Sharon Worcester

MIAMI BEACH – Patients with recurrent methicillin-resistant Staphylococcus aureus skin infections should be advised to address their environment, according to Dr. Theodore Rosen.

Toilets, telephones, hairbrushes, and bathroom sink and door handles are particular culprits in harboring MRSA, Dr. Rosen, professor of dermatology at Baylor College of Medicine, Houston, said at the South Beach Symposium.

©PRUDENCIOALVAREZ/Thinkstock

That was the finding of a recent prospective longitudinal study looking at households in Los Angeles and Chicago with at least one index case of S. aureus skin infection, he said.

Samantha J. Eells of the Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, Calif., and her colleagues enrolled 346 households of adults and children with such infections. Household fomites were surveyed for contamination at baseline and 3 months, and all isolates underwent genetic typing.

Nearly half (49%) of households were contaminated with S. aureus at baseline, and 51% of the 304 that completed follow-up were contaminated at 3 months. Of those with a USA300 MRSA body infection isolate, 58% and 63% had environmental contamination with an indistinguishable MRSA strain at baseline and at 3 months, respectively, the investigators found (Infect. Control. Hosp. Epidemiol. 2014;35:1373-82).

Numerous environmental locations were contaminated up to 3 months after the index case, but among the most common locations with MRSA contamination, with 7%-8% affected among the study households, were toilets, landline phones, index subjects’ hairbrushes, and bathroom sink and door handles. Other areas with contamination detected were children’s toys, television remote controls, kitchen counters, and kitchen sink handles.

“We found that an index subject’s infection isolate frequently persisted for at least 3 months, suggesting that it potentially serves as a reservoir that places all household members at risk for future S. aureus infections. While multiple S. aureus strain types were recovered from some households, the index subject’s infection strain persisted in more than 50% of households after 3 months,” the investigators wrote.

The findings, in the context of the high prevalence of body colonization found in the community-based population, suggests that successful outpatient decolonization may require not only eradication of nasal, skin, and oropharyngeal colonization, but also of environmental contamination, they said.

So not only can patients get MRSA from family members, sex partners, dogs and cats, and raw food sold in grocery stores, as shown in prior studies, they can also get it from the household environment, Dr. Rosen said.

“If you’re doing everything else [to eradicate colonization], you need to make sure someone who is having recurring MRSA outbreaks basically cleans up their environment,” he said.

Dr. Rosen reported having no disclosures.

MIAMI BEACH – Patients with recurrent methicillin-resistant Staphylococcus aureus skin infections should be advised to address their environment, according to Dr. Theodore Rosen.

Toilets, telephones, hairbrushes, and bathroom sink and door handles are particular culprits in harboring MRSA, Dr. Rosen, professor of dermatology at Baylor College of Medicine, Houston, said at the South Beach Symposium.

©PRUDENCIOALVAREZ/Thinkstock

That was the finding of a recent prospective longitudinal study looking at households in Los Angeles and Chicago with at least one index case of S. aureus skin infection, he said.

Samantha J. Eells of the Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, Calif., and her colleagues enrolled 346 households of adults and children with such infections. Household fomites were surveyed for contamination at baseline and 3 months, and all isolates underwent genetic typing.

Nearly half (49%) of households were contaminated with S. aureus at baseline, and 51% of the 304 that completed follow-up were contaminated at 3 months. Of those with a USA300 MRSA body infection isolate, 58% and 63% had environmental contamination with an indistinguishable MRSA strain at baseline and at 3 months, respectively, the investigators found (Infect. Control. Hosp. Epidemiol. 2014;35:1373-82).

Numerous environmental locations were contaminated up to 3 months after the index case, but among the most common locations with MRSA contamination, with 7%-8% affected among the study households, were toilets, landline phones, index subjects’ hairbrushes, and bathroom sink and door handles. Other areas with contamination detected were children’s toys, television remote controls, kitchen counters, and kitchen sink handles.

“We found that an index subject’s infection isolate frequently persisted for at least 3 months, suggesting that it potentially serves as a reservoir that places all household members at risk for future S. aureus infections. While multiple S. aureus strain types were recovered from some households, the index subject’s infection strain persisted in more than 50% of households after 3 months,” the investigators wrote.

The findings, in the context of the high prevalence of body colonization found in the community-based population, suggests that successful outpatient decolonization may require not only eradication of nasal, skin, and oropharyngeal colonization, but also of environmental contamination, they said.

So not only can patients get MRSA from family members, sex partners, dogs and cats, and raw food sold in grocery stores, as shown in prior studies, they can also get it from the household environment, Dr. Rosen said.

“If you’re doing everything else [to eradicate colonization], you need to make sure someone who is having recurring MRSA outbreaks basically cleans up their environment,” he said.

Dr. Rosen reported having no disclosures.

MIAMI BEACH – Patients with recurrent methicillin-resistant Staphylococcus aureus skin infections should be advised to address their environment, according to Dr. Theodore Rosen.

Toilets, telephones, hairbrushes, and bathroom sink and door handles are particular culprits in harboring MRSA, Dr. Rosen, professor of dermatology at Baylor College of Medicine, Houston, said at the South Beach Symposium.

©PRUDENCIOALVAREZ/Thinkstock

That was the finding of a recent prospective longitudinal study looking at households in Los Angeles and Chicago with at least one index case of S. aureus skin infection, he said.

Samantha J. Eells of the Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, Calif., and her colleagues enrolled 346 households of adults and children with such infections. Household fomites were surveyed for contamination at baseline and 3 months, and all isolates underwent genetic typing.

Nearly half (49%) of households were contaminated with S. aureus at baseline, and 51% of the 304 that completed follow-up were contaminated at 3 months. Of those with a USA300 MRSA body infection isolate, 58% and 63% had environmental contamination with an indistinguishable MRSA strain at baseline and at 3 months, respectively, the investigators found (Infect. Control. Hosp. Epidemiol. 2014;35:1373-82).

Numerous environmental locations were contaminated up to 3 months after the index case, but among the most common locations with MRSA contamination, with 7%-8% affected among the study households, were toilets, landline phones, index subjects’ hairbrushes, and bathroom sink and door handles. Other areas with contamination detected were children’s toys, television remote controls, kitchen counters, and kitchen sink handles.

“We found that an index subject’s infection isolate frequently persisted for at least 3 months, suggesting that it potentially serves as a reservoir that places all household members at risk for future S. aureus infections. While multiple S. aureus strain types were recovered from some households, the index subject’s infection strain persisted in more than 50% of households after 3 months,” the investigators wrote.

The findings, in the context of the high prevalence of body colonization found in the community-based population, suggests that successful outpatient decolonization may require not only eradication of nasal, skin, and oropharyngeal colonization, but also of environmental contamination, they said.

So not only can patients get MRSA from family members, sex partners, dogs and cats, and raw food sold in grocery stores, as shown in prior studies, they can also get it from the household environment, Dr. Rosen said.

