A review of calcipotriol plus 5-fluorouracil for actinic keratosis
An article published in the Journal of Drugs in Dermatology reviewed four studies that evaluated the use of topical calcipotriol plus 5-fluoruracil (5-FU) for the treatment of actinic keratoses (AK). The addition of calcipotriol to 5-FU was associated with greater reduction in AK, a higher percentage of patients achieving complete clearance, and less risk of progression to squamous cell carcinoma. Calcipotriol plus 5-FU lowered the risk of cSCC on the face and scalp area over a three-year period. However, patients experienced increased burning and severe erythema.
The addition of calcipotriol to 5-FU for the treatment of AK was associated with improved lesion clearance but less tolerability. More studies are needed to compare the efficacy of this combination therapy to 5-FU monotherapy, imiquimod, and tirbanibulin ointment, the authors concluded.
DermWorld Insights and Inquiries: Vascular Ehlers-Danlos syndrome: From rupture to rapture?
If there was a statistic for a dermatologic diagnostic impact factor, vascular Ehlers-Danlos syndrome (vEDS) would be at the top. Often undiagnosed until tragedy strikes, astute dermatologists who consider the diagnosis prior to an acute event may save a life if that patient is proven to have the disease.
vEDS (formerly “type IV” EDS, OMIM 130050) is characterized by the major complications of arterial and bowel rupture, uterine rupture during pregnancy, and the clinical features of easy bruising, thin skin, and visible veins. Joint hypermobility is largely limited to the digits, and skin hyperextensibility is minimal or absent. Two phenotypes have been described — the acrogeric type and the ecchymotic type. Characteristic facies with an emaciated appearance displaying prominent cheek bones and sunken cheeks, sunken or bulging eyes, eyelid telangiectasias, a pinched and thin nose, and thin lips (particularly the upper lip whose edges are undefined) is the hallmark of acrogeric variant of vEDS. One-fourth of individuals with vEDS experience a significant complication by the age of 20 years and 80% by the age of 40 years. vEDS remains a rare subtype of EDS, with an estimated prevalence of 1:90,000. Life expectancy is estimated to be 51 years of age (range six to 80 years), with the diagnosis occurring around 28 years. The median life expectancy of patients with vEDS is less for men at 46 years compared to women at 54 years. Keep reading!
Delayed complications for FDA-approved HA dermal fillers
Authors of a study in Dermatologic Surgeryused the Manufacturer and User Facility Device Experience database to determine adverse event reports for various hyaluronic acid fillers from 2016 to 2021. Of 195 confirmed delayed adverse events, 72% were nodules, 22% were hypersensitivity reactions, and 7% were granulomas. Nodules were most common on the lips. Most events occurred within two to four months after injection.
What every physician needs to know about the Disabilities Act
A recent Health Affairs study suggests that about 36% of doctors are not fully aware of what they are legally required to do to comply with the Americans with Disabilities Act (ADA). When physicians don’t provide access to medical care that patients with disabilities need, they put themselves at greater risk of lawsuits, fines, and settlements, according to an article published in MDedge. According to the study, 71% answered incorrectly about who determines reasonable accommodations, and 68% felt that they were at risk for ADA lawsuits.
[Read about ADA issues in dermatology inDermWorld.]
Under the ADA, medical practices must provide equal access to people with disabilities, accommodate their disability-related needs, and not refuse them medical services because of their disability. In 2008, the ADA was amended to clarify that people with chronic diseases, cognitive and neurological disorders, substance abuse disorders, vision and hearing loss, learning disabilities, and others, are also protected.
[How do you stay compliant with ADA guidelines while treating patients with disabilities? Find out inDermWorld.]
Not only are physicians required to provide reasonable accommodations, but they also have to pay for them, which includes transfer support services, sign language interpreters, or other services. Physicians are also expected to work with patients to determine what reasonable accommodations are needed. Health care lawyers recommend physicians ask patients whether they need help or individual assistance when they make appointments and enter those responses in their records.
Is your dermatology practice’s website ADA compliant? Read more.
Safety of tacrolimus for children with AD
In a study published inClinical and Experimental Dermatology, the authors investigated the safety and efficacy of tacrolimus 0.03% and 0.1% ointments in young children. A total of 152 children with atopic dermatitis (AD) were randomized to use either hydrocortisone cream or tacrolimus ointment and were followed for 36 months.
There was no significant difference in infection rates, and no malignancies were observed during the trial period. About 12% of the tacrolimus group had detectable blood concentrations, although it tended to occur in patients with severe disease. The authors conclude that topical tacrolimus and topical corticosteroids are safe to use in young children with moderate-to-severe AD and have comparable safety and efficacy profiles.
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