Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: In a real-world setting, patients initiating dupilumab reported longstanding moderate-to-severe atopic dermatitis (AD) with frequent type 2 comorbidities and poor quality of life (QoL).

Major finding: Patients reported experiencing AD for a median duration of 17 years, with 93.3% of patients receiving treatments for AD in the previous year, 49.5% receiving systemic medications, and 65.4% reporting a history of ≥1 type 2 inflammatory comorbidities. Overall, 89.2% of patients had a disease severity score of 3/4 (moderate/severe AD) and a mean dermatology life quality index score of 12.7, indicating a severe effect of AD on QoL.

Study details: Findings are from an interim analysis of the ongoing longitudinal, prospective, observational PROSE study including 315 adults with physician-diagnosed AD who initiated dupilumab.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees and shareholders of Regeneron Pharmaceuticals or Sanofi, and the other authors reported ties with various sources, including Sanofi and Regeneron.

Source: Bagel J et al. Baseline demographics and severity and burden of atopic dermatitis in adult patients initiating dupilumab treatment in a real-world registry (PROSE). Dermatol Ther (Heidelb). 2022 (May 20). Doi: 10.1007/s13555-022-00742-w

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Face masks worn during the COVID-19 pandemic increased the quality of life by covering facial eczemas and increased the efficacy of dupilumab therapy by minimizing exposure to allergens and air pollution in patients with atopic dermatitis (AD).

Major finding: Although the prevalence of facial eczema was similar before and after the COVID-19 pandemic (P = .7618), patients with AD showed improved Dermatology Life Quality Index scores at baseline (13.14 vs. 23.06; P < .0001) along with a higher reduction in Eczema Area and Severity Index scores after 16 weeks of dupilumab treatment (−21.46 vs. −17.83; P = .0001) in the post- vs. pre-pandemic period.

Study details: Findings are from a retrospective study including 64 adults with moderate-to-severe AD who were assessed for facial involvement at baseline and after 16 weeks of dupilumab therapy in both the pre- and post-pandemic periods.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Vanessa M et al. Facial dermatoses and use of protective mask during Covid-19 pandemic: A clinical and psychological evaluation in patients affected by moderate–severe atopic dermatitis under treatment with dupilumab. Dermatol Ther. 2022; e15573 (May 10). Doi: 10.1111/dth.15573

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Probiotic supplementation reduced the clinical severity of atopic dermatitis (AD) and improved the quality of life (QoL) in adults with AD compared with control intervention.

Major finding: Probiotic vs. control intervention significantly reduced the clinical severity of AD in both the short-term (standard mean difference [SMD] 0.63; P = .04) and long-term (SMD 1.57; P < .001) and significantly improved the long-term QoL (SMD 0.74; P < .001), with a mixture of Lactobacillus salivarius and Bifidobacterium being the best supplementation for both short- and long-term outcomes (surface under the cumulative ranking 95.2%).

Study details: Finding are from a meta-analysis of nine studies including 402 adults who received probiotic supplementation (patients with AD; n = 208) or placebo or standard treatment only (control individuals; n = 194).

Disclosures: This study was supported by the Medical and Health Research Project of China Aerospace Science and Industry Corporation. The authors declared no conflicts of interest.

Source: Li Y et al. The efficacy of probiotics supplementation for the treatment of atopic dermatitis in adults: A systematic review and meta-analysis. J Dermatolog Treat. 2022 (Jun 7). Doi: 10.1080/09546634.2022.2080170

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Children born to mothers who received probiotics vs. placebo during gestation or 1 year after childbirth showed a lower risk for infantile atopic dermatitis (AD), but a similar risk for immunoglobulin E (IgE)-associated infantile AD or sensitive constitution.

Major finding: Children born to mothers in the probiotics vs. placebo group showed a lower risk for infantile AD (risk ratio [RR] 0.86; 95% CI 0.78-0.95), although the risk for IgE-associated infantile AD (RR 0.98; 95% CI 0.79-1.22) or sensitive constitution (RR 0.93; 95% CI 0.81-1.08) was similar between both the treatment groups.

Study details: Findings are from a meta-analysis of eight randomized controlled trials including 2575 infants born to mothers who received probiotics or placebo during gestation or 1 year after birth.

Disclosures: This study did not report any source of funding. The authors declared no conflicts of interest.

Source: Pan H, Su J. Association of probiotics with atopic dermatitis among infant: A meta-analysis of randomized controlled trials. Oxid Med Cell Longev. 2022;2022:5080190 (May 23). Doi: 10.1155/2022/5080190

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Key clinical point: Dupilumab led to clinically meaningful improvements in atopic dermatitis (AD) severity, extent, and itch severity in a real-world population of adults with moderate-to-severe AD.

Major finding: At 4 months, the Investigator’s Global Assessment score reduced by ≥1 point in 81.8% of patients and by ≥2 points in 62.8% of patients. Additionally, at 4 months, the mean itch severity score and affected body surface area reduced from 7.0 to 2.8 and from 39.3% to 16.3% (both P < .0001), respectively, with improvements being significant regardless of age, sex, or treatment history (all P < .0001).

Study details: Findings are from a retrospective, observational study based on electronic medical records of adults with moderate-to-severe AD who were evaluated at 4 months after initiating dupilumab.

Disclosures: This study was funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Four authors declared being current or former employees and stockholders of Sanofi or Regeneron Pharmaceuticals. The other authors declared ties with various sources, including Regeneron and Sanofi.

Source: Eichenfield LF et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: Analysis of an electronic medical records dataset. Dermatol Ther (Heidelb). 2022 (May 11). Doi: 10.1007/s13555-022-00731-z

Human papilloma virus (HPV) vaccination coverage of at least one dose significantly increased in U.S. adolescents from 56.1% in 2015 to 75.4% in 2020, according to the National Immunization Survey–Teen (NIS-Teen).

The telephone survey, conducted among the parents or guardians of children ages 13-17, found a faster increase in coverage among males than females: 4.7 percentage points annually versus 2.7 percentage points annually. With yearly overall survey samples ranging from 21,875 to 17,970, these coverage differences between males and females narrowed over the 5 years of the survey period.

The difference between coverage among males and females decreased from 13 to 3 percentage points. Traditionally, parents of boys have been less likely to vaccinate their sons against HPV.