“If you’re doing everything else [to eradicate colonization], you need to make sure someone who is having recurring MRSA outbreaks basically cleans up their environment,” he said.

Dr. Rosen reported having no disclosures.

The usual approach to improving health-related behaviors involves education and, in some cases, financial incentives; a better approach involves using “behavioral economics” to help patients identify and overcome psychological barriers to behavioral change, according to Dr. David Asch.

During his keynote presentation titled “Using Behavioral Economics to Improve Individual and Population Health” on Thursday morning at the 2015 AGA Technology Summit, Dr. Asch will describe the concept of behavioral economics and discuss ongoing research demonstrating its value in the health care setting.

“In health care, so many of the outcomes that people achieve are highly determined by their own behaviors,” Dr. Asch, an internist at the University of Pennsylvania, Philadelphia , said in an interview.

This is true regarding diet, exercise, and medication adherence, he added, naming just a few examples.

“Human behavior is really the final common pathway toward a lot of the outcomes we care about in health and health care, and until recently there hasn’t been a lot of insight into how to improve people’s health behavior and to advance their own goals,” he said.

One thing that’s known, however, is that being armed with the knowledge that a certain behavior will derail one’s efforts doesn’t necessarily prevent that behavior. A person may know that it’s safer to use a seat belt, but may avoid using one anyway. A dieter may know that piece of chocolate cake is fattening, but will eat it anyway.

That’s why education – though important – is not typically enough on its own to change behaviors, Dr. Asch said, explaining that the premise of the educational approach is that if you tell dieters that chocolate cake is fattening, they won’t eat it, and therefore they won’t get fat.

It’s clear what a weak argument that is, he said.

Similarly, economic incentives – paying patients to take their medication or quit smoking, or, conversely, charging penalties if they don’t – may have some benefit, but these incentives are expensive and off-putting, and their effectiveness is limited, he noted.

Behavioral economics, on the other hand, has much more to do with psychology than with economics, he said, adding that “the basic principle is that all of us are irrational. We do all sorts of things that are irrational, meaning they’re not consistent with our own best interests.”

The key insight of behavioral economics, however, isn’t that people are irrational – it is that they are irrational in highly predictable ways, Dr. Asch said, explaining that people tend to make the same types of mistakes as other people, which allows for the development of solutions with widespread applicability.

“We can harness these same errors that trip us up and use them to create interventions that improve our health,” he said.

At the summit, which is sponsored by the AGA’s Center for GI Innovation and Technology, Dr. Asch will share his recent research showing how health can be improved by “taking advantage of these psychological foibles.”

One study he will discuss is looking at how behavioral economics can promote medication adherence.

“We have a large study in the field right now for patients who have been discharged from the hospital following a heart attack,” he said explaining that such patients are typically discharged on three or four different types of medications, and despite the seriousness of the condition, adherence is only about 40%.

The study uses a multipronged approach that “game-ifies” medication adherence by monitoring pill use via special pill bottles with a computer chip in the cap. A daily lottery is conducted in which patients are randomly selected for monetary prizes if they have been adherent (the data are transmitted through a cell phone signal), resulting in a doubling of compliance rates, he said.

The approach incorporates powerful psychological forces such as regret, which patients will experience if their number is drawn in the lottery and they lose out on the money because of lack of medication adherence, for example. It also enlists the help of a volunteer support person – such as an adult child of the patient – who is notified if a patient misses 2 days of medication in a row. The latter “turns an unwitnessed event into a witnessed event,” providing further impetus for compliance, Dr. Asch said, explaining that no one wants a witness to their failure.

The study is ongoing, and while it remains to be seen whether the behavioral economics approach reduces admissions and proves cost effective, it’s clear that it works to promote adherence, he said.

“And that’s almost certainly a good thing,” he added.

The usual approach to improving health-related behaviors involves education and, in some cases, financial incentives; a better approach involves using “behavioral economics” to help patients identify and overcome psychological barriers to behavioral change, according to Dr. David Asch.

During his keynote presentation titled “Using Behavioral Economics to Improve Individual and Population Health” on Thursday morning at the 2015 AGA Technology Summit, Dr. Asch will describe the concept of behavioral economics and discuss ongoing research demonstrating its value in the health care setting.

“In health care, so many of the outcomes that people achieve are highly determined by their own behaviors,” Dr. Asch, an internist at the University of Pennsylvania, Philadelphia , said in an interview.

This is true regarding diet, exercise, and medication adherence, he added, naming just a few examples.

“Human behavior is really the final common pathway toward a lot of the outcomes we care about in health and health care, and until recently there hasn’t been a lot of insight into how to improve people’s health behavior and to advance their own goals,” he said.

One thing that’s known, however, is that being armed with the knowledge that a certain behavior will derail one’s efforts doesn’t necessarily prevent that behavior. A person may know that it’s safer to use a seat belt, but may avoid using one anyway. A dieter may know that piece of chocolate cake is fattening, but will eat it anyway.

That’s why education – though important – is not typically enough on its own to change behaviors, Dr. Asch said, explaining that the premise of the educational approach is that if you tell dieters that chocolate cake is fattening, they won’t eat it, and therefore they won’t get fat.

It’s clear what a weak argument that is, he said.

Similarly, economic incentives – paying patients to take their medication or quit smoking, or, conversely, charging penalties if they don’t – may have some benefit, but these incentives are expensive and off-putting, and their effectiveness is limited, he noted.

Behavioral economics, on the other hand, has much more to do with psychology than with economics, he said, adding that “the basic principle is that all of us are irrational. We do all sorts of things that are irrational, meaning they’re not consistent with our own best interests.”

The key insight of behavioral economics, however, isn’t that people are irrational – it is that they are irrational in highly predictable ways, Dr. Asch said, explaining that people tend to make the same types of mistakes as other people, which allows for the development of solutions with widespread applicability.

“We can harness these same errors that trip us up and use them to create interventions that improve our health,” he said.

At the summit, which is sponsored by the AGA’s Center for GI Innovation and Technology, Dr. Asch will share his recent research showing how health can be improved by “taking advantage of these psychological foibles.”

One study he will discuss is looking at how behavioral economics can promote medication adherence.

“We have a large study in the field right now for patients who have been discharged from the hospital following a heart attack,” he said explaining that such patients are typically discharged on three or four different types of medications, and despite the seriousness of the condition, adherence is only about 40%.

The study uses a multipronged approach that “game-ifies” medication adherence by monitoring pill use via special pill bottles with a computer chip in the cap. A daily lottery is conducted in which patients are randomly selected for monetary prizes if they have been adherent (the data are transmitted through a cell phone signal), resulting in a doubling of compliance rates, he said.

