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Tracheobronchial tree size changes may predict IPF outcomes
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
Changes in tracheobronchial tree size may serve as a practical and noninvasive method for predicting disease severity in patients diagnosed with idiopathic pulmonary fibrosis, according to data from 150 adults.
To determine the potential predictive value of tracheobronchial tree changes on mortality, Ankush Ratwani, MD, of Georgetown University, Washington, and colleagues reviewed data from adults with IPF seen at a single center between March 2012 and December 2016. The findings were presented at the CHEST annual meeting.
The researchers measured the tracheal diameters of the patients and used the GAP index, an established system for predicting mortality in IPF patients, to determine a relationship. Overall, they found a significant correlation between GAP index scores and increasing tracheobronchial tree size across eight measurements of different levels along the tracheobronchial tree “with an increase in GAP index stage for every level of increase in tracheal measurements (P less than .005),” they noted.
Measurements included the anterior-posterior diameter at the subglottic level, aortic arch, carina, right main stem bronchus, and left main stem bronchus, as well as transverse diameter assessment at the subglottis, aortic arch, and carina. The average anterior-posterior tracheal diameters were 21.77 mm for the subglottis, 21.84 mm for the aortic arch, 20.47 mm for the carina, 15.19 for the right main stem bronchus, and 14.21 mm for the left main stem bronchus.
No correlation appeared between tracheal size and lung volume, which suggests that enlargement of the trachea is likely caused by other factors beyond fibrosis, and next steps for research should determine whether tracheal size is an independent predictor of mortality in IPF patients, the investigators noted.
“With the field of treatment and management changing for IPF over the last few years, it has becoming increasingly important to prognose these patients in order to find where they fit in the spectrum for treatment or lung transplant,” Dr. Ratwani said in an interview. “Additionally, there needs to be a noninvasive measure to show disease progression, such as with using CT scans, and correlate with other prognostic indicators to hopefully create a regression formula that encompasses multiple parameters,” he explained.
“The results were surprising in that there was a correlation of a radiographic measure that has not been looked at previously with a validated measure of prognostication in IPF (GAP Index),” Dr. Ratwani said.
Although the findings do not imply more than a correlation, the results serve as “a good start to validate the theory that as the distal airways enlarge (traction bronchiectasis) in later stages of IPF, so may the proximal airways, which may be used to easily measure disease progression and guide the conversation for transplant or treatment,” Dr. Ratwani noted. His next steps for research include studying transplant-free survival in correlation with tracheal size, as well as serial changes between CT scans with correlations of lung volumes and survival.
FROM CHEST 2017
Bariatric surgery comes with some risk of complications
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
that should acknowledged by clinicians and understood by patients, a large cohort study has shown.
Gunn Signe Jakobsen, MD, of Vestfold Hospital Trust, Tønsberg, Norway, and her colleagues wrote in an article published in JAMA, “Few studies report long-term complication rates. ... No large-scale clinical practice–based study has compared the long-term association of bariatric surgery and specialized medical obesity treatment with obesity-related somatic and mental comorbidities, nor the irrespective complication rates.”
The investigators compared outcomes from 932 patients who underwent bariatric surgery and 956 who underwent specialized medical treatment that involved either individual or group lifestyle intervention programs. The study population included 1,249 women and 639 men with an average age of 44 years and an average baseline body mass index of 44 kg/m2.
The surgery patients were more likely than the medical treatment patients to have hypertension remission (absolute risk 32% vs. 12%, respectively), and less likely to develop new-onset hypertension (absolute risk 4% vs. 12%, respectively). Diabetes remission was significantly higher among surgery patients, compared with medical treatment patients (58% vs. 13%) as was the likelihood of dyslipidemia remission (43% vs. 13%). Surgery patients also were less likely to develop new-onset diabetes or dyslipidemia than the medical treatment patients.
However, more patients who underwent bariatric surgery had low ferritin levels, compared with the medical treatment patients (26% vs. 12%). The surgery patients were significantly more likely than the medical treatment patients to develop new-onset depression (adjusted relative risk, 1.5; 95% confidence interval, 1.4-1.7), anxiety and sleep disorders (aRR, 1.3; 95% CI, 1.2-1.5), and treatment with opioids (aRR, 1.3; 95% CI, 1.2-1.4). In addition, bariatric patients were more likely to have at least one additional gastrointestinal surgical procedure (aRR, 2.0; 95% CI, 1.7-2.4), an operation for intestinal obstruction (aRR, 10.5; 95% CI, 5.1-21.5), abdominal pain (aRR, 1.9; 95% CI, 1.6-2.3), and gastroduodenal ulcers (aRR, 3.4; 95% CI 2.0-5.6).
The study was limited by several factors, including selection bias of younger, heavier patients in the bariatric surgery group, the lack of data on actual weight loss, incomplete laboratory data, and a relatively homogeneous white population, the researchers noted. However, the nearly 100% follow-up over approximately 6 years adds to the strength of the findings, which suggest that “the risk for complications should be considered in the decision-making process,” for obese patients considering bariatric surgery, they said.
Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
SOURCE: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
FROM JAMA
Key clinical point: Bariatric surgery was associated with reduced hypertension but more complications, including iron deficiency and ulcers.
Major finding: Obese adults who had bariatric surgery were at greater risk for new-onset depression (aRR, 1.5), anxiety and sleep disorders (aRR, 1.3), and ulcers (aRR 3.4).
Study details: A cohort study of 1,888 adults treated with bariatric surgery or medical therapy.
Disclosures: Dr. Jakobsen was supported by the Vestfold Hospital Trust, with no financial conflicts to disclose.
Source: Jakobsen G et al. JAMA. 2018 Jan 16;319(3):291-301.
Disparities persist in infant safe sleep practices
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Sleep-related deaths among infants in the United States decreased during the 1990s as a result of recommendations to place babies on their backs to sleep. However, the decline has leveled off in recent years, and health care providers should proactively counsel caregivers about safe sleep practices, wrote Jennifer M. Bombard, MSPH, of the Centers for Disease Control and Prevention and her colleagues in a study published online in the Morbidity and Mortality Weekly Report.
Overall, 22% of respondents from 32 states and New York City in 2015 reported placing babies in a position other than their backs to sleep. In addition, 61% of respondents from 14 states reported bed sharing, and 39% from 13 states and New York City reported using soft bedding, including bumper pads and thick blankets.
Unsafe sleep practices varied by maternal demographics; nonsupine sleep positioning was more likely among non-Hispanic blacks, individuals aged 25 years or younger, those with 12 years or less of education, and those participating in the Special Supplemental Nutrition Program for Women, Infants, and Children.
