other ADHD medications and tranquilizers declined.
“We all have a role to play in the community” to continue to reduce availability and access of illicit substances for teenagers, said National Drug Control Policy Director Michael Botticelli.
Healthcare providers in particular can drive down the overprescribing of pain medication that can contribute to opioid abuse through excess medicine and the diversion of unused medicine, he said. According to the survey results, most teens say they get their prescription opioids from friends and family.
All physicians should have some education about appropriate opioid prescribing, and should themselves educate patients and families about removing unused medicine from the home, Mr. Botticelli emphasized. In addition, healthcare providers continue to play an important role in identifying teens at increased risk for substance abuse, such as those with diagnosed or undiagnosed mental health issues, to help prevent problems before they start, Dr. Volkow noted.
Factors driving the downward trend in illicit drug use likely include the declines in alcohol and tobacco use, said Lloyd D. Johnston, PhD, principal investigator at the Institute for Social Research, University of Michigan, Ann Arbor, who was involved in the creation of the Monitoring the Future survey in 1975.
Alcohol and tobacco use “are at the lowest levels we have ever recorded,” he said. “What we are seeing is a real decline” that is contributing to fewer teens moving on to other substances; “there’s a connection,” he noted.
Approximately 56% of 12th graders reported past-year alcohol use, compared with a peak of 75% in 1997. Past-year alcohol use was 38% in 10th graders and 18% of 8th graders, also down from past peaks of 65% and 47%, respectively.
Binge drinking continued to decrease among 8th, 10th, and 12th graders, and 37%, 21%, and 6% of 12th, 10th, and 8th graders respectively reported having been drunk, all significant declines.
Smoking both regular cigarettes and e-cigarettes declined across all three age groups, continuing a long-term decrease from peak use 2 decades ago, according to the report. Past-month rates were 12% for e-cigarettes and 11% for regular cigarettes. Approximately 60% of those surveyed said they use e-cigarettes for flavor rather than nicotine, Dr. Volkow noted in a video interview discussing the findings.
Find more details about the 2016 Monitoring the Future survey at the NIDA website, drugabuse.gov.
Only topical lidocaine consistently eased infant vaccine pain
During infant vaccinations, only liposomal lidocaine provided consistent pain relief as part of a pain intervention, based on data from 352 infants.
“There is a dearth of data regarding the relative effects of combined interventions [for infants’ pain during vaccination] and their effectiveness over time,” wrote Anna Taddio, Ph.D., of the University of Toronto and her colleagues.
The researchers randomized 352 infants to one of four pain relief regimens to be used for all vaccinations during the first year of life: placebo control, parent-directed video education about infant soothing, the video plus oral sucrose, and the video plus sucrose plus topical lidocaine. The primary outcome of infant distress was assessed using the Modified Behavioural Pain Scale.
Overall, the mean pain scores were significantly lower in the video/sucrose/lidocaine group, compared with all other groups, and there were no significant differences in scores among the other groups.
“The observed treatment effect, albeit above the a priori threshold value set for clinical significance, may not be sufficiently compelling to clinicians to alter clinical practice, particularly in light of the short-lived nature of the pain,” the researchers said. However, “given that vaccination pain is iatrogenic and most infants were distressed despite the use of cointerventions, consideration should be given to adding lidocaine to reduce the burden of pain.”
Dr. Taddio disclosed a research grant from Pfizer, and materials for the study were supplied by Natus and Ferndale.
The findings were published online Dec. 12 in the Canadian Medical Association Journal (CMAJ 2016. doi: 10.1503/ cmaj.160542). Read the full study here.
During infant vaccinations, only liposomal lidocaine provided consistent pain relief as part of a pain intervention, based on data from 352 infants.
“There is a dearth of data regarding the relative effects of combined interventions [for infants’ pain during vaccination] and their effectiveness over time,” wrote Anna Taddio, Ph.D., of the University of Toronto and her colleagues.
The researchers randomized 352 infants to one of four pain relief regimens to be used for all vaccinations during the first year of life: placebo control, parent-directed video education about infant soothing, the video plus oral sucrose, and the video plus sucrose plus topical lidocaine. The primary outcome of infant distress was assessed using the Modified Behavioural Pain Scale.
Overall, the mean pain scores were significantly lower in the video/sucrose/lidocaine group, compared with all other groups, and there were no significant differences in scores among the other groups.
“The observed treatment effect, albeit above the a priori threshold value set for clinical significance, may not be sufficiently compelling to clinicians to alter clinical practice, particularly in light of the short-lived nature of the pain,” the researchers said. However, “given that vaccination pain is iatrogenic and most infants were distressed despite the use of cointerventions, consideration should be given to adding lidocaine to reduce the burden of pain.”
Dr. Taddio disclosed a research grant from Pfizer, and materials for the study were supplied by Natus and Ferndale.