The approach incorporates powerful psychological forces such as regret, which patients will experience if their number is drawn in the lottery and they lose out on the money because of lack of medication adherence, for example. It also enlists the help of a volunteer support person – such as an adult child of the patient – who is notified if a patient misses 2 days of medication in a row. The latter “turns an unwitnessed event into a witnessed event,” providing further impetus for compliance, Dr. Asch said, explaining that no one wants a witness to their failure.

The study is ongoing, and while it remains to be seen whether the behavioral economics approach reduces admissions and proves cost effective, it’s clear that it works to promote adherence, he said.

“And that’s almost certainly a good thing,” he added.

The usual approach to improving health-related behaviors involves education and, in some cases, financial incentives; a better approach involves using “behavioral economics” to help patients identify and overcome psychological barriers to behavioral change, according to Dr. David Asch.

During his keynote presentation titled “Using Behavioral Economics to Improve Individual and Population Health” on Thursday morning at the 2015 AGA Technology Summit, Dr. Asch will describe the concept of behavioral economics and discuss ongoing research demonstrating its value in the health care setting.

“In health care, so many of the outcomes that people achieve are highly determined by their own behaviors,” Dr. Asch, an internist at the University of Pennsylvania, Philadelphia , said in an interview.

This is true regarding diet, exercise, and medication adherence, he added, naming just a few examples.

“Human behavior is really the final common pathway toward a lot of the outcomes we care about in health and health care, and until recently there hasn’t been a lot of insight into how to improve people’s health behavior and to advance their own goals,” he said.

One thing that’s known, however, is that being armed with the knowledge that a certain behavior will derail one’s efforts doesn’t necessarily prevent that behavior. A person may know that it’s safer to use a seat belt, but may avoid using one anyway. A dieter may know that piece of chocolate cake is fattening, but will eat it anyway.

That’s why education – though important – is not typically enough on its own to change behaviors, Dr. Asch said, explaining that the premise of the educational approach is that if you tell dieters that chocolate cake is fattening, they won’t eat it, and therefore they won’t get fat.

It’s clear what a weak argument that is, he said.

Similarly, economic incentives – paying patients to take their medication or quit smoking, or, conversely, charging penalties if they don’t – may have some benefit, but these incentives are expensive and off-putting, and their effectiveness is limited, he noted.

Behavioral economics, on the other hand, has much more to do with psychology than with economics, he said, adding that “the basic principle is that all of us are irrational. We do all sorts of things that are irrational, meaning they’re not consistent with our own best interests.”

The key insight of behavioral economics, however, isn’t that people are irrational – it is that they are irrational in highly predictable ways, Dr. Asch said, explaining that people tend to make the same types of mistakes as other people, which allows for the development of solutions with widespread applicability.

“We can harness these same errors that trip us up and use them to create interventions that improve our health,” he said.

At the summit, which is sponsored by the AGA’s Center for GI Innovation and Technology, Dr. Asch will share his recent research showing how health can be improved by “taking advantage of these psychological foibles.”

One study he will discuss is looking at how behavioral economics can promote medication adherence.

“We have a large study in the field right now for patients who have been discharged from the hospital following a heart attack,” he said explaining that such patients are typically discharged on three or four different types of medications, and despite the seriousness of the condition, adherence is only about 40%.

The study uses a multipronged approach that “game-ifies” medication adherence by monitoring pill use via special pill bottles with a computer chip in the cap. A daily lottery is conducted in which patients are randomly selected for monetary prizes if they have been adherent (the data are transmitted through a cell phone signal), resulting in a doubling of compliance rates, he said.

The approach incorporates powerful psychological forces such as regret, which patients will experience if their number is drawn in the lottery and they lose out on the money because of lack of medication adherence, for example. It also enlists the help of a volunteer support person – such as an adult child of the patient – who is notified if a patient misses 2 days of medication in a row. The latter “turns an unwitnessed event into a witnessed event,” providing further impetus for compliance, Dr. Asch said, explaining that no one wants a witness to their failure.

The study is ongoing, and while it remains to be seen whether the behavioral economics approach reduces admissions and proves cost effective, it’s clear that it works to promote adherence, he said.

“And that’s almost certainly a good thing,” he added.

Laparoscopic sleeve gastrectomy is associated with lower rates of morbidity and similar mortality when compared with laparoscopic Roux-en-Y gastric bypass, according to an analysis of 2010-2011 data from the American College of Surgeons National Surgical Quality Improvement Program database.

Of 24,117 patients included in the analysis, 79.5% underwent laparoscopic Roux-en-Y gastric bypass (LGB), and 20.5% had laparoscopic sleeve gastrectomy (LSG). Of note, the proportion of LSG cases increased from 14.6% in 2010 to 24.8% in 2011, Dr. Monica T. Young of the University of California Irvine Medical Center, Orange, Calif., and her colleagues reported.

©Thinkstock.com

Those who underwent LGB had a significantly higher rate of 30-day risk-adjusted morbidity (odds ratio, 1.32). The 30-day mortality rate was 0.15% with bypass and 0.10% for sleeve gastrectomy, the investigators said (J. Am. Coll. Surg. 2015 [doi:
10.1016/j.jamcollsurg.2015.01.059]).

Further, sleeve gastrectomy was associated with shorter operative time (101 vs. 133 minutes) and with lower rates of blood loss requiring transfusion (0.65% vs. 1.5%), deep wound infections (0.06% vs. 0.20%), sepsis (0.34% vs. 0.58%), overall serious morbidity (3.8% vs. 5.8%), and reoperations within 30 days (1.6% vs. 2.5%).

The rate of deep venous thrombosis, however, was significantly higher with sleeve gastrectomy (0.47% vs. 0.21%). Deep vein thrombosis was the only complication found to be higher after LSG, they noted.

Older patients, those with a higher body mass index, and those who smoked or had hypertension were at significantly greater risk of serious morbidity.

Given the increasing popularity and use of sleeve gastrectomy as seen both in this study and nationally – with a reported increase in utilization from 0.9% in 2008 to 36.3% in 2012, it is important to compare outcomes with LSG with those for the preferred Roux-en-Y bypass surgery, the investigators said, noting that few large-scale studies have compared outcomes with the two procedures.

“Over the past decade, laparoscopic sleeve gastrectomy has emerged as a common utilized bariatric procedure. LSG has several advantages over LGB including preservation of endoscopic access to the upper gastrointestinal tract, avoidance of intestinal anastomosis, and prevention of dumping syndrome by pylorus preservation,” they wrote, adding that studies increasingly demonstrate its efficacy for weight loss.

The current findings support those of other recent studies, and a comparison of the data with those from 2007 to 2010 from the ACS NSQIP database showed that while reoperation rates after gastric bypass and sleeve gastrectomy have declined dramatically over time, readmission rates remain elevated.

“Therefore, it appears that further quality improvement initiatives are necessary to reduce the rate of readmissions after bariatric surgery,” the investigators wrote, noting that a national collaborative to reduce 30-day readmissions by 20% (the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, or MBSAQIP) is currently enrolling.