“These findings highlight the need to implement and evaluate interventions to continue improving safe sleep practices,” Ms. Bombard and her associates said.
They cited the Study of Attitudes and Factors Effecting Infant Care Practices, in which caregivers who received appropriate advice on safe sleep practices were significantly less likely to place infants in a nonsupine position to sleep. “Evidence-based approaches to increase use of safe sleep practices include developing health messages and educational tools for caregivers and educating health and child care professionals on safe sleep practices,” they noted.
The study was limited by several factors, including reliance on self reports and inclusion of only states with Pregnancy Risk Assessment Monitoring System records, the researchers said.
Ms. Bombard and her associates had no relevant financial disclosures.
pdnews@frontlinemedcom.com
SOURCE: Bombard J et al. MMWR. 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
FROM MMWR
Key clinical point: Health care providers can improve safe sleep for babies by counseling caregivers.
Major finding: Of respondents from 32 states and New York City in 2015, 22% reported placing babies in a position other than their backs to sleep.
Study details: The data come from the 2009-2015 Pregnancy Risk Assessment Monitoring System.
Disclosures: The researchers had no relevant financial disclosures.
Source: Bombard J et al. MMWR 2018 Jan 9. doi: 10.15585/mmwr.mm6701e1.
Alopecia tied to nearly fivefold increase in fibroids in African American women
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.” 
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.”
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
based on data from more than 400,000 women.
In a study published in JAMA Dermatology, researchers reviewed data from 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017. Overall, 14% of women with central centrifugal cicatricial alopecia (CCCA) also had a history of uterine fibroids, compared with 3% percent of black women without CCCA.
“Alopecia is more than just a cosmetic problem. … It could signal an increased risk of developing other conditions,” corresponding author Crystal Aguh, MD, of Johns Hopkins University in Baltimore said in an interview. “To our knowledge, this is the first time that an association has been noted between these two conditions. We believe that the fact that both are related to excess scarring and fibrous tissue deposition may reflect similarities in how both [conditions] develop, but this is still unknown.”
Overall, 62 of 447 women who met criteria for CCCA also had fibroids, representing a nearly fivefold increase in fibroid risk for women with CCCA.
“I was definitely surprised by the findings,” said Dr. Aguh. “I thought it would be interesting to look at any possible correlation between the two diseases, but did not expect to see such a large difference between black women with and without this form of hair loss,” she noted.
As fibroids are often asymptomatic, “physicians should screen their patients with CCCA for symptoms of fibroids such as painful menstrual cycles, heavy bleeding, unexplained anemia, or difficulty conceiving,” said Dr. Aguh. “In those patients who may not know they have fibroids, early recognition that allows for treatment will be especially beneficial.”
The findings were limited by the retrospective nature of the study. “I believe that larger studies are warranted to help us fully understand how these two conditions are connected,” Dr. Aguh said.
Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
SOURCE: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163
FROM JAMA DERMATOLOGY
Key clinical point: Dermatologists should screen patients with central centrifugal cicatricial alopecia for potential fibroids.
Major finding: Women with CCCA were nearly five times more likely to have fibroids, compared with controls.
Data source: The data come from a review of 487,104 black women seen at a single center between Aug. 1, 2013, and Aug. 1, 2017.
Disclosures: Lead author Yemisi Dina of Meharry Medical College, Nashville, Tenn., is supported in part by a grant from the National Institutes of Health. The other researchers had no financial conflicts to disclose.
Source: Dina Y et al. JAMA Dermatol. 2017 Dec 27. doi: 10.1001/jamadermatol.2017.5163.
Facial exercises improved appearance in small study of middle-aged women
The role of skin laxity and substructural fat and muscle loss in the appearance of facial aging has been recognized already, and there has been interest within the nonmedical community regarding use of facial exercise to improve appearance, Murad Alam, MD, of Northwestern University, Chicago, and his colleagues wrote in a research letter published in JAMA Dermatology.
The researchers recruited healthy women aged 40-65 years with some photodamage to the face and an interest in facial exercises. After two 90-minute, in-person training sessions with a certified instructor, the participants were asked to perform a 30-minute facial exercise session daily for 8 weeks at home, followed by sessions every other day during weeks 9-20. Sixteen patients completed the full 20-week study.
Two blinded physicians used validated assessment scales to compare photographs of the participants taken at the beginning and end of the 20-week period. Facial exercise was associated with an improved mean upper-cheek fullness score, compared with baseline (1.1 vs. 1.8, respectively; P = .003), and an improved mean lower-cheek fullness score, compared with baseline (0.9 vs. 1.6; P = .003).
In addition, blinded physicians’ estimates of the women’s ages decreased significantly: The estimates dropped from an average of 51 years at baseline to an average of 49 years after the women completed the 20 weeks of facial exercises (P = .002), Dr. Alam and his associates reported.
The study was limited by several factors, including its small sample size, the lack of a control group, and a self-selected population that may have been especially motivated to follow the exercise routine, the researchers noted.
However, the results suggest that the cause for improvements in appearance as a result of the exercises “may be exercise-actuated hypertrophy of cheek and other muscles,” they said. “Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings,” Dr. Alam and his associates concluded.
The study was supported by research funds from the department of dermatology at Northwestern University. Dr. Alam disclosed serving as a consultant for Amway and Leo Pharma and has served as an investigator on studies supported in part by Allergan, Medicis Pharmaceutical, BioForm Medical, and Ulthera.
SOURCE: Alam M et al. JAMA Dermatol. 2018 Jan 3. doi: 10.1001/jamadermatol.2017.5142
The role of skin laxity and substructural fat and muscle loss in the appearance of facial aging has been recognized already, and there has been interest within the nonmedical community regarding use of facial exercise to improve appearance, Murad Alam, MD, of Northwestern University, Chicago, and his colleagues wrote in a research letter published in JAMA Dermatology.
The researchers recruited healthy women aged 40-65 years with some photodamage to the face and an interest in facial exercises. After two 90-minute, in-person training sessions with a certified instructor, the participants were asked to perform a 30-minute facial exercise session daily for 8 weeks at home, followed by sessions every other day during weeks 9-20. Sixteen patients completed the full 20-week study.
Two blinded physicians used validated assessment scales to compare photographs of the participants taken at the beginning and end of the 20-week period. Facial exercise was associated with an improved mean upper-cheek fullness score, compared with baseline (1.1 vs. 1.8, respectively; P = .003), and an improved mean lower-cheek fullness score, compared with baseline (0.9 vs. 1.6; P = .003).
In addition, blinded physicians’ estimates of the women’s ages decreased significantly: The estimates dropped from an average of 51 years at baseline to an average of 49 years after the women completed the 20 weeks of facial exercises (P = .002), Dr. Alam and his associates reported.