The findings were published online Dec. 12 in the Canadian Medical Association Journal (CMAJ 2016. doi: 10.1503/ cmaj.160542). Read the full study here.
During infant vaccinations, only liposomal lidocaine provided consistent pain relief as part of a pain intervention, based on data from 352 infants.
“There is a dearth of data regarding the relative effects of combined interventions [for infants’ pain during vaccination] and their effectiveness over time,” wrote Anna Taddio, Ph.D., of the University of Toronto and her colleagues.
The researchers randomized 352 infants to one of four pain relief regimens to be used for all vaccinations during the first year of life: placebo control, parent-directed video education about infant soothing, the video plus oral sucrose, and the video plus sucrose plus topical lidocaine. The primary outcome of infant distress was assessed using the Modified Behavioural Pain Scale.
Overall, the mean pain scores were significantly lower in the video/sucrose/lidocaine group, compared with all other groups, and there were no significant differences in scores among the other groups.
“The observed treatment effect, albeit above the a priori threshold value set for clinical significance, may not be sufficiently compelling to clinicians to alter clinical practice, particularly in light of the short-lived nature of the pain,” the researchers said. However, “given that vaccination pain is iatrogenic and most infants were distressed despite the use of cointerventions, consideration should be given to adding lidocaine to reduce the burden of pain.”
Dr. Taddio disclosed a research grant from Pfizer, and materials for the study were supplied by Natus and Ferndale.
The findings were published online Dec. 12 in the Canadian Medical Association Journal (CMAJ 2016. doi: 10.1503/ cmaj.160542). Read the full study here.
FROM THE CANADIAN MEDICAL ASSOCIATION JOURNAL
Cannabis use, childhood trauma correlated in schizophrenia patients
Childhood trauma was correlated with cannabis use in schizophrenia patients, but no significant interaction between the two factors was found, based on data from 366 individuals, including 295 with schizophrenia and 71 with schizoaffective disorder.
“Childhood trauma and cannabis consumption are among the most studied environmental risk factors for schizophrenia and are also considered to be risk-modifying factors,” wrote Grégoire Baudin of Université François-Rabelais in Tours, France, and colleagues (Schizophr Res. 2016;175:161-7).
Overall, the proportion of patients with a history of childhood trauma (CT) was not significantly different in those with and without cannabis use disorders, the researchers reported. However, CT was a significant predictor of the number of hospitalizations and of high scores on measures of excitement and emotional distress, and poor levels of function and quality of life.
The study was limited by not being representative of the schizophrenia population as a whole, the researchers noted. However, “our results emphasize the need for clinicians to systematically inquire about the traumatic history of patients with psychotic disorders, and consider trauma-focused therapy” for people with schizophrenia and for people at risk, the investigators added.
The researchers had no financial conflicts to disclose. The study was funded in part by the FondaMental Foundation, INSERM, and Investissements d’Avenir programs. Mr. Baudin has received a research grant from the FondaMental Foundation.
Find the full study here: doi: 10.1016/j.schres.2016.04.042.
Childhood trauma was correlated with cannabis use in schizophrenia patients, but no significant interaction between the two factors was found, based on data from 366 individuals, including 295 with schizophrenia and 71 with schizoaffective disorder.
“Childhood trauma and cannabis consumption are among the most studied environmental risk factors for schizophrenia and are also considered to be risk-modifying factors,” wrote Grégoire Baudin of Université François-Rabelais in Tours, France, and colleagues (Schizophr Res. 2016;175:161-7).
Overall, the proportion of patients with a history of childhood trauma (CT) was not significantly different in those with and without cannabis use disorders, the researchers reported. However, CT was a significant predictor of the number of hospitalizations and of high scores on measures of excitement and emotional distress, and poor levels of function and quality of life.
The study was limited by not being representative of the schizophrenia population as a whole, the researchers noted. However, “our results emphasize the need for clinicians to systematically inquire about the traumatic history of patients with psychotic disorders, and consider trauma-focused therapy” for people with schizophrenia and for people at risk, the investigators added.
The researchers had no financial conflicts to disclose. The study was funded in part by the FondaMental Foundation, INSERM, and Investissements d’Avenir programs. Mr. Baudin has received a research grant from the FondaMental Foundation.
Find the full study here: doi: 10.1016/j.schres.2016.04.042.
Childhood trauma was correlated with cannabis use in schizophrenia patients, but no significant interaction between the two factors was found, based on data from 366 individuals, including 295 with schizophrenia and 71 with schizoaffective disorder.
“Childhood trauma and cannabis consumption are among the most studied environmental risk factors for schizophrenia and are also considered to be risk-modifying factors,” wrote Grégoire Baudin of Université François-Rabelais in Tours, France, and colleagues (Schizophr Res. 2016;175:161-7).
Overall, the proportion of patients with a history of childhood trauma (CT) was not significantly different in those with and without cannabis use disorders, the researchers reported. However, CT was a significant predictor of the number of hospitalizations and of high scores on measures of excitement and emotional distress, and poor levels of function and quality of life.