Additional randomized controlled trials are also needed to evaluate differences in long-term outcomes between the two procedures, they concluded.

The authors reported having no relevant financial disclosures.

Laparoscopic sleeve gastrectomy is associated with lower rates of morbidity and similar mortality when compared with laparoscopic Roux-en-Y gastric bypass, according to an analysis of 2010-2011 data from the American College of Surgeons National Surgical Quality Improvement Program database.

Of 24,117 patients included in the analysis, 79.5% underwent laparoscopic Roux-en-Y gastric bypass (LGB), and 20.5% had laparoscopic sleeve gastrectomy (LSG). Of note, the proportion of LSG cases increased from 14.6% in 2010 to 24.8% in 2011, Dr. Monica T. Young of the University of California Irvine Medical Center, Orange, Calif., and her colleagues reported.

©Thinkstock.com

Those who underwent LGB had a significantly higher rate of 30-day risk-adjusted morbidity (odds ratio, 1.32). The 30-day mortality rate was 0.15% with bypass and 0.10% for sleeve gastrectomy, the investigators said (J. Am. Coll. Surg. 2015 [doi:
10.1016/j.jamcollsurg.2015.01.059]).

Further, sleeve gastrectomy was associated with shorter operative time (101 vs. 133 minutes) and with lower rates of blood loss requiring transfusion (0.65% vs. 1.5%), deep wound infections (0.06% vs. 0.20%), sepsis (0.34% vs. 0.58%), overall serious morbidity (3.8% vs. 5.8%), and reoperations within 30 days (1.6% vs. 2.5%).

The rate of deep venous thrombosis, however, was significantly higher with sleeve gastrectomy (0.47% vs. 0.21%). Deep vein thrombosis was the only complication found to be higher after LSG, they noted.

Older patients, those with a higher body mass index, and those who smoked or had hypertension were at significantly greater risk of serious morbidity.

Given the increasing popularity and use of sleeve gastrectomy as seen both in this study and nationally – with a reported increase in utilization from 0.9% in 2008 to 36.3% in 2012, it is important to compare outcomes with LSG with those for the preferred Roux-en-Y bypass surgery, the investigators said, noting that few large-scale studies have compared outcomes with the two procedures.

“Over the past decade, laparoscopic sleeve gastrectomy has emerged as a common utilized bariatric procedure. LSG has several advantages over LGB including preservation of endoscopic access to the upper gastrointestinal tract, avoidance of intestinal anastomosis, and prevention of dumping syndrome by pylorus preservation,” they wrote, adding that studies increasingly demonstrate its efficacy for weight loss.

The current findings support those of other recent studies, and a comparison of the data with those from 2007 to 2010 from the ACS NSQIP database showed that while reoperation rates after gastric bypass and sleeve gastrectomy have declined dramatically over time, readmission rates remain elevated.

“Therefore, it appears that further quality improvement initiatives are necessary to reduce the rate of readmissions after bariatric surgery,” the investigators wrote, noting that a national collaborative to reduce 30-day readmissions by 20% (the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, or MBSAQIP) is currently enrolling.

Additional randomized controlled trials are also needed to evaluate differences in long-term outcomes between the two procedures, they concluded.

The authors reported having no relevant financial disclosures.

Laparoscopic sleeve gastrectomy is associated with lower rates of morbidity and similar mortality when compared with laparoscopic Roux-en-Y gastric bypass, according to an analysis of 2010-2011 data from the American College of Surgeons National Surgical Quality Improvement Program database.

Of 24,117 patients included in the analysis, 79.5% underwent laparoscopic Roux-en-Y gastric bypass (LGB), and 20.5% had laparoscopic sleeve gastrectomy (LSG). Of note, the proportion of LSG cases increased from 14.6% in 2010 to 24.8% in 2011, Dr. Monica T. Young of the University of California Irvine Medical Center, Orange, Calif., and her colleagues reported.

©Thinkstock.com

Those who underwent LGB had a significantly higher rate of 30-day risk-adjusted morbidity (odds ratio, 1.32). The 30-day mortality rate was 0.15% with bypass and 0.10% for sleeve gastrectomy, the investigators said (J. Am. Coll. Surg. 2015 [doi:
10.1016/j.jamcollsurg.2015.01.059]).

Further, sleeve gastrectomy was associated with shorter operative time (101 vs. 133 minutes) and with lower rates of blood loss requiring transfusion (0.65% vs. 1.5%), deep wound infections (0.06% vs. 0.20%), sepsis (0.34% vs. 0.58%), overall serious morbidity (3.8% vs. 5.8%), and reoperations within 30 days (1.6% vs. 2.5%).

The rate of deep venous thrombosis, however, was significantly higher with sleeve gastrectomy (0.47% vs. 0.21%). Deep vein thrombosis was the only complication found to be higher after LSG, they noted.

Older patients, those with a higher body mass index, and those who smoked or had hypertension were at significantly greater risk of serious morbidity.

Given the increasing popularity and use of sleeve gastrectomy as seen both in this study and nationally – with a reported increase in utilization from 0.9% in 2008 to 36.3% in 2012, it is important to compare outcomes with LSG with those for the preferred Roux-en-Y bypass surgery, the investigators said, noting that few large-scale studies have compared outcomes with the two procedures.

“Over the past decade, laparoscopic sleeve gastrectomy has emerged as a common utilized bariatric procedure. LSG has several advantages over LGB including preservation of endoscopic access to the upper gastrointestinal tract, avoidance of intestinal anastomosis, and prevention of dumping syndrome by pylorus preservation,” they wrote, adding that studies increasingly demonstrate its efficacy for weight loss.

The current findings support those of other recent studies, and a comparison of the data with those from 2007 to 2010 from the ACS NSQIP database showed that while reoperation rates after gastric bypass and sleeve gastrectomy have declined dramatically over time, readmission rates remain elevated.

“Therefore, it appears that further quality improvement initiatives are necessary to reduce the rate of readmissions after bariatric surgery,” the investigators wrote, noting that a national collaborative to reduce 30-day readmissions by 20% (the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, or MBSAQIP) is currently enrolling.

Additional randomized controlled trials are also needed to evaluate differences in long-term outcomes between the two procedures, they concluded.

The authors reported having no relevant financial disclosures.

Numerous states have achieved Healthy People 2020 goals for colorectal and cervical cancer incidence, and the proportion of persons with cancer who survive at least 5 years after diagnosis has reached 65%, but racial disparities in survival persist, according to a Centers for Disease Control and Prevention report.

An analysis of data from the U.S. Cancer Statistics for 2011 – the most recent data available – showed that a total of 1,532,066 invasive cancers were reported to cancer registries in the United States that year (annual incidence rate, 451 per 100,000 persons). Invasive cancers were considered all cancers except in situ cancers (excluding situ cancers in the urinary bladder) and basal and squamous cell cancers.