Despite the increase in uptake, however, in 2020 about 25% of adolescents had not received at least one dose of HPV vaccine. “Targeted strategies are needed to increase coverage and narrow down inequalities,” Peng-jun Lu, MD, PhD, of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, and colleagues wrote in Pediatrics.

In other NIS-Teen findings:

• Coverage in 2020 was 73.7% for males and 76.8% for females (P < .05).
• Coverage rose to 80.7% for those with a provider recommendation but was only 51.7% for those without one (P < .05).
• The rate was 80.3% for those with a well-child visit at age 11-12 years and 64.8% for those without (P < .05).
• In multivariable logistic regression, the main characteristics independently associated with a higher likelihood of vaccination included a provider recommendation, age 16-17 years, and being non-Hispanic Black, Hispanic, American Indian, or Alaskan Native.
• Other predictors of vaccination included having Medicaid insurance and having a mother who was widowed, divorced, or separated, or had no more than a high school education.
• Also predictive was having two or more provider contacts in the past 12 months, a well-child visit at age 11-12 years, and one or two vaccine providers (P < .05).
• Coverage among adolescents living in non-metropolitan statistical areas was significantly lower than those living in MSA principal cities in all years assessed (P < .05).

Provider recommendation remains significant and has historically been highly associated with HPV vaccination. In the 2012 NIS-Teen, for example, 15% of parents not intending to have their daughters vaccinated in the next 12 months cited the lack of a provider recommendation.

“To increase HPV vaccination coverage and further reduce HPV-related morbidity and mortality, providers, parents, and adolescents should use every health care visit as a chance to review vaccination histories and ensure that every adolescent receives the HPV vaccine and other needed vaccines,” Dr. Lu and associates wrote. But 18.5% of parents in the survey received no provider recommendation.

“Of note, we found that teenagers who had mothers with more education or who live in more rural communities had a lower likelihood of receiving vaccination against HPV,” Dr. Lu told this news organization. “Further research should be conducted to better understand these findings.”

According to Margaret E. Thew, DNP, FNP-BC, director of adolescent medicine at the Medical College of Wisconsin in Milwaukee, several studies have highlighted resistance to the vaccine among better-educated parents. “Parents with higher education associate the HPV vaccine with sexual activity and consequently refuse,” said Ms. Thew, who was not involved in the NIS-Teen study. “They mistakenly assume that their children are not sexually active and they lack the understanding that HPV is one of the biggest causes of oral cancer.”

Human papilloma virus (HPV) vaccination coverage of at least one dose significantly increased in U.S. adolescents from 56.1% in 2015 to 75.4% in 2020, according to the National Immunization Survey–Teen (NIS-Teen).

The telephone survey, conducted among the parents or guardians of children ages 13-17, found a faster increase in coverage among males than females: 4.7 percentage points annually versus 2.7 percentage points annually. With yearly overall survey samples ranging from 21,875 to 17,970, these coverage differences between males and females narrowed over the 5 years of the survey period.

The difference between coverage among males and females decreased from 13 to 3 percentage points. Traditionally, parents of boys have been less likely to vaccinate their sons against HPV.

Despite the increase in uptake, however, in 2020 about 25% of adolescents had not received at least one dose of HPV vaccine. “Targeted strategies are needed to increase coverage and narrow down inequalities,” Peng-jun Lu, MD, PhD, of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, and colleagues wrote in Pediatrics.

In other NIS-Teen findings:

• Coverage in 2020 was 73.7% for males and 76.8% for females (P < .05).
• Coverage rose to 80.7% for those with a provider recommendation but was only 51.7% for those without one (P < .05).
• The rate was 80.3% for those with a well-child visit at age 11-12 years and 64.8% for those without (P < .05).
• In multivariable logistic regression, the main characteristics independently associated with a higher likelihood of vaccination included a provider recommendation, age 16-17 years, and being non-Hispanic Black, Hispanic, American Indian, or Alaskan Native.
• Other predictors of vaccination included having Medicaid insurance and having a mother who was widowed, divorced, or separated, or had no more than a high school education.
• Also predictive was having two or more provider contacts in the past 12 months, a well-child visit at age 11-12 years, and one or two vaccine providers (P < .05).
• Coverage among adolescents living in non-metropolitan statistical areas was significantly lower than those living in MSA principal cities in all years assessed (P < .05).

Provider recommendation remains significant and has historically been highly associated with HPV vaccination. In the 2012 NIS-Teen, for example, 15% of parents not intending to have their daughters vaccinated in the next 12 months cited the lack of a provider recommendation.

“To increase HPV vaccination coverage and further reduce HPV-related morbidity and mortality, providers, parents, and adolescents should use every health care visit as a chance to review vaccination histories and ensure that every adolescent receives the HPV vaccine and other needed vaccines,” Dr. Lu and associates wrote. But 18.5% of parents in the survey received no provider recommendation.

“Of note, we found that teenagers who had mothers with more education or who live in more rural communities had a lower likelihood of receiving vaccination against HPV,” Dr. Lu told this news organization. “Further research should be conducted to better understand these findings.”

According to Margaret E. Thew, DNP, FNP-BC, director of adolescent medicine at the Medical College of Wisconsin in Milwaukee, several studies have highlighted resistance to the vaccine among better-educated parents. “Parents with higher education associate the HPV vaccine with sexual activity and consequently refuse,” said Ms. Thew, who was not involved in the NIS-Teen study. “They mistakenly assume that their children are not sexually active and they lack the understanding that HPV is one of the biggest causes of oral cancer.”

Human papilloma virus (HPV) vaccination coverage of at least one dose significantly increased in U.S. adolescents from 56.1% in 2015 to 75.4% in 2020, according to the National Immunization Survey–Teen (NIS-Teen).

The telephone survey, conducted among the parents or guardians of children ages 13-17, found a faster increase in coverage among males than females: 4.7 percentage points annually versus 2.7 percentage points annually. With yearly overall survey samples ranging from 21,875 to 17,970, these coverage differences between males and females narrowed over the 5 years of the survey period.

The difference between coverage among males and females decreased from 13 to 3 percentage points. Traditionally, parents of boys have been less likely to vaccinate their sons against HPV.

