Isotretinoin and the risk of psychiatric events in acne patients
A study published in JAAD compared the risk of nine psychiatric outcomes among patients with acne treated with isotretinoin versus oral antibiotics. The authors found there was a similar risk of suicide attempt between the two treatment groups; however, there was a higher risk of suicidal ideation in the isotretinoin group. Patients treated with isotretinoin experienced a lower risk of depression, post-traumatic stress disorder, anxiety, bipolar disorder, schizophrenia, and adjustment disorder. Compared with oral antibiotics, treatment with isotretinoin is not associated with an increased risk of suicide attempts in patients with acne.
What’s new in adult acne over the past few years? Find out in DermWorld Weekly.
DermWorld Insights and Inquiries: Holiday greeting 2022
Soaked and nervous by the end of the 8th inning with the Phillies down by a run, I turned to my daughter Andrea and whispered, “JT Realmuto needs to get on base any way he can — a single, error, or hit by a pitch — and let Harper have his Hall of Fame iconic moment.” It was more prayer than prediction. Within seconds there was “Bedlam at the Bank” as Bryce propelled a drive through the rain into the left field seats, overtaking the Padres in game 5 of the NLCS, leading to the 2022 National League pennant. It was glorious to be absorbed in the pursuit of a pennant and not thinking about the recent events of 2022 — monkeypox, long COVID-19, mass shootings, climate change catastrophes, inflation, election strife, the war in Ukraine, tensions with China, MIPS, impending Medicare cuts, health care inequities, etc., etc. Keep reading!
Risk of skin cancer in patients with chronic cutaneous inflammatory conditions
Authors of a review published in the Journal of the European Academy of Dermatology and Venereology examined the risk of skin cancer development in association with chronic inflammatory cutaneous diseases. Much of the literature indicates that inflammation caused by cutaneous inflammatory conditions may lead to an increased risk of skin cancer, particularly nonmelanoma skin cancer.
[Do tumor-infiltrating lymphocytes predict melanoma outcomes? Find out inDermWorld.]
The association between melanoma is less clear, with some conditions, such as prurigo nodularis and psoriasis, suggesting there is a heightened risk for melanoma, with others, such as atopic dermatitis and lichen sclerosus, suggesting there is no correlation. The authors recommend that physicians regularly monitor and perform skin exams on patients with chronic inflammatory diseases, especially patients who may be more susceptible, such as those on immunosuppressants.
Melanoma controversies: Screening, biopsy practices questioned as incidence rate increases. Read more inDermWorld.
A systematic review published in JAAD evaluated the effects of electronic cigarette (e-cigarette) use on cutaneous wound healing. The review included 13 articles, including case reports, animal studies, and human studies. The case reports found drops in oximeter readings of free flaps and tissue flap necrosis after e-cigarette use. Animal studies found significantly more tissue flap necrosis with e-cigarette exposure compared with controls — at a rate similar to that noted with traditional cigarettes. Human studies also showed a reduction in transcutaneous oxygen tension and blood flow after e-cigarette exposure — with and without nicotine. The authors recommend that physicians counsel patients regarding cessation in the preoperative and postoperative periods.
Dermatologists discuss perioperative management of patients on anticoagulant therapy inDermWorld.
Treating hidradenitis suppurativa with upadacitinib
A retrospective cohort study published in JAAD identified 20 patients with moderate-to-severe hidradenitis suppurative (HS) treated with the JAK1 inhibitor upadacitinib. All patients received upadacitinib 15 mg per day until week four. Those not achieving HS clinical response (HiSCR) at week four were increased to 30 mg per day. Patients were reviewed at 12 and 24 weeks. At week four, 75% of the patients achieved HiSCR50, which increased to 100% at week 12. The pain rating scores and quality of life scores improved significantly by week four. Escalation to 30-mg dosing was strongly associated with improved outcomes in Hurley stage 3 disease. Overall, the authors found their single-center experience of upadacitinib monotherapy for HS was positive, with high levels of clinical response and no serious adverse effects.
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