Incidence rates were higher for men than for women (508 vs. 410 per 100,000), and were highest among blacks (458 per 100,000). The 5-year survival rate, calculated for cases diagnosed between 2003 and 2010, was similar among men and women at 65%, but lower among blacks (60%) for every cancer site, S. Jane Henley of the National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta and her colleagues reported in the March 13 issue of the Morbidity and Mortality Weekly Report.

Survival was highest among those diagnosed before age 45 years (81%) and decreased with increasing age.

The most common cancer reported was prostate cancer (128 per 100,000 men), followed by female breast cancer (122 per 100,000 women), lung and bronchus cancer (61 per 100,000 persons), and colon and rectum cancer (40 per 100,000 persons). Together these cancers accounted for half of those diagnosed in 2011, and 5-year relative survival in patients diagnosed with these cancers was highest for prostate cancer (97%) and breast cancer (88%), the investigators said (MMWR 2015;63:237-42).

Survival was intermediate for colorectal cancer (63%) and lowest for lung cancer (18%).

The cervical cancer incidence rate was 7.5 per 100,000 the authors noted.

A geographic breakdown shows that incidence ranged from 374 per 100,000 persons in New Mexico to 509 per 100,000 persons in Washington, D.C.

“Healthy People 2020 targets were reached in 37 states for incidence of colorectal cancer and in 28 states for incidence of cervical cancer,” they wrote, noting that this report is the first to include incidence rates in Puerto Rico; those rates were lower for all cancer sites, compared with the states and the District of Columbia (339 per 100,000 persons) – a finding that reflects screening practices and risk factors that may differ from in the states.

The inclusion of survival data is also a first and provides a basis for tracking progress.

“Cancer incidence and survival data can guide the planning and evaluation of cancer prevention and control programs,” the authors said, adding that such data can also assist in long-term planning for cancer diagnostic and treatment services, and help public health officials set priorities for allocating health resources.

Though limited by potential systematic misclassification of race and ethnicity, by the possibility that cancer reporting was delayed thus leading to underestimation of certain cancers, and by the fact that relative survival rates were calculated only for white and black racial groups due to lack of accurate life tables for other racial/ethnic groups, the findings are nonetheless important for helping public health officials to monitor cancer incidence, mortality, and survival and to identify populations that might benefit most from targeted prevention and control efforts, they said.

The findings can also help guide the planning of health care allocation and support services and track progress toward Healthy People 2020 goals, they added.

Dr. Lisa Richardson, the director of the CDC’s Division of Cancer Prevention and Control further stressed the value of monitoring cancer incidence and survival rates in a statement.

“These data are an important reminder that a key to surviving with cancer is making sure everyone has access to care from early diagnosis to treatment. We know, for example, that early detection of colorectal cancer has had the largest impact on long-term survival rates,” she said.

Numerous states have achieved Healthy People 2020 goals for colorectal and cervical cancer incidence, and the proportion of persons with cancer who survive at least 5 years after diagnosis has reached 65%, but racial disparities in survival persist, according to a Centers for Disease Control and Prevention report.

An analysis of data from the U.S. Cancer Statistics for 2011 – the most recent data available – showed that a total of 1,532,066 invasive cancers were reported to cancer registries in the United States that year (annual incidence rate, 451 per 100,000 persons). Invasive cancers were considered all cancers except in situ cancers (excluding situ cancers in the urinary bladder) and basal and squamous cell cancers.

Incidence rates were higher for men than for women (508 vs. 410 per 100,000), and were highest among blacks (458 per 100,000). The 5-year survival rate, calculated for cases diagnosed between 2003 and 2010, was similar among men and women at 65%, but lower among blacks (60%) for every cancer site, S. Jane Henley of the National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta and her colleagues reported in the March 13 issue of the Morbidity and Mortality Weekly Report.

Survival was highest among those diagnosed before age 45 years (81%) and decreased with increasing age.

The most common cancer reported was prostate cancer (128 per 100,000 men), followed by female breast cancer (122 per 100,000 women), lung and bronchus cancer (61 per 100,000 persons), and colon and rectum cancer (40 per 100,000 persons). Together these cancers accounted for half of those diagnosed in 2011, and 5-year relative survival in patients diagnosed with these cancers was highest for prostate cancer (97%) and breast cancer (88%), the investigators said (MMWR 2015;63:237-42).

Survival was intermediate for colorectal cancer (63%) and lowest for lung cancer (18%).

The cervical cancer incidence rate was 7.5 per 100,000 the authors noted.

A geographic breakdown shows that incidence ranged from 374 per 100,000 persons in New Mexico to 509 per 100,000 persons in Washington, D.C.

“Healthy People 2020 targets were reached in 37 states for incidence of colorectal cancer and in 28 states for incidence of cervical cancer,” they wrote, noting that this report is the first to include incidence rates in Puerto Rico; those rates were lower for all cancer sites, compared with the states and the District of Columbia (339 per 100,000 persons) – a finding that reflects screening practices and risk factors that may differ from in the states.

The inclusion of survival data is also a first and provides a basis for tracking progress.

“Cancer incidence and survival data can guide the planning and evaluation of cancer prevention and control programs,” the authors said, adding that such data can also assist in long-term planning for cancer diagnostic and treatment services, and help public health officials set priorities for allocating health resources.

Though limited by potential systematic misclassification of race and ethnicity, by the possibility that cancer reporting was delayed thus leading to underestimation of certain cancers, and by the fact that relative survival rates were calculated only for white and black racial groups due to lack of accurate life tables for other racial/ethnic groups, the findings are nonetheless important for helping public health officials to monitor cancer incidence, mortality, and survival and to identify populations that might benefit most from targeted prevention and control efforts, they said.

The findings can also help guide the planning of health care allocation and support services and track progress toward Healthy People 2020 goals, they added.

Dr. Lisa Richardson, the director of the CDC’s Division of Cancer Prevention and Control further stressed the value of monitoring cancer incidence and survival rates in a statement.

“These data are an important reminder that a key to surviving with cancer is making sure everyone has access to care from early diagnosis to treatment. We know, for example, that early detection of colorectal cancer has had the largest impact on long-term survival rates,” she said.

Numerous states have achieved Healthy People 2020 goals for colorectal and cervical cancer incidence, and the proportion of persons with cancer who survive at least 5 years after diagnosis has reached 65%, but racial disparities in survival persist, according to a Centers for Disease Control and Prevention report.

An analysis of data from the U.S. Cancer Statistics for 2011 – the most recent data available – showed that a total of 1,532,066 invasive cancers were reported to cancer registries in the United States that year (annual incidence rate, 451 per 100,000 persons). Invasive cancers were considered all cancers except in situ cancers (excluding situ cancers in the urinary bladder) and basal and squamous cell cancers.