The study was limited by not being representative of the schizophrenia population as a whole, the researchers noted. However, “our results emphasize the need for clinicians to systematically inquire about the traumatic history of patients with psychotic disorders, and consider trauma-focused therapy” for people with schizophrenia and for people at risk, the investigators added.
The researchers had no financial conflicts to disclose. The study was funded in part by the FondaMental Foundation, INSERM, and Investissements d’Avenir programs. Mr. Baudin has received a research grant from the FondaMental Foundation.
Find the full study here: doi: 10.1016/j.schres.2016.04.042.
FROM SCHIZOPHRENIA RESEARCH
Younger age, greater anxiety, affect pain after breast reconstruction
Younger age, bilateral procedure, and presurgery depression and anxiety are among the significant contributors to pain after breast reconstruction surgery, according to findings from a prospective study of 2,207 women who underwent several types of breast reconstruction procedures.
Although breast reconstruction is an important element of breast cancer treatment, and most acute postoperative pain resolves with time and pain management intervention, some patients suffer from persistent, severe postoperative pain that increases their risk for long-term pain and clinical morbidity, wrote Anita R. Kulkarni, MD, of Memorial Sloan-Kettering Cancer Center, New York, and her colleagues.
Overall, greater acute postoperative pain was significantly associated with younger age, bilateral procedures, higher levels of preoperative pain, and higher levels of preoperative anxiety and depression, the researchers said.
“Moreover, the degree of patients’ self-reported preoperative anxiety and depressive symptoms both appeared to bear a linear relationship with the magnitude of increased postoperative pain at 1 week” on the MPQ sensory pain rating, they noted.
Similarly, lower scores of physical well-being based on the BREAST-Q physical well-being scale were significantly associated with younger age, bilateral procedures, immediate reconstruction, and higher levels of preoperative pain, anxiety, and depression.
The average age of the women was 50 years, and 87% were white. Most patients (69%) had tissue expander (TE)/implant reconstruction procedures; 93% were immediate reconstruction; and 53% were bilateral reconstruction. The majority (90%) underwent surgery as part of breast cancer treatment.
“The comparative effect of procedure type on postoperative pain showed variable results across our multiple pain scales,” the researchers said.
The patients who underwent autologous flap reconstruction procedures – pedicled transverse rectus abdominis myocutaneous flap (PTRAMS), deep inferior epigastric perforator (DIEP), or superficial inferior epigastric artery (SIEA) – reported less-severe postoperative pain than did those who had TE/Implant procedures. Specifically, patients with SIEA and DIEP procedures reported significantly less pain 1 week after surgery than did those who had TE/Implant procedures, based on the MPQ sensory scale. In addition, patients with PTRAMS reported significantly less postoperative pain 1 week after surgery than did those who had TE/Implant procedures based on the NPRS scale. All three flap procedures were significantly associated with less-severe postoperative pain, compared with TE/Implant procedures.
The findings support data from previous studies that identified preoperative pain, mood disturbance, and age as factors for increased risk of acute postoperative pain, the researchers noted. In addition, “the findings have important implications for the identification of women who might be at risk for significant early postoperative pain following breast reconstruction, as acute postoperative pain is associated with poor functional outcomes, diminished quality of life, and the risk for development of persistent postsurgical pain,” they wrote.
The study results were limited by several factors, including the lack of standardization for postoperative pain treatment regimens, variability in the timing of preoperative assessment, and nonresponder bias, the researchers said.
However, “Once high-risk patients are identified, appropriate referrals can be considered to facilitate careful monitoring of postsurgical pain for selected patients,” they said. “Early intervention can give clinicians the opportunity to reduce postoperative morbidity and improve patients’ surgical experience and satisfaction with breast reconstruction outcome,” they added.
The researchers had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health/National Cancer Institute.
Younger age, bilateral procedure, and presurgery depression and anxiety are among the significant contributors to pain after breast reconstruction surgery, according to findings from a prospective study of 2,207 women who underwent several types of breast reconstruction procedures.
Although breast reconstruction is an important element of breast cancer treatment, and most acute postoperative pain resolves with time and pain management intervention, some patients suffer from persistent, severe postoperative pain that increases their risk for long-term pain and clinical morbidity, wrote Anita R. Kulkarni, MD, of Memorial Sloan-Kettering Cancer Center, New York, and her colleagues.
Overall, greater acute postoperative pain was significantly associated with younger age, bilateral procedures, higher levels of preoperative pain, and higher levels of preoperative anxiety and depression, the researchers said.
“Moreover, the degree of patients’ self-reported preoperative anxiety and depressive symptoms both appeared to bear a linear relationship with the magnitude of increased postoperative pain at 1 week” on the MPQ sensory pain rating, they noted.
Similarly, lower scores of physical well-being based on the BREAST-Q physical well-being scale were significantly associated with younger age, bilateral procedures, immediate reconstruction, and higher levels of preoperative pain, anxiety, and depression.