Despite the increase in uptake, however, in 2020 about 25% of adolescents had not received at least one dose of HPV vaccine. “Targeted strategies are needed to increase coverage and narrow down inequalities,” Peng-jun Lu, MD, PhD, of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention in Atlanta, and colleagues wrote in Pediatrics.

In other NIS-Teen findings:

• Coverage in 2020 was 73.7% for males and 76.8% for females (P < .05).
• Coverage rose to 80.7% for those with a provider recommendation but was only 51.7% for those without one (P < .05).
• The rate was 80.3% for those with a well-child visit at age 11-12 years and 64.8% for those without (P < .05).
• In multivariable logistic regression, the main characteristics independently associated with a higher likelihood of vaccination included a provider recommendation, age 16-17 years, and being non-Hispanic Black, Hispanic, American Indian, or Alaskan Native.
• Other predictors of vaccination included having Medicaid insurance and having a mother who was widowed, divorced, or separated, or had no more than a high school education.
• Also predictive was having two or more provider contacts in the past 12 months, a well-child visit at age 11-12 years, and one or two vaccine providers (P < .05).
• Coverage among adolescents living in non-metropolitan statistical areas was significantly lower than those living in MSA principal cities in all years assessed (P < .05).

Provider recommendation remains significant and has historically been highly associated with HPV vaccination. In the 2012 NIS-Teen, for example, 15% of parents not intending to have their daughters vaccinated in the next 12 months cited the lack of a provider recommendation.

“To increase HPV vaccination coverage and further reduce HPV-related morbidity and mortality, providers, parents, and adolescents should use every health care visit as a chance to review vaccination histories and ensure that every adolescent receives the HPV vaccine and other needed vaccines,” Dr. Lu and associates wrote. But 18.5% of parents in the survey received no provider recommendation.

“Of note, we found that teenagers who had mothers with more education or who live in more rural communities had a lower likelihood of receiving vaccination against HPV,” Dr. Lu told this news organization. “Further research should be conducted to better understand these findings.”

According to Margaret E. Thew, DNP, FNP-BC, director of adolescent medicine at the Medical College of Wisconsin in Milwaukee, several studies have highlighted resistance to the vaccine among better-educated parents. “Parents with higher education associate the HPV vaccine with sexual activity and consequently refuse,” said Ms. Thew, who was not involved in the NIS-Teen study. “They mistakenly assume that their children are not sexually active and they lack the understanding that HPV is one of the biggest causes of oral cancer.”

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Key clinical point: Patients with atopic dermatitis (AD) experience a fluctuation in depression severity over time, with the likelihood of experiencing depressive symptoms being the highest in patients with severe AD.

Major finding: Among patients with ≥2 follow-up visits, most (49.46%) experienced a fluctuation in depression severity, whereas 45.65% experienced a persistent severity of depression. High Eczema Area Severity Index (adjusted odds ratio [aOR] 7.622; 95% CI 3.881-14.968) and itch (aOR 14.745; 95% CI 4.696-46.297) scores were strongly associated with difficulty in concentrating over time.

Study details: Findings are from a longitudinal, dermatology practice-based study including 695 adults with AD who were evaluated at baseline and at every 6-month follow-up visits.

Disclosures: This study was funded by the US Agency for Healthcare Research and Quality, the Dermatology Foundation, and Galderma. R Chavda and S Gabriel declared being employees of Galderma, and JI Silverberg declared serving as a consultant for Galderma.

Source: Chatrath S et al. Longitudinal course and predictors of depressive symptoms in atopic dermatitis.  J Am Acad Dermatol. 2022 (May 9). Doi: 10.1016/j.jaad.2022.04.061

Hypertensive disorders of pregnancy (HDP) are associated with a greater than twofold risk of developing hypertension a decade later, new research suggests.

Investigators prospectively studied patients who had and who had not experienced HDP 10 years earlier; most self-identified as Black. They found that those with a history of HDP had a 2.4-fold higher risk for new hypertension than those without such a history.

Patients who developed hypertension showed greater left ventricular (LV) remodeling (including greater relative wall thickness), worse diastolic function, more abnormal longitudinal strain, and higher effective arterial elastance than those without hypertension, regardless of the presence or absence of an HDP history.

“We know that patients with preeclampsia are at a higher risk for heart disease later in life, and it seems to be driven by the development of new hypertension,” lead author Lisa Levine, MD, MSCE, director, pregnancy and heart disease program, Hospital of the University of Pennsylvania, Philadelphia, told this news organization.

It is critically important to “study a more diverse population, including a larger percentage of Black patients, since HDP and CVD both disproportionately affect Black women,” Dr. Levine said. “And it is important to screen patients for hypertension, getting them into primary care for visits, getting them diagnosed sooner, and treating them early for hypertension.”

The study was published in the Journal of the American College of Cardiology.
 

Understudied population

HDP includes gestational hypertension and preeclampsia, Dr. Levine explained. “We already know that patients who have had preeclampsia are at higher risk for stroke, heart failure [HF], and myocardial infarction later in life,” she said. The goal of this study was to see whether, instead of waiting 20-30 years, they could look only 10 years later to see which patients would be at highest risk for future heart disease, Dr. Levine said.

In particular, it’s known that cardiovascular disease (CVD) and HDP “disproportionately affect Black women,” Dr. Levine continued. “What makes our study different from other studies is that we focused predominantly on the Black African American population, since it’s understudied and also at highest risk for preeclampsia and heart disease,” she said.

They set out to “evaluate differences in CV risk factors as well as subclinical CVD among a well-characterized group of racially diverse patients with and without a history of HDP 10 years earlier,” the authors state.

To investigate the question, the researchers performed a prospective, cross-sectional study between April 2016 and December 2019 of patients with and without a diagnosis of HDP during a previous pregnancy at least 10 years earlier (from 2005 to 2007). Patients were drawn from a parent cohort in a previously performed observational study of patients with preeclampsia or HDP and normotensive control subjects.

The current study focused on 135 patients (85% Black), 84 with a history of HDP and 51 without. Of the Black patients, 91.7% had a history of HDP, compared with 8.3% of the White patients.