The study was limited by several factors, including its small sample size, the lack of a control group, and a self-selected population that may have been especially motivated to follow the exercise routine, the researchers noted.
However, the results suggest that the cause for improvements in appearance as a result of the exercises “may be exercise-actuated hypertrophy of cheek and other muscles,” they said. “Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings,” Dr. Alam and his associates concluded.
The study was supported by research funds from the department of dermatology at Northwestern University. Dr. Alam disclosed serving as a consultant for Amway and Leo Pharma and has served as an investigator on studies supported in part by Allergan, Medicis Pharmaceutical, BioForm Medical, and Ulthera.
SOURCE: Alam M et al. JAMA Dermatol. 2018 Jan 3. doi: 10.1001/jamadermatol.2017.5142
The role of skin laxity and substructural fat and muscle loss in the appearance of facial aging has been recognized already, and there has been interest within the nonmedical community regarding use of facial exercise to improve appearance, Murad Alam, MD, of Northwestern University, Chicago, and his colleagues wrote in a research letter published in JAMA Dermatology.
The researchers recruited healthy women aged 40-65 years with some photodamage to the face and an interest in facial exercises. After two 90-minute, in-person training sessions with a certified instructor, the participants were asked to perform a 30-minute facial exercise session daily for 8 weeks at home, followed by sessions every other day during weeks 9-20. Sixteen patients completed the full 20-week study.
Two blinded physicians used validated assessment scales to compare photographs of the participants taken at the beginning and end of the 20-week period. Facial exercise was associated with an improved mean upper-cheek fullness score, compared with baseline (1.1 vs. 1.8, respectively; P = .003), and an improved mean lower-cheek fullness score, compared with baseline (0.9 vs. 1.6; P = .003).
In addition, blinded physicians’ estimates of the women’s ages decreased significantly: The estimates dropped from an average of 51 years at baseline to an average of 49 years after the women completed the 20 weeks of facial exercises (P = .002), Dr. Alam and his associates reported.
The study was limited by several factors, including its small sample size, the lack of a control group, and a self-selected population that may have been especially motivated to follow the exercise routine, the researchers noted.
However, the results suggest that the cause for improvements in appearance as a result of the exercises “may be exercise-actuated hypertrophy of cheek and other muscles,” they said. “Further research is warranted to isolate the causes and effects of exercise-related changes and to assess the generalizability of these findings,” Dr. Alam and his associates concluded.
The study was supported by research funds from the department of dermatology at Northwestern University. Dr. Alam disclosed serving as a consultant for Amway and Leo Pharma and has served as an investigator on studies supported in part by Allergan, Medicis Pharmaceutical, BioForm Medical, and Ulthera.
SOURCE: Alam M et al. JAMA Dermatol. 2018 Jan 3. doi: 10.1001/jamadermatol.2017.5142
FROM JAMA DERMATOLOGY
Key clinical point: A 20-week program of facial exercise significantly improved facial fullness and perceived age among women aged 40-65 years.
Major finding: Fullness of the upper and lower cheek significantly improved from baseline after the exercise program, based on a validated scale.
Data source: The data come from a study of 27 women aged 40-65 years.
Disclosures: The study was supported by research funds from the department of dermatology at Northwestern University. Dr. Alam disclosed serving as a consultant for Amway and LEO Pharma and has served as an investigator on studies supported in part by Allergan, Medicis Pharmaceutical, BioForm Medical, and Ulthera.
Source: Alam M et al. JAMA Dermatol. 2018 Jan 3. doi: 10.1001/jamadermatol.2017.5142.
Rituximab tackles relapse of severe, difficult-to-treat pemphigus
, based on data from a case series of 11 patients.
“We found that treatment with rituximab alone, even at a low dose, not only prevented relapse but also maintained complete remission with a better benefit-to-risk ratio than treatment with corticosteroids,” Julia Sanchez, MD, of Reims (France) University Hospital and her colleagues reported in a research letter in JAMA Dermatology.
The study population consisted of patients diagnosed with pemphigus at a single center from Jan. 1, 2014, to Dec. 31, 2014, and treated with at least one cycle of rituximab for corticosteroid dependence, corticosteroid resistance, or adverse events. All the patients were in remission at the time of the first maintenance dose of rituximab.
All patients received a 1-g rituximab infusion every 6 months for 24-67 months; some patients changed to a once-yearly dose after 18 months. Although 5 patients experienced grade 3 or 4 adverse events (1 patient had sepsis; 2, diabetes; 1, hypertension; and 2, endocrine disorders) between the initial therapy cycle and the first rituximab maintenance infusion, no adverse events were reported by any of the 11 patients during the maintenance therapy period.
All 11 patients remained in remission after their last follow-up visit (an average of 78 months after the first cycle), at which point 10 patients had discontinued the therapy.
“A progressive decrease in serum anti-desmoglein autoantibody levels to less than 14 U/mL occurred in all cases along with clinical complete remission even after maintenance therapy cessation,” Dr. Sanchez and her associates noted.
Future research should address questions including the optimal dose and dosing frequency of rituximab, as well as the cost-effectiveness of the treatment and criteria for treatment withdrawal, they said.
The researchers had no relevant financial conflicts disclosures.
SOURCE: JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.5176.
, based on data from a case series of 11 patients.
“We found that treatment with rituximab alone, even at a low dose, not only prevented relapse but also maintained complete remission with a better benefit-to-risk ratio than treatment with corticosteroids,” Julia Sanchez, MD, of Reims (France) University Hospital and her colleagues reported in a research letter in JAMA Dermatology.
The study population consisted of patients diagnosed with pemphigus at a single center from Jan. 1, 2014, to Dec. 31, 2014, and treated with at least one cycle of rituximab for corticosteroid dependence, corticosteroid resistance, or adverse events. All the patients were in remission at the time of the first maintenance dose of rituximab.
All patients received a 1-g rituximab infusion every 6 months for 24-67 months; some patients changed to a once-yearly dose after 18 months. Although 5 patients experienced grade 3 or 4 adverse events (1 patient had sepsis; 2, diabetes; 1, hypertension; and 2, endocrine disorders) between the initial therapy cycle and the first rituximab maintenance infusion, no adverse events were reported by any of the 11 patients during the maintenance therapy period.
All 11 patients remained in remission after their last follow-up visit (an average of 78 months after the first cycle), at which point 10 patients had discontinued the therapy.
“A progressive decrease in serum anti-desmoglein autoantibody levels to less than 14 U/mL occurred in all cases along with clinical complete remission even after maintenance therapy cessation,” Dr. Sanchez and her associates noted.