The average age of the women was 50 years, and 87% were white. Most patients (69%) had tissue expander (TE)/implant reconstruction procedures; 93% were immediate reconstruction; and 53% were bilateral reconstruction. The majority (90%) underwent surgery as part of breast cancer treatment.
“The comparative effect of procedure type on postoperative pain showed variable results across our multiple pain scales,” the researchers said.
The patients who underwent autologous flap reconstruction procedures – pedicled transverse rectus abdominis myocutaneous flap (PTRAMS), deep inferior epigastric perforator (DIEP), or superficial inferior epigastric artery (SIEA) – reported less-severe postoperative pain than did those who had TE/Implant procedures. Specifically, patients with SIEA and DIEP procedures reported significantly less pain 1 week after surgery than did those who had TE/Implant procedures, based on the MPQ sensory scale. In addition, patients with PTRAMS reported significantly less postoperative pain 1 week after surgery than did those who had TE/Implant procedures based on the NPRS scale. All three flap procedures were significantly associated with less-severe postoperative pain, compared with TE/Implant procedures.
The findings support data from previous studies that identified preoperative pain, mood disturbance, and age as factors for increased risk of acute postoperative pain, the researchers noted. In addition, “the findings have important implications for the identification of women who might be at risk for significant early postoperative pain following breast reconstruction, as acute postoperative pain is associated with poor functional outcomes, diminished quality of life, and the risk for development of persistent postsurgical pain,” they wrote.
The study results were limited by several factors, including the lack of standardization for postoperative pain treatment regimens, variability in the timing of preoperative assessment, and nonresponder bias, the researchers said.
However, “Once high-risk patients are identified, appropriate referrals can be considered to facilitate careful monitoring of postsurgical pain for selected patients,” they said. “Early intervention can give clinicians the opportunity to reduce postoperative morbidity and improve patients’ surgical experience and satisfaction with breast reconstruction outcome,” they added.
The researchers had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health/National Cancer Institute.
Younger age, bilateral procedure, and presurgery depression and anxiety are among the significant contributors to pain after breast reconstruction surgery, according to findings from a prospective study of 2,207 women who underwent several types of breast reconstruction procedures.
Although breast reconstruction is an important element of breast cancer treatment, and most acute postoperative pain resolves with time and pain management intervention, some patients suffer from persistent, severe postoperative pain that increases their risk for long-term pain and clinical morbidity, wrote Anita R. Kulkarni, MD, of Memorial Sloan-Kettering Cancer Center, New York, and her colleagues.
Overall, greater acute postoperative pain was significantly associated with younger age, bilateral procedures, higher levels of preoperative pain, and higher levels of preoperative anxiety and depression, the researchers said.
“Moreover, the degree of patients’ self-reported preoperative anxiety and depressive symptoms both appeared to bear a linear relationship with the magnitude of increased postoperative pain at 1 week” on the MPQ sensory pain rating, they noted.
Similarly, lower scores of physical well-being based on the BREAST-Q physical well-being scale were significantly associated with younger age, bilateral procedures, immediate reconstruction, and higher levels of preoperative pain, anxiety, and depression.
The average age of the women was 50 years, and 87% were white. Most patients (69%) had tissue expander (TE)/implant reconstruction procedures; 93% were immediate reconstruction; and 53% were bilateral reconstruction. The majority (90%) underwent surgery as part of breast cancer treatment.
“The comparative effect of procedure type on postoperative pain showed variable results across our multiple pain scales,” the researchers said.
The patients who underwent autologous flap reconstruction procedures – pedicled transverse rectus abdominis myocutaneous flap (PTRAMS), deep inferior epigastric perforator (DIEP), or superficial inferior epigastric artery (SIEA) – reported less-severe postoperative pain than did those who had TE/Implant procedures. Specifically, patients with SIEA and DIEP procedures reported significantly less pain 1 week after surgery than did those who had TE/Implant procedures, based on the MPQ sensory scale. In addition, patients with PTRAMS reported significantly less postoperative pain 1 week after surgery than did those who had TE/Implant procedures based on the NPRS scale. All three flap procedures were significantly associated with less-severe postoperative pain, compared with TE/Implant procedures.
The findings support data from previous studies that identified preoperative pain, mood disturbance, and age as factors for increased risk of acute postoperative pain, the researchers noted. In addition, “the findings have important implications for the identification of women who might be at risk for significant early postoperative pain following breast reconstruction, as acute postoperative pain is associated with poor functional outcomes, diminished quality of life, and the risk for development of persistent postsurgical pain,” they wrote.
The study results were limited by several factors, including the lack of standardization for postoperative pain treatment regimens, variability in the timing of preoperative assessment, and nonresponder bias, the researchers said.
