How effective are field treatments for actinic keratosis?
Authors of a review published in Dermatologic Surgery evaluated the efficacy of field treatments for actinic keratoses (AKs). Overall, the clearance rate was comparable among regimens. The clearance rate was highest with photodynamic therapy (PDT) with BF-200 aminolevulinic acid (ALA) 10% gel (62-91%) and 5-fluorouracil (5-FU) 4% or 5% cream (54%-80%) and lowest with diclofenac sodium 3% gel and imiquimod 3.75% gel.
[A review of calcipotriol plus 5-fluorouracil for actinic keratosis. Read more.]
The estimated cost ranged from $433 (5-FU 4% cream) to $1,503 (5-FU 0.5% cream). Tirbanibulin 1% ointment had an efficacy similar to that of imiquimod. Field therapy with 5-FU and PDT had similar effective cost. When considering patient adherence, ALA-PDT may be the most cost-effective field treatment for AKs, according to the study authors.
Dermatologists discuss how to balance the latest evidence, patient preferences, and clinical experience when treating AKs. Read more in DermWorld.
DermWorld Insights and Inquiries: Saving face — The importance of recognizing facial discoid dermatosis
I get excited when astute dermatologists describe and label dermatoses that I have seen but could not adequately diagnose. Two recent examples include acute inflammatory edema and alpha-gal syndrome. I (and presumably you too) have encountered patients with persistent, well-defined, minimally scaly, erythematous plaques on the face that were psoriasiform, but without other evidence of psoriasis, seborrheic dermatitis, chronic cutaneous (discoid) lupus, tinea, or contact dermatitis. I have biopsied such patients to be certain that these lesions were not keratinocyte carcinomas, with the pathology reports interpreted as psoriasiform dermatitis. I have treated these patients with the proverbial kitchen sink (topical steroids, calcineurin inhibitors, retinoids, excimer laser, etc.) to little avail. Despite the recalcitrance to most therapeutic maneuvers, there have been cases successfully treated with topical calcipotriol combined with clobetasol or betamethasone in combination with low-dose acitretin. Keep reading!
A systematic review of intralesional treatments for plantar warts
Authors of a study published in the Journal of Drugs in Dermatology reviewed emerging intralesional therapies for plantar warts. The review included 26 original peer-reviewed articles on the safety and efficacy of intralesional plantar wart treatments from 2012 to 2021. The following treatments were identified: vitamin D3 (80%), bleomycin (74%), 5-fluorouracil (59%), Candida antigen (66%), zinc sulfate (70%), and purified protein derivative (67%).
[Remedies for warts abound, but high-quality studies are lacking. Read more in DermWorld.]
While intralesional vitamin D3 demonstrated promising results, according to the study authors, it’s not accessible in the United States. Both Candida antigen and bleomycin are superior to cryotherapy and should be considered for treating recalcitrant plantar warts. While the HPV vaccine showed success in case reports, it warrants further study.
Risk of needle contamination, complications with hyaluronic acid fillers
Authors of a study published in Dermatologic Surgery explored whether storing prefilled syringes with residual HA gel for retouches after the first aesthetic procedure led to microbial needle contamination. Following injection procedures, 35 hyaluronic acid gel filler syringes with new sterile needles were stored in refrigerated vaults at 4 degrees Celsius for touch-up procedures.
[Read about filler reversal with hyaluronidase inDermWorld Weekly.]
Prior to the touch-up, swabs of the needles were tested for the presence of Staphylococcus aureus, Streptococcus pyogenes, anaerobic bacteria, and yeasts. All tests were negative for contaminant organisms, and no patients developed any signs or symptoms of infection.
What factors are associated with matching to a dermatology residency?
Authors of a research letter published in JAAD compared matched versus unmatched MD, DO, and international medical graduates (IMG) applicants to determine which factors differed among applicants from 2016, 2018, and 2020. Factors included U.S. Medical Licensing Examination scores, number of contiguous ranks, number of research elements, number of distinct research experiences, and possession of a PhD or graduate degree.
Overall, MD applicants were consistently more likely to match compared with DO and IMG applicants. Matched MD applicants had higher U.S. Medical Licensing Examination scores compared with unmatched MD and matched IMG applicants. Although the number of research elements increased over the years, it was not a deciding factor between matched MD and DO applicants and matched MD and IMG applicants. The mean number of contiguous ranks for matched MD applicants was higher than that for unmatched MD applicants and both unmatched and matched IMG applicants. All MD and IMG applicants were more likely to have a PhD than all DO applicants. In 2020, despite matched U.S. MD and DO applicants having similar applicant profiles, the match favored MD applicants, suggesting the importance of other variables such as access to a home dermatology program or early access to mentors, the authors wrote.
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