Future research should address questions including the optimal dose and dosing frequency of rituximab, as well as the cost-effectiveness of the treatment and criteria for treatment withdrawal, they said.
The researchers had no relevant financial conflicts disclosures.
SOURCE: JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.5176.
, based on data from a case series of 11 patients.
“We found that treatment with rituximab alone, even at a low dose, not only prevented relapse but also maintained complete remission with a better benefit-to-risk ratio than treatment with corticosteroids,” Julia Sanchez, MD, of Reims (France) University Hospital and her colleagues reported in a research letter in JAMA Dermatology.
The study population consisted of patients diagnosed with pemphigus at a single center from Jan. 1, 2014, to Dec. 31, 2014, and treated with at least one cycle of rituximab for corticosteroid dependence, corticosteroid resistance, or adverse events. All the patients were in remission at the time of the first maintenance dose of rituximab.
All patients received a 1-g rituximab infusion every 6 months for 24-67 months; some patients changed to a once-yearly dose after 18 months. Although 5 patients experienced grade 3 or 4 adverse events (1 patient had sepsis; 2, diabetes; 1, hypertension; and 2, endocrine disorders) between the initial therapy cycle and the first rituximab maintenance infusion, no adverse events were reported by any of the 11 patients during the maintenance therapy period.
All 11 patients remained in remission after their last follow-up visit (an average of 78 months after the first cycle), at which point 10 patients had discontinued the therapy.
“A progressive decrease in serum anti-desmoglein autoantibody levels to less than 14 U/mL occurred in all cases along with clinical complete remission even after maintenance therapy cessation,” Dr. Sanchez and her associates noted.
Future research should address questions including the optimal dose and dosing frequency of rituximab, as well as the cost-effectiveness of the treatment and criteria for treatment withdrawal, they said.
The researchers had no relevant financial conflicts disclosures.
SOURCE: JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.5176.
FROM JAMA DERMATOLOGY
Key clinical point: Treatment with rituximab prevented relapse and maintained remission in 11 patients with severe, difficult-to-treat pemphigus.
Major finding: All 11 patients treated with a 1-g dose of rituximab given every 6 months maintained remission at an average of 78 months after the first cycle.
Data source: The data come from a single-center, retrospective case series of 11 adults.
Disclosures: The researchers had no relevant financial disclosures.
Source: JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.5176.
Very preterm birth is linked to reduced risk of eczema
according to data from a meta-analysis of 18 studies.
Previous research suggests that low birth weight is protective against the development of atopic dermatitis, said Tingting Zhu, PhD, of West China Second University Hospital, Chengdu, and colleagues.
Preterm birth (before 37 completed weeks’ gestation) was divided into subgroups of extremely preterm (less than 28 weeks’ gestation), very preterm (28 weeks’ to less than 32 weeks’ gestation), and moderate/late preterm (32 weeks’ gestation to less than 37 weeks’ gestation).
In an analysis based on gestational age, children had a significantly reduced risk of eczema if they were very preterm (relative risk, 0.77; 95% confidence interval, 0.70-0.84, P less than .01; adjusted RR, 0.73; 95% CI, 0.64-0.82; P less than 0.01), compared with children born full term. The association between eczema and preterm birth was no longer significant among children born moderately preterm, Dr. Zhu and associates reported.
The reasons for the impact of very preterm birth on eczema are unclear, but maturation of the stratum corneum at 29-37 weeks’ gestational age could play a role, the researchers noted. Also, limited microflora in very preterm infants could affect acquiring immune tolerance and lead to reduced risk of eczema. The study was limited by several factors, including variations in gestational age and inconsistent assessments of eczema among the studies.
However, the large sample size lends strength to the results, and further studies are needed to explore how the environment, nutrition, immune system development, and skin barrier function impact the risk of eczema in very preterm infants, Dr. Zhu and associates said.
The researchers had no relevant financial disclosures. The researchers had no financial conflicts to disclose. The study was funded in part by the National Science Foundation of China, the Ministry of Health of China, and various other grants.
SOURCE: Zhu T et al. J Amer Dermatol. 2018. doi: 10.1016/j.jaad.2017.12.015.
according to data from a meta-analysis of 18 studies.
Previous research suggests that low birth weight is protective against the development of atopic dermatitis, said Tingting Zhu, PhD, of West China Second University Hospital, Chengdu, and colleagues.
Preterm birth (before 37 completed weeks’ gestation) was divided into subgroups of extremely preterm (less than 28 weeks’ gestation), very preterm (28 weeks’ to less than 32 weeks’ gestation), and moderate/late preterm (32 weeks’ gestation to less than 37 weeks’ gestation).
In an analysis based on gestational age, children had a significantly reduced risk of eczema if they were very preterm (relative risk, 0.77; 95% confidence interval, 0.70-0.84, P less than .01; adjusted RR, 0.73; 95% CI, 0.64-0.82; P less than 0.01), compared with children born full term. The association between eczema and preterm birth was no longer significant among children born moderately preterm, Dr. Zhu and associates reported.
The reasons for the impact of very preterm birth on eczema are unclear, but maturation of the stratum corneum at 29-37 weeks’ gestational age could play a role, the researchers noted. Also, limited microflora in very preterm infants could affect acquiring immune tolerance and lead to reduced risk of eczema. The study was limited by several factors, including variations in gestational age and inconsistent assessments of eczema among the studies.
However, the large sample size lends strength to the results, and further studies are needed to explore how the environment, nutrition, immune system development, and skin barrier function impact the risk of eczema in very preterm infants, Dr. Zhu and associates said.
The researchers had no relevant financial disclosures. The researchers had no financial conflicts to disclose. The study was funded in part by the National Science Foundation of China, the Ministry of Health of China, and various other grants.
SOURCE: Zhu T et al. J Amer Dermatol. 2018. doi: 10.1016/j.jaad.2017.12.015.
according to data from a meta-analysis of 18 studies.
Previous research suggests that low birth weight is protective against the development of atopic dermatitis, said Tingting Zhu, PhD, of West China Second University Hospital, Chengdu, and colleagues.
Preterm birth (before 37 completed weeks’ gestation) was divided into subgroups of extremely preterm (less than 28 weeks’ gestation), very preterm (28 weeks’ to less than 32 weeks’ gestation), and moderate/late preterm (32 weeks’ gestation to less than 37 weeks’ gestation).
In an analysis based on gestational age, children had a significantly reduced risk of eczema if they were very preterm (relative risk, 0.77; 95% confidence interval, 0.70-0.84, P less than .01; adjusted RR, 0.73; 95% CI, 0.64-0.82; P less than 0.01), compared with children born full term. The association between eczema and preterm birth was no longer significant among children born moderately preterm, Dr. Zhu and associates reported.