However, “Once high-risk patients are identified, appropriate referrals can be considered to facilitate careful monitoring of postsurgical pain for selected patients,” they said. “Early intervention can give clinicians the opportunity to reduce postoperative morbidity and improve patients’ surgical experience and satisfaction with breast reconstruction outcome,” they added.
The researchers had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health/National Cancer Institute.
FROM THE JOURNAL OF PLASTIC, RECONSTRUCTIVE & AESTHETIC SURGERY OPEN
Key clinical point: Identifying women at increased risk for severe acute postoperative pain allows clinicians the opportunity to reduce postoperative morbidity and improve patients’ surgical experience.
Major finding: Younger age (P = .002), bilateral procedures (P less than .0001), higher levels of preoperative pain (P less than .0001), and higher levels of preoperative anxiety (P less than .01) were among the strongest factors significantly associated with acute postoperative pain.
Data source: A prospective study of 2,207 women who underwent several types of breast reconstruction procedures.
Disclosures: The researchers had no financial conflicts to disclose. The study was supported in part by a grant from the National Institutes of Health/National Cancer Institute.
Presume parents want HPV vaccines for tweens
Clinics in which providers presented human papillomavirus (HPV) vaccination as an assumed part of tween health care had a 5% increase in HPV vaccination coverage, compared with clinics that did not receive “announcement” training, based on data from a parallel-group, randomized trial of 30 pediatric and family medicine clinics in North Carolina.
Many providers hesitate to recommend HPV vaccination for 11- to 12-year-olds for a number of reasons, including lack of time and anticipation of a lengthy conversation about sex, wrote Noel T. Brewer, PhD, of the University of North Carolina, Chapel Hill, and his colleagues.
At 6 months after the training period, 17,173 children aged 11-12 years and 37,796 children aged 13-17 years were seen at the clinics. Overall, clinics that underwent announcement training increased HPV vaccine initiation for 11- and 12-year-olds by 5.4% over the control clinics. Clinics that received conversation training showed no significant increase in vaccine initiation, compared with controls. Intervention groups did not differ from the controls in terms of other ages (adolescents aged 13-17 years) or other immunization coverage, including HPV series completion, Tdap, and meningococcal vaccines.
The findings were limited by several factors, including the collection of data from a single Southeastern state that may not be generalizable to other areas, the researchers noted. The results, however, “support training providers to use announcements as an approach to address low HPV vaccination uptake in primary care clinics,” especially at the recommended ages for routine vaccination, Dr. Brewer and his associates said.
Read the full study here (Pediatrics 2016;139:e20161764. doi: 10.1542/peds.2016-1764).
Clinics in which providers presented human papillomavirus (HPV) vaccination as an assumed part of tween health care had a 5% increase in HPV vaccination coverage, compared with clinics that did not receive “announcement” training, based on data from a parallel-group, randomized trial of 30 pediatric and family medicine clinics in North Carolina.
Many providers hesitate to recommend HPV vaccination for 11- to 12-year-olds for a number of reasons, including lack of time and anticipation of a lengthy conversation about sex, wrote Noel T. Brewer, PhD, of the University of North Carolina, Chapel Hill, and his colleagues.
At 6 months after the training period, 17,173 children aged 11-12 years and 37,796 children aged 13-17 years were seen at the clinics. Overall, clinics that underwent announcement training increased HPV vaccine initiation for 11- and 12-year-olds by 5.4% over the control clinics. Clinics that received conversation training showed no significant increase in vaccine initiation, compared with controls. Intervention groups did not differ from the controls in terms of other ages (adolescents aged 13-17 years) or other immunization coverage, including HPV series completion, Tdap, and meningococcal vaccines.
The findings were limited by several factors, including the collection of data from a single Southeastern state that may not be generalizable to other areas, the researchers noted. The results, however, “support training providers to use announcements as an approach to address low HPV vaccination uptake in primary care clinics,” especially at the recommended ages for routine vaccination, Dr. Brewer and his associates said.
Read the full study here (Pediatrics 2016;139:e20161764. doi: 10.1542/peds.2016-1764).
Clinics in which providers presented human papillomavirus (HPV) vaccination as an assumed part of tween health care had a 5% increase in HPV vaccination coverage, compared with clinics that did not receive “announcement” training, based on data from a parallel-group, randomized trial of 30 pediatric and family medicine clinics in North Carolina.
Many providers hesitate to recommend HPV vaccination for 11- to 12-year-olds for a number of reasons, including lack of time and anticipation of a lengthy conversation about sex, wrote Noel T. Brewer, PhD, of the University of North Carolina, Chapel Hill, and his colleagues.
At 6 months after the training period, 17,173 children aged 11-12 years and 37,796 children aged 13-17 years were seen at the clinics. Overall, clinics that underwent announcement training increased HPV vaccine initiation for 11- and 12-year-olds by 5.4% over the control clinics. Clinics that received conversation training showed no significant increase in vaccine initiation, compared with controls. Intervention groups did not differ from the controls in terms of other ages (adolescents aged 13-17 years) or other immunization coverage, including HPV series completion, Tdap, and meningococcal vaccines.
