This month’s news from across the specialty
What’s hot
December 1, 2023
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Our surgical prep may benefit non-surgical elderly patients. A study of extended bacterial decolonization in 28,956 nursing home residents in 28 nursing homes found decreased hospitalizations relative to residents in the control arm (doi: 10.1056/NEJMoa2215254). The residents in the treatment arm received nasal iodophor/chlorhexidine BID five times a days every other week AND a chlorhexidine bath (4% for rinse off bathing, 2% for bed bathing) on admission and then for all routine bathing. Both arms of the study were followed for 18 months before the intervention (15,004 residents). After a four-month, phase-in period to train the staff and supply the treatment arm homes, both arms were followed for an additional 18 months (13,952 residents). The intervention was recorded as both intention to treat and additionally with assessment of adherence to protocol. For the primary outcome of rate of admissions related to infection, the number needed to treat was 9.7 to prevent one infection-related hospitalization. As we consider our post-operative care protocols for recommending chlorhexidine washes for surgical sites with a high risk for infection, we might consider extending the treatment population and duration of treatment to all our patients, forever.
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Small vessel vasculitis is distressing, not only for the patient and their family members, but also for their treating physicians. While we know that most cases of leukocytoclastic vasculitis (LCV) are idiopathic and skin limited, rarer associations with underlying connective tissue disease and cancer may lead to unnecessary and costly work-up.
It is with interest that I read about one of the larger retrospective analyses of leukocytoclastic vasculitis (LCV) that covered adults presenting with an initial episode of LCV (J Am Acad Dermatol. 2023 Sep;89(3):582-584). Records of biopsy-proven LCV at Massachusetts General Hospital, Brigham and Women’s Hospital, and the Hospital of the University of Pennsylvania, from 2000-2014, were identified and reviewed.
440 patients were studied: average age was 55 years, and 56% were male. 80% of cases were skin-limited, and 60% of those cases were idiopathic. Of the skin-limited cases, most common identified causes were medications (27.5%) and infection (9.9%). Cancer was an identified cause in only 1.6% of skin-limited LCV cases. Cases were deemed skin-limited or nonsystemic if there was no associated systemic disease or internal organ involvement. Among cases attributed to systemic disease, the most common associated systemic diseases were IgA vasculitis / HSP (12.0% of total LCV cases) and connective tissue disease-associated vasculitis (3.0% of total LCV cases).
Overall, 92% of LCV cases in this study were skin-limited (80%) or associated with igA vasculitis (12%). Patients with LCV related to underlying systemic disease tended to have symptoms related to systemic involvement. Altogether, this is a great reminder to pursue a diligent yet cost-effective evaluation.
As dermatologists, we always advocate for excellent protection against ultraviolet light exposure, but we speak less frequently about the effects of visible light on the health and cosmesis of the skin. Emerging research suggests we should be thinking about the effects of visible light, as well, particularly for our patients with Fitzpatrick skin type III and greater who are prone to pigmentary disturbances.
Visible light in the 400-700nm wavelength range comprises approximately 45% of all solar radiation and can worsen pigmentary disorders such as melasma, as well as induce erythema. Many traditional sunscreen products (both chemical and physical blockers) provide limited protection in this range. However, sunscreens that contain pigments — so called “tinted sunscreens” — as well as those with metal oxides as the active ingredient can provide additional coverage due to their ability to absorb, scatter, and reflect visible light.
When making sunscreen recommendations to our patients who develop erythema rapidly upon exposure to light or struggle with dyschromia, recommending tinted or metal oxide-containing sunscreens may help not only by providing some cosmetic coverage at the time of application, but also a reduction in progression long-term.
Occupational hand dermatitis (OHD) is an extremely common occupational disease, especially in the health care setting where up to 30% of health care workers can be impacted. The increased prevalence seen in the health care group is due in part to the substantial wet work, hand washing, and glove usage that is part of this group of workers’ daily routine. OHD impacts the employee with sick leave, disability, job loss, and decreased quality of life. OHD also impacts employers and society as well due to disability and lost workdays.
A recent study looked at educational training of health care workers prior to the job starting to reduce occupational disease (Dermatitis. 34(5): 413-418. 2023). The authors focused on prevention, early identification, and management of hand dermatitis and found that a 10-minute online training module significantly improved the average knowledge of OHD by 19%. At a six-month follow-up survey, participants scored higher than they did in the pretraining test indicating retention of the information gained. After initial training, 72.8% of participants indicated they would make at least one modification to their behavior related to skin care practices because of the training. At the six-month follow-up, 70% of participants, reported a change in hand care habits because of the education.
This study demonstrates that a short online training module was successful in improving OHD knowledge, knowledge retention, and improved skin care practices. This emphasizes the importance of expert-controlled education in a usable format and demonstrates it can have a significant impact on reducing or preventing OHD in the health care setting. Dermatologists should and can play a key role in creating and supporting these educational efforts to help reduce OHD in health care environments.
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup.