The reasons for the impact of very preterm birth on eczema are unclear, but maturation of the stratum corneum at 29-37 weeks’ gestational age could play a role, the researchers noted. Also, limited microflora in very preterm infants could affect acquiring immune tolerance and lead to reduced risk of eczema. The study was limited by several factors, including variations in gestational age and inconsistent assessments of eczema among the studies.
However, the large sample size lends strength to the results, and further studies are needed to explore how the environment, nutrition, immune system development, and skin barrier function impact the risk of eczema in very preterm infants, Dr. Zhu and associates said.
The researchers had no relevant financial disclosures. The researchers had no financial conflicts to disclose. The study was funded in part by the National Science Foundation of China, the Ministry of Health of China, and various other grants.
SOURCE: Zhu T et al. J Amer Dermatol. 2018. doi: 10.1016/j.jaad.2017.12.015.
FROM JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Key clinical point: Very preterm birth was associated with a significantly reduced risk of eczema, compared with full-term birth, but no difference in risk appeared between moderate preterm and full-term birth.
Major finding: Children had a significantly reduced risk of eczema if they were very preterm (RR, 0.77; 95% CI, 0.70-0.84; P less than .01; aRR 0.73, 95% CI, 0.64-0.82; P less than .01), compared with children born full term.
Data source: The data come from a meta-analysis of 18 studies.
Disclosures: The researchers had no financial conflicts to disclose. The study was funded in part by the National Science Foundation of China, the Ministry of Health of China, and various other grants.
Source: Zhu T et al. J Amer Dermatol. 2018. doi: 10.1016/j.jaad.2017.12.015.
Minorities less likely to seek treatment for psoriasis
Black, Asian, and other non-Hispanic Americans are less likely than are whites to seek treatment for psoriasis, according to data on 842 patients, reported Alexander H. Fischer, MD, of the University of Pennsylvania, Philadelphia, and his colleagues.
Data from previous studies have shown that racial and ethnic minorities have more severe psoriasis and a lower quality of life as a result of the disease, compared with white patients, the researchers noted in a study published as a research letter in the Journal of the American Academy of Dermatology.
A total of 51% of non-Hispanic whites with psoriasis sought treatment from a dermatologist, compared with 47% of Hispanic whites and 38% of non-Hispanic minorities (blacks, Asians, native Hawaiians, Pacific Islanders, and others). In addition, non-Hispanic minorities had significantly fewer ambulatory visits for psoriasis per year than did whites (a mean of 1.30 visits vs. 2.69 visits). Black, Asian, and other non-Hispanic minorities were about 40% less likely than were non-Hispanic whites to seek care for psoriasis.
The number of psoriasis prescriptions obtained was not significantly different among the racial/ethnic groups, the researchers reported.
The study is important because of the lack of data on psoriasis in nonwhite populations, senior author Junko Takeshita, MD, PhD, also of the University of Pennsylvania, said in an interview.
“Based on a few existing studies, we know that psoriasis is less common among minorities, but minorities, particularly blacks, may have more severe disease,” she said. “Also, minorities report poorer quality of life due to psoriasis than whites, independent of psoriasis severity. Furthermore, we previously published a study among Medicare beneficiaries with psoriasis that revealed that blacks are about 70% less likely to receive biologic therapies than whites, independent of socioeconomic status and access to medical care,” she added.
“The take-home message for clinicians is that while psoriasis is less common among minorities than whites, minorities may suffer from a larger burden of disease, yet have fewer visits and are less likely to see a dermatologist for their psoriasis,” Dr. Takeshita said. “This disparity in health care utilization for psoriasis does not seem to be entirely explained by racial/ethnic differences in socioeconomic status and health insurance. It is yet unknown why this disparity exists, and I’m not sure that minority patients being ‘hesitant to pursue care’ is the entire answer, though it may be a contributing factor,” she noted.
The study findings were limited by several factors including the relatively small sample size and the use of self-reports.
Many factors could be contributing to the disparity, including patient, physician/other health care provider, and health care system factors, but “once we identify the major causes of the disparity, we can develop methods to address the causes and reduce the disparity,” said Dr. Takeshita, who is a dermatologist and an epidemiologist. In the meantime, she added, “some things I think that are important to ensure equitable care for psoriasis are making sure that clinicians/dermatologists are comfortable diagnosing and treating psoriasis in nonwhite individuals, and encouraging clinicians to help increase awareness of psoriasis by educating their minority patients that psoriasis is still a common skin disease among nonwhite individuals.”
The study was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Takeshita has received a research grant from Pfizer; she and another author, Joel Gelfand, MD, have received payment for psoriasis-related continuing medical education work supported indirectly by Eli Lilly; Dr. Gelfand’s other disclosures included serving as a consultant for, and having received research grants from, several other pharmaceutical companies. Dr. Fischer, a medical student at Johns Hopkins University, Baltimore, at the time of the research, and a fourth author had no financial disclosures.
SOURCE: Fischer AH et al. J Am Acad Dermatol. 2018 Jan;78[1]:200-3. doi: 10.1016/j.jaad.2017.07.052.
Black, Asian, and other non-Hispanic Americans are less likely than are whites to seek treatment for psoriasis, according to data on 842 patients, reported Alexander H. Fischer, MD, of the University of Pennsylvania, Philadelphia, and his colleagues.
Data from previous studies have shown that racial and ethnic minorities have more severe psoriasis and a lower quality of life as a result of the disease, compared with white patients, the researchers noted in a study published as a research letter in the Journal of the American Academy of Dermatology.
A total of 51% of non-Hispanic whites with psoriasis sought treatment from a dermatologist, compared with 47% of Hispanic whites and 38% of non-Hispanic minorities (blacks, Asians, native Hawaiians, Pacific Islanders, and others). In addition, non-Hispanic minorities had significantly fewer ambulatory visits for psoriasis per year than did whites (a mean of 1.30 visits vs. 2.69 visits). Black, Asian, and other non-Hispanic minorities were about 40% less likely than were non-Hispanic whites to seek care for psoriasis.
The number of psoriasis prescriptions obtained was not significantly different among the racial/ethnic groups, the researchers reported.
The study is important because of the lack of data on psoriasis in nonwhite populations, senior author Junko Takeshita, MD, PhD, also of the University of Pennsylvania, said in an interview.
“Based on a few existing studies, we know that psoriasis is less common among minorities, but minorities, particularly blacks, may have more severe disease,” she said. “Also, minorities report poorer quality of life due to psoriasis than whites, independent of psoriasis severity. Furthermore, we previously published a study among Medicare beneficiaries with psoriasis that revealed that blacks are about 70% less likely to receive biologic therapies than whites, independent of socioeconomic status and access to medical care,” she added.