The findings were limited by several factors, including the collection of data from a single Southeastern state that may not be generalizable to other areas, the researchers noted. The results, however, “support training providers to use announcements as an approach to address low HPV vaccination uptake in primary care clinics,” especially at the recommended ages for routine vaccination, Dr. Brewer and his associates said.
Read the full study here (Pediatrics 2016;139:e20161764. doi: 10.1542/peds.2016-1764).
FROM PEDIATRICS
Survey finds high rate of misdiagnosed fungal infections
Fungal skin infections may be missed or misdiagnosed by many dermatologists, according to the results of a survey published online in the Journal of the American Academy of Dermatology.
For the interactive survey, conducted during a session on fungal infections at the 2016 Orlando Dermatology Aesthetic and Clinical Conference, board-certified dermatologists viewed 13 clinical images (which included other conditions such as secondary syphilis and pityriasis rosea) and were asked via an audience response system whether or not they thought the case was a fungal skin infection. In only 1 of the 13 cases presented did 90% of the dermatologists correctly categorize the case as either a dermatomycosis or not, reported Ramsin Joseph Yadgar of George Washington University in Washington, D.C., and colleagues.
Although most cases (8 of 13) “were appropriately categorized by more than 50% of the audience, this percentage decreased as accuracy of categorization increased,” they wrote. “For example, in only 4 of the 13 cases did audience members accurately categorize the cases with more than 75% accuracy,” they said (J Am Acad Dermatol. 2016 Nov 11. pii: S0190-9622[16]30883-0. doi: 10.1016/j.jaad.2016.09.041).
“Dermatology is full of doppelgangers,” Dr. Friedman, director of the residency program and of translational research in the department of dermatology at George Washington University, said in an interview.
“While we [dermatologists] pride ourselves on our visual prowess, there are many skin diseases which do not follow the textbook and can be quite protean in their presentations,” he said.
The variability in presentation makes diagnosing fungal infections especially challenging, he noted. “Fungal infections of the skin can have many clinical flavors and can infect skin, hair and nails. Also, inappropriate treatment can obscure the appearance of the infection, and the fact that there are multiple other conditions that can look like these [fungal] infections makes proper identification difficult.”
Although the results were limited by several factors including possible selection bias, lack of measurable response rate, and small sample size, the findings highlight how easy it can be to miss a diagnosis of fungal infection, “which can result in inappropriate therapy, worsening of symptoms, and even additional skin and soft-tissue infections,” the researchers wrote.
“Keep an open mind and cast a wider differential,” to help catch fungal infections, and use all the dermatologic tools, including slide preps, cultures, and biopsies, Dr. Friedman said. Better diagnostic tools and improved training for clinicians outside of dermatology also could reduce the misdiagnosis of fungal infections, he added. “Many of these patients are misdiagnosed in the emergency department, urgent care, or primary care settings,” and delayed treatment increases associated morbidity, he said.
Mr. Yadgar, Dr. Friedman, and another coauthor, Neal Bhatia, MD, of Therapeutics Clinical Research, San Diego, Calif., had no financial conflicts to disclose. There was no funding source.
Fungal skin infections may be missed or misdiagnosed by many dermatologists, according to the results of a survey published online in the Journal of the American Academy of Dermatology.
For the interactive survey, conducted during a session on fungal infections at the 2016 Orlando Dermatology Aesthetic and Clinical Conference, board-certified dermatologists viewed 13 clinical images (which included other conditions such as secondary syphilis and pityriasis rosea) and were asked via an audience response system whether or not they thought the case was a fungal skin infection. In only 1 of the 13 cases presented did 90% of the dermatologists correctly categorize the case as either a dermatomycosis or not, reported Ramsin Joseph Yadgar of George Washington University in Washington, D.C., and colleagues.
Although most cases (8 of 13) “were appropriately categorized by more than 50% of the audience, this percentage decreased as accuracy of categorization increased,” they wrote. “For example, in only 4 of the 13 cases did audience members accurately categorize the cases with more than 75% accuracy,” they said (J Am Acad Dermatol. 2016 Nov 11. pii: S0190-9622[16]30883-0. doi: 10.1016/j.jaad.2016.09.041).
“Dermatology is full of doppelgangers,” Dr. Friedman, director of the residency program and of translational research in the department of dermatology at George Washington University, said in an interview.
“While we [dermatologists] pride ourselves on our visual prowess, there are many skin diseases which do not follow the textbook and can be quite protean in their presentations,” he said.
The variability in presentation makes diagnosing fungal infections especially challenging, he noted. “Fungal infections of the skin can have many clinical flavors and can infect skin, hair and nails. Also, inappropriate treatment can obscure the appearance of the infection, and the fact that there are multiple other conditions that can look like these [fungal] infections makes proper identification difficult.”