During an in-person visit, the researchers assessed participants’ blood pressure and other clinical risk factors for CVD, including fasting glucose and lipids. They also used noninvasive means to measure cardiac and vascular structure and function.
 

Importance of routine screening

The risk for new hypertension was 2.4 times higher in patients with a history of HDP than in those without HDP, with stage 2 hypertension noted in 56.0% of patients with and in 23.5% without HDP (P < .001). This equates to a relative risk of 2.4 (95% confidence interval, 1.39-4.14), even after adjustment for race, maternal age, body mass index, and history of preterm birth.

“Importantly, 18% of patients with a history of HDP met criteria for a new diagnosis of hypertension identified through the study visit,” the authors report.

There were no differences in many cardiac measures (left ventricular (LV) structure, global longitudinal strain, diastolic function, arterial stiffness, or endothelial function) between patients with and without a history of HDP.

However, patients with chronic hypertension (CHTN), regardless of HDP history, had other cardiac abnormalities, including greater LV remodeling, worse diastolic function, and higher effective arterial elastance.

“The data regarding increased risk of hypertension after HDP is not a novel finding, however our cohort is unique in the high baseline rate of stage 2 hypertension, even among patients without a history of HDP,” the authors comment.

In fact, when they looked at the diagnosis of either stage 1 or stage 2 hypertension, they found that more than 80% of patients with and 60% of patients without a history of HDP had hypertension. Notably, among patients with a history of HDP, only 39% had a formal diagnosis of either stage 1 or stage 2 hypertension, further highlighting “the importance of routine screening for CHTN in this population,” they state.

“Further studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women,” Dr. Levine added.
 

‘Opportunity of a lifetime’

Commenting for this news organization, Malamo Countouris, MD, MS, assistant professor of medicine and codirector, postpartum hypertension program, University of Pittsburgh Medical Center, said hypertension is “underrecognized and undertreated among young, premenopausal, Black women.”

Pregnancy “gives us a clue, through HDP, as to who is high risk to develop chronic hypertension and subsequent subclinical structural cardiac changes in the decade after delivery,” said Dr. Countouris, who was not involved with the study.

“The jury is still out on whether HDP contributes independently to cardiovascular changes in the years after delivery. Ongoing research is needed to clarify the unique or compounding contributions of pregnancy complications and hypertension,” she added.

In an accompanying editorial , Josephine Chou, MD, MS, director of cardio-obstetrics and codirector of maternal cardiology, Yale University, New Haven, Conn., called the study a “laudable contribution to understanding of HDP and hypertension within the first decade after pregnancy,” saying that it “paves the way for future efforts to improve postpartum CV care, enabling us to grasp this opportunity of a lifetime to ultimately reduce maternal and pregnancy-related morbidity and mortality.”

This study was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the American Association of Obstetricians and Gynecologists Foundation. Dr. Levine reports no relevant financial relationships. The other authors’ disclosures are listed on the original paper. Dr. Countouris reports receiving funding from the American Heart Association. Dr. Chou reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertensive disorders of pregnancy (HDP) are associated with a greater than twofold risk of developing hypertension a decade later, new research suggests.

Investigators prospectively studied patients who had and who had not experienced HDP 10 years earlier; most self-identified as Black. They found that those with a history of HDP had a 2.4-fold higher risk for new hypertension than those without such a history.

Patients who developed hypertension showed greater left ventricular (LV) remodeling (including greater relative wall thickness), worse diastolic function, more abnormal longitudinal strain, and higher effective arterial elastance than those without hypertension, regardless of the presence or absence of an HDP history.

“We know that patients with preeclampsia are at a higher risk for heart disease later in life, and it seems to be driven by the development of new hypertension,” lead author Lisa Levine, MD, MSCE, director, pregnancy and heart disease program, Hospital of the University of Pennsylvania, Philadelphia, told this news organization.

It is critically important to “study a more diverse population, including a larger percentage of Black patients, since HDP and CVD both disproportionately affect Black women,” Dr. Levine said. “And it is important to screen patients for hypertension, getting them into primary care for visits, getting them diagnosed sooner, and treating them early for hypertension.”

The study was published in the Journal of the American College of Cardiology.
 

Understudied population

HDP includes gestational hypertension and preeclampsia, Dr. Levine explained. “We already know that patients who have had preeclampsia are at higher risk for stroke, heart failure [HF], and myocardial infarction later in life,” she said. The goal of this study was to see whether, instead of waiting 20-30 years, they could look only 10 years later to see which patients would be at highest risk for future heart disease, Dr. Levine said.

In particular, it’s known that cardiovascular disease (CVD) and HDP “disproportionately affect Black women,” Dr. Levine continued. “What makes our study different from other studies is that we focused predominantly on the Black African American population, since it’s understudied and also at highest risk for preeclampsia and heart disease,” she said.

They set out to “evaluate differences in CV risk factors as well as subclinical CVD among a well-characterized group of racially diverse patients with and without a history of HDP 10 years earlier,” the authors state.

To investigate the question, the researchers performed a prospective, cross-sectional study between April 2016 and December 2019 of patients with and without a diagnosis of HDP during a previous pregnancy at least 10 years earlier (from 2005 to 2007). Patients were drawn from a parent cohort in a previously performed observational study of patients with preeclampsia or HDP and normotensive control subjects.

The current study focused on 135 patients (85% Black), 84 with a history of HDP and 51 without. Of the Black patients, 91.7% had a history of HDP, compared with 8.3% of the White patients.

During an in-person visit, the researchers assessed participants’ blood pressure and other clinical risk factors for CVD, including fasting glucose and lipids. They also used noninvasive means to measure cardiac and vascular structure and function.
 

Importance of routine screening

The risk for new hypertension was 2.4 times higher in patients with a history of HDP than in those without HDP, with stage 2 hypertension noted in 56.0% of patients with and in 23.5% without HDP (P < .001). This equates to a relative risk of 2.4 (95% confidence interval, 1.39-4.14), even after adjustment for race, maternal age, body mass index, and history of preterm birth.

“Importantly, 18% of patients with a history of HDP met criteria for a new diagnosis of hypertension identified through the study visit,” the authors report.

There were no differences in many cardiac measures (left ventricular (LV) structure, global longitudinal strain, diastolic function, arterial stiffness, or endothelial function) between patients with and without a history of HDP.