“The take-home message for clinicians is that while psoriasis is less common among minorities than whites, minorities may suffer from a larger burden of disease, yet have fewer visits and are less likely to see a dermatologist for their psoriasis,” Dr. Takeshita said. “This disparity in health care utilization for psoriasis does not seem to be entirely explained by racial/ethnic differences in socioeconomic status and health insurance. It is yet unknown why this disparity exists, and I’m not sure that minority patients being ‘hesitant to pursue care’ is the entire answer, though it may be a contributing factor,” she noted.
The study findings were limited by several factors including the relatively small sample size and the use of self-reports.
Many factors could be contributing to the disparity, including patient, physician/other health care provider, and health care system factors, but “once we identify the major causes of the disparity, we can develop methods to address the causes and reduce the disparity,” said Dr. Takeshita, who is a dermatologist and an epidemiologist. In the meantime, she added, “some things I think that are important to ensure equitable care for psoriasis are making sure that clinicians/dermatologists are comfortable diagnosing and treating psoriasis in nonwhite individuals, and encouraging clinicians to help increase awareness of psoriasis by educating their minority patients that psoriasis is still a common skin disease among nonwhite individuals.”
The study was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Takeshita has received a research grant from Pfizer; she and another author, Joel Gelfand, MD, have received payment for psoriasis-related continuing medical education work supported indirectly by Eli Lilly; Dr. Gelfand’s other disclosures included serving as a consultant for, and having received research grants from, several other pharmaceutical companies. Dr. Fischer, a medical student at Johns Hopkins University, Baltimore, at the time of the research, and a fourth author had no financial disclosures.
SOURCE: Fischer AH et al. J Am Acad Dermatol. 2018 Jan;78[1]:200-3. doi: 10.1016/j.jaad.2017.07.052.
Black, Asian, and other non-Hispanic Americans are less likely than are whites to seek treatment for psoriasis, according to data on 842 patients, reported Alexander H. Fischer, MD, of the University of Pennsylvania, Philadelphia, and his colleagues.
Data from previous studies have shown that racial and ethnic minorities have more severe psoriasis and a lower quality of life as a result of the disease, compared with white patients, the researchers noted in a study published as a research letter in the Journal of the American Academy of Dermatology.
A total of 51% of non-Hispanic whites with psoriasis sought treatment from a dermatologist, compared with 47% of Hispanic whites and 38% of non-Hispanic minorities (blacks, Asians, native Hawaiians, Pacific Islanders, and others). In addition, non-Hispanic minorities had significantly fewer ambulatory visits for psoriasis per year than did whites (a mean of 1.30 visits vs. 2.69 visits). Black, Asian, and other non-Hispanic minorities were about 40% less likely than were non-Hispanic whites to seek care for psoriasis.
The number of psoriasis prescriptions obtained was not significantly different among the racial/ethnic groups, the researchers reported.
The study is important because of the lack of data on psoriasis in nonwhite populations, senior author Junko Takeshita, MD, PhD, also of the University of Pennsylvania, said in an interview.
“Based on a few existing studies, we know that psoriasis is less common among minorities, but minorities, particularly blacks, may have more severe disease,” she said. “Also, minorities report poorer quality of life due to psoriasis than whites, independent of psoriasis severity. Furthermore, we previously published a study among Medicare beneficiaries with psoriasis that revealed that blacks are about 70% less likely to receive biologic therapies than whites, independent of socioeconomic status and access to medical care,” she added.
“The take-home message for clinicians is that while psoriasis is less common among minorities than whites, minorities may suffer from a larger burden of disease, yet have fewer visits and are less likely to see a dermatologist for their psoriasis,” Dr. Takeshita said. “This disparity in health care utilization for psoriasis does not seem to be entirely explained by racial/ethnic differences in socioeconomic status and health insurance. It is yet unknown why this disparity exists, and I’m not sure that minority patients being ‘hesitant to pursue care’ is the entire answer, though it may be a contributing factor,” she noted.
The study findings were limited by several factors including the relatively small sample size and the use of self-reports.
Many factors could be contributing to the disparity, including patient, physician/other health care provider, and health care system factors, but “once we identify the major causes of the disparity, we can develop methods to address the causes and reduce the disparity,” said Dr. Takeshita, who is a dermatologist and an epidemiologist. In the meantime, she added, “some things I think that are important to ensure equitable care for psoriasis are making sure that clinicians/dermatologists are comfortable diagnosing and treating psoriasis in nonwhite individuals, and encouraging clinicians to help increase awareness of psoriasis by educating their minority patients that psoriasis is still a common skin disease among nonwhite individuals.”
The study was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Takeshita has received a research grant from Pfizer; she and another author, Joel Gelfand, MD, have received payment for psoriasis-related continuing medical education work supported indirectly by Eli Lilly; Dr. Gelfand’s other disclosures included serving as a consultant for, and having received research grants from, several other pharmaceutical companies. Dr. Fischer, a medical student at Johns Hopkins University, Baltimore, at the time of the research, and a fourth author had no financial disclosures.
SOURCE: Fischer AH et al. J Am Acad Dermatol. 2018 Jan;78[1]:200-3. doi: 10.1016/j.jaad.2017.07.052.
FROM THE JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Key clinical point: Black, Asian, and non-Hispanic patients with psoriasis often have more severe disease than do white patients but are significantly less likely to seek care.
Major finding:
Data source: A cohort study of data from the Medical Expenditure Panel Survey on 842 psoriasis patients in the United States.
Disclosures: The study was supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Two of the four authors had no financial disclosures. One author has received a research grant from Pfizer and payment for psoriasis-related continuing medical education work supported indirectly by Eli Lilly; another author’s disclosures included the latter, as well serving as a consultant for, and having received research grants from, several other pharmaceutical companies.
Source: Fischer AH et al. J Am Acad Dermatol. 2018 Jan;78[1]:200-3. doi: 10.1016/j.jaad.2017.07.05
Topical fluorouracil reduces risk for surgery for SCC
in a population of high-risk older adults.
The findings were published online Jan. 3 in JAMA Dermatology.
Although topical fluorouracil can help reduce actinic keratoses and cure some superficial basal cell and squamous cell carcinomas, it has not been studied as a strategy to prevent the development of lesions that might require surgery, wrote Martin A. Weinstock, MD, PhD, of Providence (R.I.) Veterans Affairs Medical Center, and his colleagues (JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631).
Overall, 299 of the 932 participants developed a basal cell carcinoma and 108 developed an SCC over 4 years of follow-up (the median follow-up was 2.8 years). During the 4-year follow-up, no effect was seen on SCC or BCC.