Incidence rates were higher for men than for women (508 vs. 410 per 100,000), and were highest among blacks (458 per 100,000). The 5-year survival rate, calculated for cases diagnosed between 2003 and 2010, was similar among men and women at 65%, but lower among blacks (60%) for every cancer site, S. Jane Henley of the National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta and her colleagues reported in the March 13 issue of the Morbidity and Mortality Weekly Report.

Survival was highest among those diagnosed before age 45 years (81%) and decreased with increasing age.

The most common cancer reported was prostate cancer (128 per 100,000 men), followed by female breast cancer (122 per 100,000 women), lung and bronchus cancer (61 per 100,000 persons), and colon and rectum cancer (40 per 100,000 persons). Together these cancers accounted for half of those diagnosed in 2011, and 5-year relative survival in patients diagnosed with these cancers was highest for prostate cancer (97%) and breast cancer (88%), the investigators said (MMWR 2015;63:237-42).

Survival was intermediate for colorectal cancer (63%) and lowest for lung cancer (18%).

The cervical cancer incidence rate was 7.5 per 100,000 the authors noted.

A geographic breakdown shows that incidence ranged from 374 per 100,000 persons in New Mexico to 509 per 100,000 persons in Washington, D.C.

“Healthy People 2020 targets were reached in 37 states for incidence of colorectal cancer and in 28 states for incidence of cervical cancer,” they wrote, noting that this report is the first to include incidence rates in Puerto Rico; those rates were lower for all cancer sites, compared with the states and the District of Columbia (339 per 100,000 persons) – a finding that reflects screening practices and risk factors that may differ from in the states.

The inclusion of survival data is also a first and provides a basis for tracking progress.

“Cancer incidence and survival data can guide the planning and evaluation of cancer prevention and control programs,” the authors said, adding that such data can also assist in long-term planning for cancer diagnostic and treatment services, and help public health officials set priorities for allocating health resources.

Though limited by potential systematic misclassification of race and ethnicity, by the possibility that cancer reporting was delayed thus leading to underestimation of certain cancers, and by the fact that relative survival rates were calculated only for white and black racial groups due to lack of accurate life tables for other racial/ethnic groups, the findings are nonetheless important for helping public health officials to monitor cancer incidence, mortality, and survival and to identify populations that might benefit most from targeted prevention and control efforts, they said.

The findings can also help guide the planning of health care allocation and support services and track progress toward Healthy People 2020 goals, they added.

Dr. Lisa Richardson, the director of the CDC’s Division of Cancer Prevention and Control further stressed the value of monitoring cancer incidence and survival rates in a statement.

“These data are an important reminder that a key to surviving with cancer is making sure everyone has access to care from early diagnosis to treatment. We know, for example, that early detection of colorectal cancer has had the largest impact on long-term survival rates,” she said.

MIAMI BEACH – A promising new treatment for axillary hyperhidrosis will soon be evaluated in a clinical trial.

The novel molecular compound – a “soft anticholinergic” – was safe and effective as a topical treatment in a recent pilot study, Dr. Brian Berman reported in a session on innovations in clinical therapeutics at the South Beach Symposium.

Currently known as BBI-4000, the product is locally active but quickly metabolized if absorbed, which reduces the risk of treatment-related adverse events, said Dr. Berman of the University of Miami.

No comparable first-line topical prescription treatment exists for axillary hyperhidrosis, he noted.

In the pilot study – the results of which were reported in September by the manufacturer, Brickell Biotech – 18 subjects were randomized to receive once-daily treatment with either a high topical concentration, a low topical concentration, or topical vehicle for 14 days. Of the 12 patients receiving active treatment, 75% achieved at least a 50% sweat reduction, compared with 33% of the 6 patients in the vehicle group.

Further, 67% of those receiving active treatment, compared with 33% in the vehicle group, achieved at least a two-point improvement in their Hyperhidrosis Disease Severity Scale score, indicating substantial improvement, Dr. Berman said.

No treatment-related adverse events were reported, and none of the patients discontinued treatment because of adverse events.

Based on these findings, Brickell Biotech has initiated a randomized, double-blind, vehicle-controlled phase IIb clinical trial with plans to enroll 180 patients with primary axillary hyperhidrosis. The trial will assess the safety and efficacy of three different concentrations of BBI-4000, compared with vehicle.

Dr. Berman is a consultant, researcher, and/or speaker for Beiersdorf, DUSA Pharmaceuticals, Ferndale Pharmaceuticals, Galderma Laboratories, Genentech, Halscion, LEO Pharmaceuticals, Onset Therapeutics, Sensus Healthcare, Tigercat Pharma, and TopMD Skin Care. He also owns stock in TopMD Skin Care.

MIAMI BEACH – A promising new treatment for axillary hyperhidrosis will soon be evaluated in a clinical trial.

The novel molecular compound – a “soft anticholinergic” – was safe and effective as a topical treatment in a recent pilot study, Dr. Brian Berman reported in a session on innovations in clinical therapeutics at the South Beach Symposium.

Currently known as BBI-4000, the product is locally active but quickly metabolized if absorbed, which reduces the risk of treatment-related adverse events, said Dr. Berman of the University of Miami.

No comparable first-line topical prescription treatment exists for axillary hyperhidrosis, he noted.

In the pilot study – the results of which were reported in September by the manufacturer, Brickell Biotech – 18 subjects were randomized to receive once-daily treatment with either a high topical concentration, a low topical concentration, or topical vehicle for 14 days. Of the 12 patients receiving active treatment, 75% achieved at least a 50% sweat reduction, compared with 33% of the 6 patients in the vehicle group.

Further, 67% of those receiving active treatment, compared with 33% in the vehicle group, achieved at least a two-point improvement in their Hyperhidrosis Disease Severity Scale score, indicating substantial improvement, Dr. Berman said.

No treatment-related adverse events were reported, and none of the patients discontinued treatment because of adverse events.

Based on these findings, Brickell Biotech has initiated a randomized, double-blind, vehicle-controlled phase IIb clinical trial with plans to enroll 180 patients with primary axillary hyperhidrosis. The trial will assess the safety and efficacy of three different concentrations of BBI-4000, compared with vehicle.

Dr. Berman is a consultant, researcher, and/or speaker for Beiersdorf, DUSA Pharmaceuticals, Ferndale Pharmaceuticals, Galderma Laboratories, Genentech, Halscion, LEO Pharmaceuticals, Onset Therapeutics, Sensus Healthcare, Tigercat Pharma, and TopMD Skin Care. He also owns stock in TopMD Skin Care.

MIAMI BEACH – A promising new treatment for axillary hyperhidrosis will soon be evaluated in a clinical trial.

The novel molecular compound – a “soft anticholinergic” – was safe and effective as a topical treatment in a recent pilot study, Dr. Brian Berman reported in a session on innovations in clinical therapeutics at the South Beach Symposium.