However, patients with chronic hypertension (CHTN), regardless of HDP history, had other cardiac abnormalities, including greater LV remodeling, worse diastolic function, and higher effective arterial elastance.

“The data regarding increased risk of hypertension after HDP is not a novel finding, however our cohort is unique in the high baseline rate of stage 2 hypertension, even among patients without a history of HDP,” the authors comment.

In fact, when they looked at the diagnosis of either stage 1 or stage 2 hypertension, they found that more than 80% of patients with and 60% of patients without a history of HDP had hypertension. Notably, among patients with a history of HDP, only 39% had a formal diagnosis of either stage 1 or stage 2 hypertension, further highlighting “the importance of routine screening for CHTN in this population,” they state.

“Further studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women,” Dr. Levine added.
 

‘Opportunity of a lifetime’

Commenting for this news organization, Malamo Countouris, MD, MS, assistant professor of medicine and codirector, postpartum hypertension program, University of Pittsburgh Medical Center, said hypertension is “underrecognized and undertreated among young, premenopausal, Black women.”

Pregnancy “gives us a clue, through HDP, as to who is high risk to develop chronic hypertension and subsequent subclinical structural cardiac changes in the decade after delivery,” said Dr. Countouris, who was not involved with the study.

“The jury is still out on whether HDP contributes independently to cardiovascular changes in the years after delivery. Ongoing research is needed to clarify the unique or compounding contributions of pregnancy complications and hypertension,” she added.

In an accompanying editorial , Josephine Chou, MD, MS, director of cardio-obstetrics and codirector of maternal cardiology, Yale University, New Haven, Conn., called the study a “laudable contribution to understanding of HDP and hypertension within the first decade after pregnancy,” saying that it “paves the way for future efforts to improve postpartum CV care, enabling us to grasp this opportunity of a lifetime to ultimately reduce maternal and pregnancy-related morbidity and mortality.”

This study was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the American Association of Obstetricians and Gynecologists Foundation. Dr. Levine reports no relevant financial relationships. The other authors’ disclosures are listed on the original paper. Dr. Countouris reports receiving funding from the American Heart Association. Dr. Chou reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Hypertensive disorders of pregnancy (HDP) are associated with a greater than twofold risk of developing hypertension a decade later, new research suggests.

Investigators prospectively studied patients who had and who had not experienced HDP 10 years earlier; most self-identified as Black. They found that those with a history of HDP had a 2.4-fold higher risk for new hypertension than those without such a history.

Patients who developed hypertension showed greater left ventricular (LV) remodeling (including greater relative wall thickness), worse diastolic function, more abnormal longitudinal strain, and higher effective arterial elastance than those without hypertension, regardless of the presence or absence of an HDP history.

“We know that patients with preeclampsia are at a higher risk for heart disease later in life, and it seems to be driven by the development of new hypertension,” lead author Lisa Levine, MD, MSCE, director, pregnancy and heart disease program, Hospital of the University of Pennsylvania, Philadelphia, told this news organization.

It is critically important to “study a more diverse population, including a larger percentage of Black patients, since HDP and CVD both disproportionately affect Black women,” Dr. Levine said. “And it is important to screen patients for hypertension, getting them into primary care for visits, getting them diagnosed sooner, and treating them early for hypertension.”

The study was published in the Journal of the American College of Cardiology.
 

Understudied population

HDP includes gestational hypertension and preeclampsia, Dr. Levine explained. “We already know that patients who have had preeclampsia are at higher risk for stroke, heart failure [HF], and myocardial infarction later in life,” she said. The goal of this study was to see whether, instead of waiting 20-30 years, they could look only 10 years later to see which patients would be at highest risk for future heart disease, Dr. Levine said.

In particular, it’s known that cardiovascular disease (CVD) and HDP “disproportionately affect Black women,” Dr. Levine continued. “What makes our study different from other studies is that we focused predominantly on the Black African American population, since it’s understudied and also at highest risk for preeclampsia and heart disease,” she said.

They set out to “evaluate differences in CV risk factors as well as subclinical CVD among a well-characterized group of racially diverse patients with and without a history of HDP 10 years earlier,” the authors state.

To investigate the question, the researchers performed a prospective, cross-sectional study between April 2016 and December 2019 of patients with and without a diagnosis of HDP during a previous pregnancy at least 10 years earlier (from 2005 to 2007). Patients were drawn from a parent cohort in a previously performed observational study of patients with preeclampsia or HDP and normotensive control subjects.

The current study focused on 135 patients (85% Black), 84 with a history of HDP and 51 without. Of the Black patients, 91.7% had a history of HDP, compared with 8.3% of the White patients.

During an in-person visit, the researchers assessed participants’ blood pressure and other clinical risk factors for CVD, including fasting glucose and lipids. They also used noninvasive means to measure cardiac and vascular structure and function.
 

Importance of routine screening

The risk for new hypertension was 2.4 times higher in patients with a history of HDP than in those without HDP, with stage 2 hypertension noted in 56.0% of patients with and in 23.5% without HDP (P < .001). This equates to a relative risk of 2.4 (95% confidence interval, 1.39-4.14), even after adjustment for race, maternal age, body mass index, and history of preterm birth.

“Importantly, 18% of patients with a history of HDP met criteria for a new diagnosis of hypertension identified through the study visit,” the authors report.

There were no differences in many cardiac measures (left ventricular (LV) structure, global longitudinal strain, diastolic function, arterial stiffness, or endothelial function) between patients with and without a history of HDP.

However, patients with chronic hypertension (CHTN), regardless of HDP history, had other cardiac abnormalities, including greater LV remodeling, worse diastolic function, and higher effective arterial elastance.

“The data regarding increased risk of hypertension after HDP is not a novel finding, however our cohort is unique in the high baseline rate of stage 2 hypertension, even among patients without a history of HDP,” the authors comment.

In fact, when they looked at the diagnosis of either stage 1 or stage 2 hypertension, they found that more than 80% of patients with and 60% of patients without a history of HDP had hypertension. Notably, among patients with a history of HDP, only 39% had a formal diagnosis of either stage 1 or stage 2 hypertension, further highlighting “the importance of routine screening for CHTN in this population,” they state.