But during the first year, significantly fewer participants in the fluorouracil group than in the control group developed an SCC (5 vs. 20), representing a 75% reduction in the risk of SCCs needing surgery (P = .002).
The number of participants who developed a BCC during the study period was not significantly different between the treatment and control groups (45 vs. 50). During the first year, the BCC risk was reduced by 11%, but it was not statistically significant.
Most patients in the treated group experienced erythema in the first 2 weeks, and more than half described adverse effects of treatment as severe (21%) or moderate (40%). But almost 90% said they would be willing to be treated again if the treatment was shown to reduce the risk of developing skin cancers, the authors wrote.
The study was limited by several factors including the potential unblinding of participants because of side effects and by the homogenous study population, the researchers noted. However, the results suggest the potential value of proactive topical treatment to reduce the need for surgery, they said. “It is reasonable at this point to consider the use of a standard and perhaps annual course of topical fluorouracil, 5%, to the face and ears for the reduction of SCC risk in high-risk populations, and potentially for a reduction in need for Mohs surgery; more detailed study could define precisely the groups that would most benefit,” they wrote.
Lead author Dr. Weinstock is employed by the dermatology practice affiliated with Brown University and is director of the dermatoepidemiology division at Brown. He disclosed serving as a consultant to AbbVie, Castle, and Celgene. Another author disclosed having received grant support from Pfizer for an independent research grant. The remaining 23 authors had no disclosures. The study was partly funded by the U.S. Department of Veterans Affairs.
SOURCE: Weinstock, M et al. JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631.
in a population of high-risk older adults.
The findings were published online Jan. 3 in JAMA Dermatology.
Although topical fluorouracil can help reduce actinic keratoses and cure some superficial basal cell and squamous cell carcinomas, it has not been studied as a strategy to prevent the development of lesions that might require surgery, wrote Martin A. Weinstock, MD, PhD, of Providence (R.I.) Veterans Affairs Medical Center, and his colleagues (JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631).
Overall, 299 of the 932 participants developed a basal cell carcinoma and 108 developed an SCC over 4 years of follow-up (the median follow-up was 2.8 years). During the 4-year follow-up, no effect was seen on SCC or BCC.
But during the first year, significantly fewer participants in the fluorouracil group than in the control group developed an SCC (5 vs. 20), representing a 75% reduction in the risk of SCCs needing surgery (P = .002).
The number of participants who developed a BCC during the study period was not significantly different between the treatment and control groups (45 vs. 50). During the first year, the BCC risk was reduced by 11%, but it was not statistically significant.
Most patients in the treated group experienced erythema in the first 2 weeks, and more than half described adverse effects of treatment as severe (21%) or moderate (40%). But almost 90% said they would be willing to be treated again if the treatment was shown to reduce the risk of developing skin cancers, the authors wrote.
The study was limited by several factors including the potential unblinding of participants because of side effects and by the homogenous study population, the researchers noted. However, the results suggest the potential value of proactive topical treatment to reduce the need for surgery, they said. “It is reasonable at this point to consider the use of a standard and perhaps annual course of topical fluorouracil, 5%, to the face and ears for the reduction of SCC risk in high-risk populations, and potentially for a reduction in need for Mohs surgery; more detailed study could define precisely the groups that would most benefit,” they wrote.
Lead author Dr. Weinstock is employed by the dermatology practice affiliated with Brown University and is director of the dermatoepidemiology division at Brown. He disclosed serving as a consultant to AbbVie, Castle, and Celgene. Another author disclosed having received grant support from Pfizer for an independent research grant. The remaining 23 authors had no disclosures. The study was partly funded by the U.S. Department of Veterans Affairs.
SOURCE: Weinstock, M et al. JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631.
in a population of high-risk older adults.
The findings were published online Jan. 3 in JAMA Dermatology.
Although topical fluorouracil can help reduce actinic keratoses and cure some superficial basal cell and squamous cell carcinomas, it has not been studied as a strategy to prevent the development of lesions that might require surgery, wrote Martin A. Weinstock, MD, PhD, of Providence (R.I.) Veterans Affairs Medical Center, and his colleagues (JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631).
Overall, 299 of the 932 participants developed a basal cell carcinoma and 108 developed an SCC over 4 years of follow-up (the median follow-up was 2.8 years). During the 4-year follow-up, no effect was seen on SCC or BCC.
But during the first year, significantly fewer participants in the fluorouracil group than in the control group developed an SCC (5 vs. 20), representing a 75% reduction in the risk of SCCs needing surgery (P = .002).
The number of participants who developed a BCC during the study period was not significantly different between the treatment and control groups (45 vs. 50). During the first year, the BCC risk was reduced by 11%, but it was not statistically significant.
Most patients in the treated group experienced erythema in the first 2 weeks, and more than half described adverse effects of treatment as severe (21%) or moderate (40%). But almost 90% said they would be willing to be treated again if the treatment was shown to reduce the risk of developing skin cancers, the authors wrote.
The study was limited by several factors including the potential unblinding of participants because of side effects and by the homogenous study population, the researchers noted. However, the results suggest the potential value of proactive topical treatment to reduce the need for surgery, they said. “It is reasonable at this point to consider the use of a standard and perhaps annual course of topical fluorouracil, 5%, to the face and ears for the reduction of SCC risk in high-risk populations, and potentially for a reduction in need for Mohs surgery; more detailed study could define precisely the groups that would most benefit,” they wrote.
Lead author Dr. Weinstock is employed by the dermatology practice affiliated with Brown University and is director of the dermatoepidemiology division at Brown. He disclosed serving as a consultant to AbbVie, Castle, and Celgene. Another author disclosed having received grant support from Pfizer for an independent research grant. The remaining 23 authors had no disclosures. The study was partly funded by the U.S. Department of Veterans Affairs.
SOURCE: Weinstock, M et al. JAMA Dermatol. 2017 Jan 3. doi: 10.1001/jamadermatol.2017.3631.
FROM JAMA DERMATOLOGY
Key clinical point: Treatment with topical fluorouracil for 2-4 weeks significantly reduced the risk of squamous cell carcinoma in a high-risk population.
Major finding: After a year of treatment, topical fluorouracil reduced the risk of SCC that would need surgery by 75% compared with a placebo.
Data source: A randomized trial of 932 veterans, most of whom were male, at high risk for keratinocyte carcinoma.
Disclosures: Lead author Martin Weinstock, MD, has served as a consultant to AbbVie, Castle, and Celgene. Another author disclosed having received grant support from Pfizer for an independent research grant. The remaining 23 authors had no disclosures. The study was partly funded by the U.S. Department of Veterans Affairs.