Although the results were limited by several factors including possible selection bias, lack of measurable response rate, and small sample size, the findings highlight how easy it can be to miss a diagnosis of fungal infection, “which can result in inappropriate therapy, worsening of symptoms, and even additional skin and soft-tissue infections,” the researchers wrote.
“Keep an open mind and cast a wider differential,” to help catch fungal infections, and use all the dermatologic tools, including slide preps, cultures, and biopsies, Dr. Friedman said. Better diagnostic tools and improved training for clinicians outside of dermatology also could reduce the misdiagnosis of fungal infections, he added. “Many of these patients are misdiagnosed in the emergency department, urgent care, or primary care settings,” and delayed treatment increases associated morbidity, he said.
Mr. Yadgar, Dr. Friedman, and another coauthor, Neal Bhatia, MD, of Therapeutics Clinical Research, San Diego, Calif., had no financial conflicts to disclose. There was no funding source.
Fungal skin infections may be missed or misdiagnosed by many dermatologists, according to the results of a survey published online in the Journal of the American Academy of Dermatology.
For the interactive survey, conducted during a session on fungal infections at the 2016 Orlando Dermatology Aesthetic and Clinical Conference, board-certified dermatologists viewed 13 clinical images (which included other conditions such as secondary syphilis and pityriasis rosea) and were asked via an audience response system whether or not they thought the case was a fungal skin infection. In only 1 of the 13 cases presented did 90% of the dermatologists correctly categorize the case as either a dermatomycosis or not, reported Ramsin Joseph Yadgar of George Washington University in Washington, D.C., and colleagues.
Although most cases (8 of 13) “were appropriately categorized by more than 50% of the audience, this percentage decreased as accuracy of categorization increased,” they wrote. “For example, in only 4 of the 13 cases did audience members accurately categorize the cases with more than 75% accuracy,” they said (J Am Acad Dermatol. 2016 Nov 11. pii: S0190-9622[16]30883-0. doi: 10.1016/j.jaad.2016.09.041).
“Dermatology is full of doppelgangers,” Dr. Friedman, director of the residency program and of translational research in the department of dermatology at George Washington University, said in an interview.
“While we [dermatologists] pride ourselves on our visual prowess, there are many skin diseases which do not follow the textbook and can be quite protean in their presentations,” he said.
The variability in presentation makes diagnosing fungal infections especially challenging, he noted. “Fungal infections of the skin can have many clinical flavors and can infect skin, hair and nails. Also, inappropriate treatment can obscure the appearance of the infection, and the fact that there are multiple other conditions that can look like these [fungal] infections makes proper identification difficult.”
Although the results were limited by several factors including possible selection bias, lack of measurable response rate, and small sample size, the findings highlight how easy it can be to miss a diagnosis of fungal infection, “which can result in inappropriate therapy, worsening of symptoms, and even additional skin and soft-tissue infections,” the researchers wrote.
“Keep an open mind and cast a wider differential,” to help catch fungal infections, and use all the dermatologic tools, including slide preps, cultures, and biopsies, Dr. Friedman said. Better diagnostic tools and improved training for clinicians outside of dermatology also could reduce the misdiagnosis of fungal infections, he added. “Many of these patients are misdiagnosed in the emergency department, urgent care, or primary care settings,” and delayed treatment increases associated morbidity, he said.
Mr. Yadgar, Dr. Friedman, and another coauthor, Neal Bhatia, MD, of Therapeutics Clinical Research, San Diego, Calif., had no financial conflicts to disclose. There was no funding source.
FROM JAAD
Key clinical point: Fungal infections may often be missed or misdiagnosed by dermatologists.
Major finding: In 1 of 13 cases did 90% of an audience of dermatologists correctly categorize the condition.
Data source: A survey of board-certified dermatologists, asked whether or not 13 clinical images were a fungal infection or not, during a session on fungal infections at a dermatology meeting.
Disclosures: The research team had no relevant financial conflicts to disclose.
VIDEO: Tune in to psoriasis patients’ quality of life
LAS VEGAS – Physicians often fail to predict the impact of disease on quality of life in their psoriasis patients, which can help guide treatment, Joel Gelfand, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
“This is true across all medical conditions,” said Dr. Gelfand, professor of dermatology, at the University of Pennsylvania, Philadelphia. For example, some patients with psoriasis may have extensive disease, but it doesn’t bother them, and therefore they may need less treatment, he pointed out.
In his practice, patients with psoriasis are asked to rate physical symptoms (including flaking and itching) and emotional symptoms (including anxiety and depression) related to their disease on a scale of 0 to 10, with 10 being the worst. “The higher those scores are, the more aggressive I’ll be in treating them,” he said. Patient scores can be tracked over time, to review progress with their chosen treatment, he noted.