“Further studies should evaluate the optimal time period to screen for postpartum hypertension and a monitoring plan for these at-risk women,” Dr. Levine added.
 

‘Opportunity of a lifetime’

Commenting for this news organization, Malamo Countouris, MD, MS, assistant professor of medicine and codirector, postpartum hypertension program, University of Pittsburgh Medical Center, said hypertension is “underrecognized and undertreated among young, premenopausal, Black women.”

Pregnancy “gives us a clue, through HDP, as to who is high risk to develop chronic hypertension and subsequent subclinical structural cardiac changes in the decade after delivery,” said Dr. Countouris, who was not involved with the study.

“The jury is still out on whether HDP contributes independently to cardiovascular changes in the years after delivery. Ongoing research is needed to clarify the unique or compounding contributions of pregnancy complications and hypertension,” she added.

In an accompanying editorial , Josephine Chou, MD, MS, director of cardio-obstetrics and codirector of maternal cardiology, Yale University, New Haven, Conn., called the study a “laudable contribution to understanding of HDP and hypertension within the first decade after pregnancy,” saying that it “paves the way for future efforts to improve postpartum CV care, enabling us to grasp this opportunity of a lifetime to ultimately reduce maternal and pregnancy-related morbidity and mortality.”

This study was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the American Association of Obstetricians and Gynecologists Foundation. Dr. Levine reports no relevant financial relationships. The other authors’ disclosures are listed on the original paper. Dr. Countouris reports receiving funding from the American Heart Association. Dr. Chou reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

For generally healthy patients taking isotretinoin for acne and who have no underlying abnormalities or preexisting conditions that warrant further examination, it is sufficient to test ALT and triglycerides once at baseline, ideally within a month prior to the start of treatment, and a second time at peak dose.

Other tests such as complete blood cell counts and basic metabolic panels as well as specific laboratory tests such as LDL and HDL cholesterol should not be routinely monitored.

Those are key conclusions from a Delphi consensus study that included 22 acne experts from five continents and was published in JAMA Dermatology.

“Our results apply findings from recent literature and are in accordance with recent studies that have recommended against excessive laboratory monitoring,” senior corresponding author Arash Mostaghimi, MD, MPA, MPH, and coauthors wrote. “For instance, several studies in both teenagers and adults have shown that routine complete blood cell count laboratory tests are unnecessary without suspicion of an underlying abnormality and that rare abnormalities, if present, either resolved or remained stable without clinical impact on treatment. Likewise, liver function tests and lipid panels ordered at baseline and after 2 months of therapy were deemed sufficient if the clinical context and results do not suggest potential abnormalities.”

The authors also noted that, while published acne management guidelines exist, such as the American Academy of Dermatology work group guidelines and the National Institute for Health and Care Excellence guideline, “the specific recommendations surrounding laboratory monitoring frequency are nonstandardized and often nonspecific.”

To establish a consensus for isotretinoin laboratory monitoring, Dr. Mostaghimi, of the department of dermatology at Brigham and Women’s Hospital, Boston, and colleagues used a Delphi process to administer four rounds of electronic surveys to 22 board-certified dermatologists between 2021 and 2022. The primary outcome measured was whether participants could reach consensus on key isotretinoin lab monitoring parameters. Responses that failed to reach a threshold of 70% indicated no consensus.

The surveyed dermatologists had been in practice for a mean of 23.7 years, 54.5% were female, 54.5% practiced in an academic setting, and 63.9% were based in North America. They reached consensus for checking ALT within a month prior to initiation (89.5%) and at peak dose (89.5%), but not checking monthly (76.2%) or after completing treatment (73.7%). They also reached consensus on checking triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not to check monthly (84.2%) or after completing treatment (73.7%).

Meanwhile, consensus was achieved for not checking complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all > 70%), as well as not checking gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), LDL cholesterol (73.7%), HDL cholesterol (73.7%), or C-reactive protein (77.3%).

“Additional research is required to determine best practices for laboratory measures that did not reach consensus,” the authors wrote. The study results “are intended to guide appropriate clinical decision-making,” they added. “Although our recommendations cannot replace clinical judgment based on the unique circumstances of individual patients, we believe they provide a framework for management of a typical, otherwise healthy patient being treated with isotretinoin for acne. More routine monitoring, or reduced monitoring, should be considered on a case-by-case basis accounting for the unique medical history, circumstances, and baseline abnormalities, if present, of each patient.”

“Practicing dermatologists, including myself, routinely check blood laboratory values during isotretinoin treatment,” said Lawrence J. Green, MD, clinical professor of dermatology at George Washington University, Washington, who was asked to comment on the study. “Even though just a small number of U.S.-based and international acne researchers were involved in this Delphi consensus statement, this article still makes us practicing clinicians feel more comfortable in checking fewer lab chemistries and also less frequently checking labs when we use isotretinoin.

“That said, I don’t think most of us are ready, because of legal reasons, to do that infrequent monitoring” during isotretinoin therapy, Dr. Green added. “I think most dermatologists do not routinely perform CBCs anymore, but we still feel obligated to check triglycerides and liver function more frequently” than recommended in the new study.

Dr. Mostaghimi reported receiving grants and personal fees from Pfizer, personal fees from Eli Lilly, personal fees and licensing from Concert, personal fees from Bioniz, holds equity and advisory board membership from Hims & Hers and Figure 1, personal fees from Digital Diagnostics, and personal fees from AbbVie outside the submitted work. Other authors reported serving as an adviser, a speaker consultant, investigator, and/or board member, or having received honoraria from different pharmaceutical companies; several authors had no disclosures. Dr. Green disclosed that he is a speaker, consultant, or investigator for numerous pharmaceutical companies.

For generally healthy patients taking isotretinoin for acne and who have no underlying abnormalities or preexisting conditions that warrant further examination, it is sufficient to test ALT and triglycerides once at baseline, ideally within a month prior to the start of treatment, and a second time at peak dose.

Other tests such as complete blood cell counts and basic metabolic panels as well as specific laboratory tests such as LDL and HDL cholesterol should not be routinely monitored.

Those are key conclusions from a Delphi consensus study that included 22 acne experts from five continents and was published in JAMA Dermatology.