Source: Weinstock, M et al. JAMA Dermatol. 2017 Jan 3; doi:10.1001/jamadermatol.2017.3631
Children of moms with RA have higher risk of RA, too
The prevalence of rheumatoid arthritis, as well as thyroid disease and epilepsy, was significantly higher in children whose mothers had RA, according to data from a nationwide cohort study in Denmark.
RA runs in families, and many women with RA are concerned about the possible impact of their disease on a developing fetus, wrote Line R. Jølving of Odense (Denmark) University Hospital and the University of Southern Denmark in Odense and her colleagues in Arthritis Care & Research. “However, we do not have sufficient knowledge on the association between maternal RA and long-term chronic childhood outcomes, and still we do not know which specific chronic diseases to be especially aware of in children of women with RA,” they said.
Overall, the risk of RA was almost three times as high for the children of mothers with RA (hazard ratio, 2.89) as it was for the children of women without RA. In addition, the risk of thyroid disease was more than twice as high (HR, 2.19), and the risk of epilepsy was more than 50% higher (HR, 1.61). Maternal RA during pregnancy had no significant impact on children’s anxiety and personality disorders or on the presence of chronic lung disease.
Mothers with RA were generally older than were those without the condition. The children of mothers with RA were significantly more likely to be born via cesarean section, preterm, and small for gestational age, the researchers said.
The results were limited by the potential inclusion of misclassified diagnoses of child outcomes and by the lack of data on medication use. In addition, the study was not designed to determine the effect of biologic mechanisms or genes, the researchers said. Despite these limitations, “the findings in this study are relevant for pediatricians, rheumatologists, and general practitioners in order to have special awareness of early symptoms of RA, thyroid disease, and epilepsy in offspring of mothers with RA,” they said.
The researchers had no financial conflicts to disclose. The study was funded by several sources, including the Region of Southern Denmark, the University of Southern Denmark in Odense, the Center for Clinical Epidemiology, Odense University Hospital, and the Colitis-Crohn Association in Denmark.
SOURCE: Jølving L et al. Arthritis Care Res. 2017 Dec 11. doi: 10.1002/acr.23461.
The prevalence of rheumatoid arthritis, as well as thyroid disease and epilepsy, was significantly higher in children whose mothers had RA, according to data from a nationwide cohort study in Denmark.
RA runs in families, and many women with RA are concerned about the possible impact of their disease on a developing fetus, wrote Line R. Jølving of Odense (Denmark) University Hospital and the University of Southern Denmark in Odense and her colleagues in Arthritis Care & Research. “However, we do not have sufficient knowledge on the association between maternal RA and long-term chronic childhood outcomes, and still we do not know which specific chronic diseases to be especially aware of in children of women with RA,” they said.
Overall, the risk of RA was almost three times as high for the children of mothers with RA (hazard ratio, 2.89) as it was for the children of women without RA. In addition, the risk of thyroid disease was more than twice as high (HR, 2.19), and the risk of epilepsy was more than 50% higher (HR, 1.61). Maternal RA during pregnancy had no significant impact on children’s anxiety and personality disorders or on the presence of chronic lung disease.
Mothers with RA were generally older than were those without the condition. The children of mothers with RA were significantly more likely to be born via cesarean section, preterm, and small for gestational age, the researchers said.
The results were limited by the potential inclusion of misclassified diagnoses of child outcomes and by the lack of data on medication use. In addition, the study was not designed to determine the effect of biologic mechanisms or genes, the researchers said. Despite these limitations, “the findings in this study are relevant for pediatricians, rheumatologists, and general practitioners in order to have special awareness of early symptoms of RA, thyroid disease, and epilepsy in offspring of mothers with RA,” they said.
The researchers had no financial conflicts to disclose. The study was funded by several sources, including the Region of Southern Denmark, the University of Southern Denmark in Odense, the Center for Clinical Epidemiology, Odense University Hospital, and the Colitis-Crohn Association in Denmark.
SOURCE: Jølving L et al. Arthritis Care Res. 2017 Dec 11. doi: 10.1002/acr.23461.
The prevalence of rheumatoid arthritis, as well as thyroid disease and epilepsy, was significantly higher in children whose mothers had RA, according to data from a nationwide cohort study in Denmark.
RA runs in families, and many women with RA are concerned about the possible impact of their disease on a developing fetus, wrote Line R. Jølving of Odense (Denmark) University Hospital and the University of Southern Denmark in Odense and her colleagues in Arthritis Care & Research. “However, we do not have sufficient knowledge on the association between maternal RA and long-term chronic childhood outcomes, and still we do not know which specific chronic diseases to be especially aware of in children of women with RA,” they said.
Overall, the risk of RA was almost three times as high for the children of mothers with RA (hazard ratio, 2.89) as it was for the children of women without RA. In addition, the risk of thyroid disease was more than twice as high (HR, 2.19), and the risk of epilepsy was more than 50% higher (HR, 1.61). Maternal RA during pregnancy had no significant impact on children’s anxiety and personality disorders or on the presence of chronic lung disease.
Mothers with RA were generally older than were those without the condition. The children of mothers with RA were significantly more likely to be born via cesarean section, preterm, and small for gestational age, the researchers said.
The results were limited by the potential inclusion of misclassified diagnoses of child outcomes and by the lack of data on medication use. In addition, the study was not designed to determine the effect of biologic mechanisms or genes, the researchers said. Despite these limitations, “the findings in this study are relevant for pediatricians, rheumatologists, and general practitioners in order to have special awareness of early symptoms of RA, thyroid disease, and epilepsy in offspring of mothers with RA,” they said.
The researchers had no financial conflicts to disclose. The study was funded by several sources, including the Region of Southern Denmark, the University of Southern Denmark in Odense, the Center for Clinical Epidemiology, Odense University Hospital, and the Colitis-Crohn Association in Denmark.
SOURCE: Jølving L et al. Arthritis Care Res. 2017 Dec 11. doi: 10.1002/acr.23461.
FROM ARTHRITIS CARE & RESEARCH
Key clinical point: Children whose mothers had RA were significantly more likely to have RA, epilepsy, and thyroid problems than children born to mothers without RA.
Major finding: Children of mothers with RA were almost three times as likely to have RA (hazard ratio, 2.89).
Data source: A nationwide cohort study of live births in Denmark that included 2,106 children born to women with RA and 1,378,539 children born to women without RA.
Disclosures: The researchers had no financial conflicts to disclose. The study was funded by several sources, including the Region of Southern Denmark, the University of Southern Denmark in Odense, the Center for Clinical Epidemiology, Odense University Hospital, and the Colitis-Crohn Association in Denmark.
Source: Jølving L et al. Arthritis Care Res. 2017 Dec 11. doi: 10.1002/acr.23461.