Dr. Gelfand disclosed relationships with multiple companies including AbbVie, Janssen, Lilly, Novartis, Celgene, Merck, Sanofi, Pfizer, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – Physicians often fail to predict the impact of disease on quality of life in their psoriasis patients, which can help guide treatment, Joel Gelfand, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
“This is true across all medical conditions,” said Dr. Gelfand, professor of dermatology, at the University of Pennsylvania, Philadelphia. For example, some patients with psoriasis may have extensive disease, but it doesn’t bother them, and therefore they may need less treatment, he pointed out.
In his practice, patients with psoriasis are asked to rate physical symptoms (including flaking and itching) and emotional symptoms (including anxiety and depression) related to their disease on a scale of 0 to 10, with 10 being the worst. “The higher those scores are, the more aggressive I’ll be in treating them,” he said. Patient scores can be tracked over time, to review progress with their chosen treatment, he noted.
Dr. Gelfand disclosed relationships with multiple companies including AbbVie, Janssen, Lilly, Novartis, Celgene, Merck, Sanofi, Pfizer, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – Physicians often fail to predict the impact of disease on quality of life in their psoriasis patients, which can help guide treatment, Joel Gelfand, MD, said in a video interview at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar.
“This is true across all medical conditions,” said Dr. Gelfand, professor of dermatology, at the University of Pennsylvania, Philadelphia. For example, some patients with psoriasis may have extensive disease, but it doesn’t bother them, and therefore they may need less treatment, he pointed out.
In his practice, patients with psoriasis are asked to rate physical symptoms (including flaking and itching) and emotional symptoms (including anxiety and depression) related to their disease on a scale of 0 to 10, with 10 being the worst. “The higher those scores are, the more aggressive I’ll be in treating them,” he said. Patient scores can be tracked over time, to review progress with their chosen treatment, he noted.
Dr. Gelfand disclosed relationships with multiple companies including AbbVie, Janssen, Lilly, Novartis, Celgene, Merck, Sanofi, Pfizer, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
At SDEF LAS VEGAS DERMATOLOGY SEMINAR
VIDEO: Challenging case – consider HSV with erythema multiforme
LAS VEGAS – In a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar, Miriam S. Bettencourt, MD, shared a challenging diagnostic case of erythema multiforme associated with herpes simplex, in a patient who presented with blisters all over his body.
“We know that 90% of cases of erythema multiforme are related to herpetic infections,” but this patient had no recent history of herpes simplex outbreaks, Dr. Bettencourt, of the University of Nevada, Las Vegas, said in a video interview.
‘“Let’s remember that HSV [herpes simplex virus] ... can be associated with erythema multiforme even if a patient does not have any flares,” Dr. Bettencourt said. A consult with a rheumatologist can be helpful, as in this case, if a patient has a positive antinuclear antibody test, which could not be explained, she added, noting that the patient is doing well after 6 months of therapy.
Dr. Bettencourt disclosed relationships with AbbVie, Allergan, Aqua, Celgene, Janssen, IntraDerm, Leo, Promius, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – In a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar, Miriam S. Bettencourt, MD, shared a challenging diagnostic case of erythema multiforme associated with herpes simplex, in a patient who presented with blisters all over his body.
“We know that 90% of cases of erythema multiforme are related to herpetic infections,” but this patient had no recent history of herpes simplex outbreaks, Dr. Bettencourt, of the University of Nevada, Las Vegas, said in a video interview.
‘“Let’s remember that HSV [herpes simplex virus] ... can be associated with erythema multiforme even if a patient does not have any flares,” Dr. Bettencourt said. A consult with a rheumatologist can be helpful, as in this case, if a patient has a positive antinuclear antibody test, which could not be explained, she added, noting that the patient is doing well after 6 months of therapy.
Dr. Bettencourt disclosed relationships with AbbVie, Allergan, Aqua, Celgene, Janssen, IntraDerm, Leo, Promius, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
LAS VEGAS – In a presentation at Skin Disease Education Foundation’s annual Las Vegas dermatology seminar, Miriam S. Bettencourt, MD, shared a challenging diagnostic case of erythema multiforme associated with herpes simplex, in a patient who presented with blisters all over his body.
“We know that 90% of cases of erythema multiforme are related to herpetic infections,” but this patient had no recent history of herpes simplex outbreaks, Dr. Bettencourt, of the University of Nevada, Las Vegas, said in a video interview.
‘“Let’s remember that HSV [herpes simplex virus] ... can be associated with erythema multiforme even if a patient does not have any flares,” Dr. Bettencourt said. A consult with a rheumatologist can be helpful, as in this case, if a patient has a positive antinuclear antibody test, which could not be explained, she added, noting that the patient is doing well after 6 months of therapy.
Dr. Bettencourt disclosed relationships with AbbVie, Allergan, Aqua, Celgene, Janssen, IntraDerm, Leo, Promius, and Valeant.
SDEF and this news organization are owned by the same parent company.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT SDEF LAS VEGAS DERMATOLOGY SEMINAR