“Our results apply findings from recent literature and are in accordance with recent studies that have recommended against excessive laboratory monitoring,” senior corresponding author Arash Mostaghimi, MD, MPA, MPH, and coauthors wrote. “For instance, several studies in both teenagers and adults have shown that routine complete blood cell count laboratory tests are unnecessary without suspicion of an underlying abnormality and that rare abnormalities, if present, either resolved or remained stable without clinical impact on treatment. Likewise, liver function tests and lipid panels ordered at baseline and after 2 months of therapy were deemed sufficient if the clinical context and results do not suggest potential abnormalities.”

The authors also noted that, while published acne management guidelines exist, such as the American Academy of Dermatology work group guidelines and the National Institute for Health and Care Excellence guideline, “the specific recommendations surrounding laboratory monitoring frequency are nonstandardized and often nonspecific.”

To establish a consensus for isotretinoin laboratory monitoring, Dr. Mostaghimi, of the department of dermatology at Brigham and Women’s Hospital, Boston, and colleagues used a Delphi process to administer four rounds of electronic surveys to 22 board-certified dermatologists between 2021 and 2022. The primary outcome measured was whether participants could reach consensus on key isotretinoin lab monitoring parameters. Responses that failed to reach a threshold of 70% indicated no consensus.

The surveyed dermatologists had been in practice for a mean of 23.7 years, 54.5% were female, 54.5% practiced in an academic setting, and 63.9% were based in North America. They reached consensus for checking ALT within a month prior to initiation (89.5%) and at peak dose (89.5%), but not checking monthly (76.2%) or after completing treatment (73.7%). They also reached consensus on checking triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not to check monthly (84.2%) or after completing treatment (73.7%).

Meanwhile, consensus was achieved for not checking complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all > 70%), as well as not checking gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), LDL cholesterol (73.7%), HDL cholesterol (73.7%), or C-reactive protein (77.3%).

“Additional research is required to determine best practices for laboratory measures that did not reach consensus,” the authors wrote. The study results “are intended to guide appropriate clinical decision-making,” they added. “Although our recommendations cannot replace clinical judgment based on the unique circumstances of individual patients, we believe they provide a framework for management of a typical, otherwise healthy patient being treated with isotretinoin for acne. More routine monitoring, or reduced monitoring, should be considered on a case-by-case basis accounting for the unique medical history, circumstances, and baseline abnormalities, if present, of each patient.”

“Practicing dermatologists, including myself, routinely check blood laboratory values during isotretinoin treatment,” said Lawrence J. Green, MD, clinical professor of dermatology at George Washington University, Washington, who was asked to comment on the study. “Even though just a small number of U.S.-based and international acne researchers were involved in this Delphi consensus statement, this article still makes us practicing clinicians feel more comfortable in checking fewer lab chemistries and also less frequently checking labs when we use isotretinoin.

“That said, I don’t think most of us are ready, because of legal reasons, to do that infrequent monitoring” during isotretinoin therapy, Dr. Green added. “I think most dermatologists do not routinely perform CBCs anymore, but we still feel obligated to check triglycerides and liver function more frequently” than recommended in the new study.

Dr. Mostaghimi reported receiving grants and personal fees from Pfizer, personal fees from Eli Lilly, personal fees and licensing from Concert, personal fees from Bioniz, holds equity and advisory board membership from Hims & Hers and Figure 1, personal fees from Digital Diagnostics, and personal fees from AbbVie outside the submitted work. Other authors reported serving as an adviser, a speaker consultant, investigator, and/or board member, or having received honoraria from different pharmaceutical companies; several authors had no disclosures. Dr. Green disclosed that he is a speaker, consultant, or investigator for numerous pharmaceutical companies.

For generally healthy patients taking isotretinoin for acne and who have no underlying abnormalities or preexisting conditions that warrant further examination, it is sufficient to test ALT and triglycerides once at baseline, ideally within a month prior to the start of treatment, and a second time at peak dose.

Other tests such as complete blood cell counts and basic metabolic panels as well as specific laboratory tests such as LDL and HDL cholesterol should not be routinely monitored.

Those are key conclusions from a Delphi consensus study that included 22 acne experts from five continents and was published in JAMA Dermatology.

“Our results apply findings from recent literature and are in accordance with recent studies that have recommended against excessive laboratory monitoring,” senior corresponding author Arash Mostaghimi, MD, MPA, MPH, and coauthors wrote. “For instance, several studies in both teenagers and adults have shown that routine complete blood cell count laboratory tests are unnecessary without suspicion of an underlying abnormality and that rare abnormalities, if present, either resolved or remained stable without clinical impact on treatment. Likewise, liver function tests and lipid panels ordered at baseline and after 2 months of therapy were deemed sufficient if the clinical context and results do not suggest potential abnormalities.”

The authors also noted that, while published acne management guidelines exist, such as the American Academy of Dermatology work group guidelines and the National Institute for Health and Care Excellence guideline, “the specific recommendations surrounding laboratory monitoring frequency are nonstandardized and often nonspecific.”

To establish a consensus for isotretinoin laboratory monitoring, Dr. Mostaghimi, of the department of dermatology at Brigham and Women’s Hospital, Boston, and colleagues used a Delphi process to administer four rounds of electronic surveys to 22 board-certified dermatologists between 2021 and 2022. The primary outcome measured was whether participants could reach consensus on key isotretinoin lab monitoring parameters. Responses that failed to reach a threshold of 70% indicated no consensus.

The surveyed dermatologists had been in practice for a mean of 23.7 years, 54.5% were female, 54.5% practiced in an academic setting, and 63.9% were based in North America. They reached consensus for checking ALT within a month prior to initiation (89.5%) and at peak dose (89.5%), but not checking monthly (76.2%) or after completing treatment (73.7%). They also reached consensus on checking triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not to check monthly (84.2%) or after completing treatment (73.7%).

Meanwhile, consensus was achieved for not checking complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all > 70%), as well as not checking gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), LDL cholesterol (73.7%), HDL cholesterol (73.7%), or C-reactive protein (77.3%).