Currently known as BBI-4000, the product is locally active but quickly metabolized if absorbed, which reduces the risk of treatment-related adverse events, said Dr. Berman of the University of Miami.

No comparable first-line topical prescription treatment exists for axillary hyperhidrosis, he noted.

In the pilot study – the results of which were reported in September by the manufacturer, Brickell Biotech – 18 subjects were randomized to receive once-daily treatment with either a high topical concentration, a low topical concentration, or topical vehicle for 14 days. Of the 12 patients receiving active treatment, 75% achieved at least a 50% sweat reduction, compared with 33% of the 6 patients in the vehicle group.

Further, 67% of those receiving active treatment, compared with 33% in the vehicle group, achieved at least a two-point improvement in their Hyperhidrosis Disease Severity Scale score, indicating substantial improvement, Dr. Berman said.

No treatment-related adverse events were reported, and none of the patients discontinued treatment because of adverse events.

Based on these findings, Brickell Biotech has initiated a randomized, double-blind, vehicle-controlled phase IIb clinical trial with plans to enroll 180 patients with primary axillary hyperhidrosis. The trial will assess the safety and efficacy of three different concentrations of BBI-4000, compared with vehicle.

Dr. Berman is a consultant, researcher, and/or speaker for Beiersdorf, DUSA Pharmaceuticals, Ferndale Pharmaceuticals, Galderma Laboratories, Genentech, Halscion, LEO Pharmaceuticals, Onset Therapeutics, Sensus Healthcare, Tigercat Pharma, and TopMD Skin Care. He also owns stock in TopMD Skin Care.

MIAMI BEACH – A large gel particle hyaluronic acid filler with lidocaine (LGP-HAL) was safe and effective for midface augmentation and correction of midface contour deficiencies in a randomized, multicenter, pivotal study.

The product (Perlane, Galderma Laboratories), which is currently approved for moderate to severe facial folds and wrinkles, provided visible, clinically meaningful, aesthetic results for at least 12 months based on assessment by a blinded evaluator, Dr. David E. Bank reported in a poster at the South Beach Symposium.

At 8 weeks after initial treatment, 89% of 150 treated subjects experienced at least a one-point improvement in their combined right and left side Medicis Midface Volume Scale (MMVS) score, compared with 16% of 50 patients who were not treated.

Further, the treated subjects were assessed as having greater midface fullness than the nontreated subjects at every measurement during the first 12 months after treatment, according to Dr. Bank of New York–Presbyterian Hospital/Columbia University Medical Center, New York.

Study participants were men and women aged 18-65 years (mean of 53 years) with MMVS scores of two, three, or four on the validated one- to four-point scale, with one indicating a fairly full midface and four indicating substantial loss of fullness in the midface area. At the initial treatment, the 150 treatment group subjects were injected with a mean volume of 4.21 mL. All but one received subcutaneous injections, and 115 received supraperiosteal injections.

They were evaluated at weeks 2 (when an optional touch-up was allowed) and 4, and months 2, 4, 6, 8, 10, and 12 following the initial treatment.

The treatment group subjects were treated again at 12 months, along with those not treated initially. Another touch-up was allowed at a 2-week assessment, and additional assessments were conducted at weeks 3 and 4.

Treatment was well tolerated. More than 80% of events reported after treatment were mild in severity, and the adverse events that occurred in more than 5% of subjects included implant site hematoma, hemorrhage, pain, swelling, and headache.

One subject had two cases of implant site inflammation that were deemed related by the investigators, and one experienced a serious adverse event (implant site hematoma) deemed related to the procedure as opposed to the device.

No additional risk was seen in those who were treated twice, Dr. Bank noted.

“Facial shape plays an important role in facial attractiveness,” he wrote, adding that full cheeks, in particular, play an important role.

Aging, however, is associated with increased tissue laxity, soft-tissue descent and deflation, and loss of bone, which all contribute to deficiencies in the midface.

Hyaluronic fillers have been used successfully to correct such deficiencies, and the current findings suggest that LGP-HAL also can be used safely to enhance midface aesthetics, he concluded.

This study was funded by Galderma Laboratories.

MIAMI BEACH – A large gel particle hyaluronic acid filler with lidocaine (LGP-HAL) was safe and effective for midface augmentation and correction of midface contour deficiencies in a randomized, multicenter, pivotal study.

The product (Perlane, Galderma Laboratories), which is currently approved for moderate to severe facial folds and wrinkles, provided visible, clinically meaningful, aesthetic results for at least 12 months based on assessment by a blinded evaluator, Dr. David E. Bank reported in a poster at the South Beach Symposium.

At 8 weeks after initial treatment, 89% of 150 treated subjects experienced at least a one-point improvement in their combined right and left side Medicis Midface Volume Scale (MMVS) score, compared with 16% of 50 patients who were not treated.

Further, the treated subjects were assessed as having greater midface fullness than the nontreated subjects at every measurement during the first 12 months after treatment, according to Dr. Bank of New York–Presbyterian Hospital/Columbia University Medical Center, New York.

Study participants were men and women aged 18-65 years (mean of 53 years) with MMVS scores of two, three, or four on the validated one- to four-point scale, with one indicating a fairly full midface and four indicating substantial loss of fullness in the midface area. At the initial treatment, the 150 treatment group subjects were injected with a mean volume of 4.21 mL. All but one received subcutaneous injections, and 115 received supraperiosteal injections.

They were evaluated at weeks 2 (when an optional touch-up was allowed) and 4, and months 2, 4, 6, 8, 10, and 12 following the initial treatment.

The treatment group subjects were treated again at 12 months, along with those not treated initially. Another touch-up was allowed at a 2-week assessment, and additional assessments were conducted at weeks 3 and 4.

Treatment was well tolerated. More than 80% of events reported after treatment were mild in severity, and the adverse events that occurred in more than 5% of subjects included implant site hematoma, hemorrhage, pain, swelling, and headache.

One subject had two cases of implant site inflammation that were deemed related by the investigators, and one experienced a serious adverse event (implant site hematoma) deemed related to the procedure as opposed to the device.

No additional risk was seen in those who were treated twice, Dr. Bank noted.

“Facial shape plays an important role in facial attractiveness,” he wrote, adding that full cheeks, in particular, play an important role.

Aging, however, is associated with increased tissue laxity, soft-tissue descent and deflation, and loss of bone, which all contribute to deficiencies in the midface.

Hyaluronic fillers have been used successfully to correct such deficiencies, and the current findings suggest that LGP-HAL also can be used safely to enhance midface aesthetics, he concluded.

This study was funded by Galderma Laboratories.

MIAMI BEACH – A large gel particle hyaluronic acid filler with lidocaine (LGP-HAL) was safe and effective for midface augmentation and correction of midface contour deficiencies in a randomized, multicenter, pivotal study.

The product (Perlane, Galderma Laboratories), which is currently approved for moderate to severe facial folds and wrinkles, provided visible, clinically meaningful, aesthetic results for at least 12 months based on assessment by a blinded evaluator, Dr. David E. Bank reported in a poster at the South Beach Symposium.

At 8 weeks after initial treatment, 89% of 150 treated subjects experienced at least a one-point improvement in their combined right and left side Medicis Midface Volume Scale (MMVS) score, compared with 16% of 50 patients who were not treated.

Further, the treated subjects were assessed as having greater midface fullness than the nontreated subjects at every measurement during the first 12 months after treatment, according to Dr. Bank of New York–Presbyterian Hospital/Columbia University Medical Center, New York.

Study participants were men and women aged 18-65 years (mean of 53 years) with MMVS scores of two, three, or four on the validated one- to four-point scale, with one indicating a fairly full midface and four indicating substantial loss of fullness in the midface area. At the initial treatment, the 150 treatment group subjects were injected with a mean volume of 4.21 mL. All but one received subcutaneous injections, and 115 received supraperiosteal injections.

They were evaluated at weeks 2 (when an optional touch-up was allowed) and 4, and months 2, 4, 6, 8, 10, and 12 following the initial treatment.

The treatment group subjects were treated again at 12 months, along with those not treated initially. Another touch-up was allowed at a 2-week assessment, and additional assessments were conducted at weeks 3 and 4.

Treatment was well tolerated. More than 80% of events reported after treatment were mild in severity, and the adverse events that occurred in more than 5% of subjects included implant site hematoma, hemorrhage, pain, swelling, and headache.

One subject had two cases of implant site inflammation that were deemed related by the investigators, and one experienced a serious adverse event (implant site hematoma) deemed related to the procedure as opposed to the device.

No additional risk was seen in those who were treated twice, Dr. Bank noted.

“Facial shape plays an important role in facial attractiveness,” he wrote, adding that full cheeks, in particular, play an important role.

Aging, however, is associated with increased tissue laxity, soft-tissue descent and deflation, and loss of bone, which all contribute to deficiencies in the midface.

Hyaluronic fillers have been used successfully to correct such deficiencies, and the current findings suggest that LGP-HAL also can be used safely to enhance midface aesthetics, he concluded.

This study was funded by Galderma Laboratories.

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.

MIAMI BEACH – Do you cringe when a patient comes in wanting treatment for acne scars? Fear not; such patients are usually very motivated, and effective treatment options exist, according to Dr. Gary Monheit.

It’s true that you can’t perfect their skin, that there is a need to deal with the psychology of what their scarring has meant for them, and that it may take a significant amount of time to temper expectations, he said at the South Beach Symposium.

“But once you win them over, they can be some of the most grateful patients you have. … Don’t turn them away,” he said.

There’s not a lot of training available for treating acne scars, but using existing skill, good judgment, and a combination of tools and techniques can lead to excellent results, said Dr. Monheit, who is in private practice in Birmingham, Ala.

Leveling patient expectations comes down to educating patients about the different kinds of scars and the fact that each type requires different tools.

For example, fillers can be useful – but only for distensible scars. If the scar rises up when the skin is stretched, that’s a distensible scar that will respond to a filler, he explained.

Conversely, if injectable fillers are used in scars with bands that hold them down in deeper tissue, the filler will migrate, surround the scar, and exaggerate its appearance.

A classification system described by Dr. Greg Goodman (Int. J. Dermatol. 2011;50:1179-94]) is useful for determining the best treatment approach based on scar type, he said.

Dr. Goodman described level 1 scars as flat with red, white, or brown marks. Level 2 scars are mild scars visible primarily at close distance, such as while looking in the mirror. Level 3 scars are visible at a conversational distance, but are distensible. Level 4 scars are more severe and are nondistensible.

Peels, cosmeceuticals, and light resurfacing techniques such as the V-beam laser or intense pulsed light, are best for mild scars like level 1 scars, as they typically are erythematous and involve color change, Dr. Monheit said.

For hyperpigmented level 1 scars, consider using topical treatments such as salicylic acid or bleaching agents. For hypopigmented scars, there is a need to blend skin color.

The main thing with these types of scars is to address the color and texture, he said.

Level 2 scars are atrophic, and involve textural and color change. Other resurfacing techniques, including deeper peels, dermabrasion, and laser resurfacing such as with a fractional laser or an ablative laser are particularly useful for these, he said, noting that the treatments can be combined as necessary to achieve the desired results.

Dermarolling also can be helpful for deeper scars.

“As you get into the dermis and deeper, you are breaking collagen bonds and letting skin rise to the surface, and you can also use [dermarolling] as a conduit for whatever you are doing,” he explained.

Needling is another approach that is relatively safe, inexpensive, and involves minimal down time. However, the treatment can be bloody and painful with the depths typically needed for treating scars, he noted.

Moderate scars that are distensible, like level 3 scars, generally need lifting. Fillers are good for these types of scars, and often there is very little more that needs to be done.

Nondistensible scars that are more severe typically require a combination approach. One of the best tools for these types of scars is subcision to loosen them, which creates a pocket that then can be either allowed to fill with blood to raise the scar up or treated with an injectable filler. This is followed by resurfacing to smooth the surface of the skin.

Dr. Monheit described one patient in whom he subcised the nondistensible scars and injected a very small amount – just enough for a surface lift – of Radiesse filler. Significant improvement was seen after two treatment sessions, and then resurfacing was performed.

In another patient with nondistensible scars, he excised a little bit of skin at the scar and performed what amounted to a collagen graft by “chopping it into little pieces – making little pellets – and essentially stuffing those pellets into the pockets with a tiny little needle, giving it lift and stability.” This was followed by resurfacing.

“It really does give a nice result,” he said, noting that subcision may cause some red bumps at first, but these will settle down and the scar will smooth out.

A different approach is needed for other types of scars, such as ice pick scars.

One approach is to punch out the scar surgically and either float the scar up or put a little punch graft in, he said.

Another approach that he uses for ice pick scars is to lightly apply 90% trichloroacetic acid to the base of the scar with a toothpick. This causes an inflammatory reaction that destroys the scar and raises it up, making it distensible and resurfaceable, he said.

Ice pick scars, as well as boxcar scars, divot scars, and hypertrophic scars, need to be refined during the treatment process.

Also keep in mind that patients lose volume as they age, which can cause acne scars to become more prominent. Sometimes a patient will come in with old scars that never bothered them before, and suddenly the scars are much more visible.

“If you volume-fill the face, you’ll improve the scars,” he said, describing one 48-year-old woman who was treated successfully with three sessions of Sculptra, topped off with a little bit of Radiesse.

Dr. Monheit has consulted or performed contracted research for Allergan, Contura, Dermik Laboratories, Galderma Laboratories, Ipsen/Medicis, Kythera Biopharmaceuticals, MELA Sciences, Merz Pharmaceuticals, MyoScience, and Revance Therapeutics.