“Additional research is required to determine best practices for laboratory measures that did not reach consensus,” the authors wrote. The study results “are intended to guide appropriate clinical decision-making,” they added. “Although our recommendations cannot replace clinical judgment based on the unique circumstances of individual patients, we believe they provide a framework for management of a typical, otherwise healthy patient being treated with isotretinoin for acne. More routine monitoring, or reduced monitoring, should be considered on a case-by-case basis accounting for the unique medical history, circumstances, and baseline abnormalities, if present, of each patient.”

“Practicing dermatologists, including myself, routinely check blood laboratory values during isotretinoin treatment,” said Lawrence J. Green, MD, clinical professor of dermatology at George Washington University, Washington, who was asked to comment on the study. “Even though just a small number of U.S.-based and international acne researchers were involved in this Delphi consensus statement, this article still makes us practicing clinicians feel more comfortable in checking fewer lab chemistries and also less frequently checking labs when we use isotretinoin.

“That said, I don’t think most of us are ready, because of legal reasons, to do that infrequent monitoring” during isotretinoin therapy, Dr. Green added. “I think most dermatologists do not routinely perform CBCs anymore, but we still feel obligated to check triglycerides and liver function more frequently” than recommended in the new study.

Dr. Mostaghimi reported receiving grants and personal fees from Pfizer, personal fees from Eli Lilly, personal fees and licensing from Concert, personal fees from Bioniz, holds equity and advisory board membership from Hims & Hers and Figure 1, personal fees from Digital Diagnostics, and personal fees from AbbVie outside the submitted work. Other authors reported serving as an adviser, a speaker consultant, investigator, and/or board member, or having received honoraria from different pharmaceutical companies; several authors had no disclosures. Dr. Green disclosed that he is a speaker, consultant, or investigator for numerous pharmaceutical companies.

Pyogenic granulomas (PGs), also called lobular capillary hemangiomas, manifest as friable, moist or glistening, papules. PGs are a benign vascular proliferation. They often have a collarette, which is subtle in this lesion, and they bleed with minimal trauma. They are commonly seen on the gingiva during pregnancy, the umbilical area in newborns, or at sites of trauma.

Since PGs often occur during pregnancy, it’s been suggested that their development is related to hormonal changes.¹ It’s also been suggested that PGs are the result of an abnormal hypertrophic healing response, as they can occur in men, infants (at the umbilical stump), and even within blood vessels.¹

Although benign and painless, PGs are usually hard to ignore due to their raised appearance, tendency to bleed, and the low likelihood that they will resolve on their own. There are multiple physical treatment options available, including excision with primary closure, curettage followed by electrodessication, laser treatment, and cryosurgery. Topical therapies include timolol (a beta-blocker that has been used successfully with congenital hemangiomas), imiquimod, and trichloroacetic acid.¹ These topical medications do not require any anesthetic, which may make them an appealing option for children. Unfortunately, topical medications require multiple applications over a period of 2 or more weeks.

In this case, the lesion was shaved off and sent out to pathology to rule out amelanotic melanoma. The pathology for this patient confirmed PG. Immediately following the lesion’s removal, the physician performed 2 cycles of curettage and electrodessication. Thus, the patient’s treatment was completed on the same day as her evaluation.

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Photo courtesy of Daniel Stulberg, MD. Text courtesy of Daniel Stulberg, MD, FAAFP, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque.

Pyogenic granulomas (PGs), also called lobular capillary hemangiomas, manifest as friable, moist or glistening, papules. PGs are a benign vascular proliferation. They often have a collarette, which is subtle in this lesion, and they bleed with minimal trauma. They are commonly seen on the gingiva during pregnancy, the umbilical area in newborns, or at sites of trauma.

Since PGs often occur during pregnancy, it’s been suggested that their development is related to hormonal changes.¹ It’s also been suggested that PGs are the result of an abnormal hypertrophic healing response, as they can occur in men, infants (at the umbilical stump), and even within blood vessels.¹

Although benign and painless, PGs are usually hard to ignore due to their raised appearance, tendency to bleed, and the low likelihood that they will resolve on their own. There are multiple physical treatment options available, including excision with primary closure, curettage followed by electrodessication, laser treatment, and cryosurgery. Topical therapies include timolol (a beta-blocker that has been used successfully with congenital hemangiomas), imiquimod, and trichloroacetic acid.¹ These topical medications do not require any anesthetic, which may make them an appealing option for children. Unfortunately, topical medications require multiple applications over a period of 2 or more weeks.

In this case, the lesion was shaved off and sent out to pathology to rule out amelanotic melanoma. The pathology for this patient confirmed PG. Immediately following the lesion’s removal, the physician performed 2 cycles of curettage and electrodessication. Thus, the patient’s treatment was completed on the same day as her evaluation.

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Photo courtesy of Daniel Stulberg, MD. Text courtesy of Daniel Stulberg, MD, FAAFP, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque.

Pyogenic granulomas (PGs), also called lobular capillary hemangiomas, manifest as friable, moist or glistening, papules. PGs are a benign vascular proliferation. They often have a collarette, which is subtle in this lesion, and they bleed with minimal trauma. They are commonly seen on the gingiva during pregnancy, the umbilical area in newborns, or at sites of trauma.

Since PGs often occur during pregnancy, it’s been suggested that their development is related to hormonal changes.¹ It’s also been suggested that PGs are the result of an abnormal hypertrophic healing response, as they can occur in men, infants (at the umbilical stump), and even within blood vessels.¹

Although benign and painless, PGs are usually hard to ignore due to their raised appearance, tendency to bleed, and the low likelihood that they will resolve on their own. There are multiple physical treatment options available, including excision with primary closure, curettage followed by electrodessication, laser treatment, and cryosurgery. Topical therapies include timolol (a beta-blocker that has been used successfully with congenital hemangiomas), imiquimod, and trichloroacetic acid.¹ These topical medications do not require any anesthetic, which may make them an appealing option for children. Unfortunately, topical medications require multiple applications over a period of 2 or more weeks.

In this case, the lesion was shaved off and sent out to pathology to rule out amelanotic melanoma. The pathology for this patient confirmed PG. Immediately following the lesion’s removal, the physician performed 2 cycles of curettage and electrodessication. Thus, the patient’s treatment was completed on the same day as her evaluation.

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Photo courtesy of Daniel Stulberg, MD. Text courtesy of Daniel Stulberg, MD, FAAFP, Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque.