Micrographic surgery vs. conventional excision: Reducing rates of BCC, SCC
A study published in the Journal of the European Academy of Dermatology and Venereology assessed recurrence rates of micrographic surgery and conventional excision in patients with nonmelanoma skin cancers. Micrographic surgery had a recurrence rate of 3.1%, whereas conventional excision had a recurrence rate of 5.3%. Subgroup analysis showed a relative risk and an absolute risk difference of 0.37 and 3.7% for basal cell carcinoma and 0.57 and 1.9% for squamous cell carcinoma, respectively. The relative risks for primary and recurrent tumors were 0.39 and 0.67, respectively.
Note: This article originally used the term “Mohs” rather than “Micrographic surgery.” The JEADV study evaluated multiple micrographic surgery techniques. DermWorld Weekly regrets the error.
DermWorld Insights and Inquiries: Senile gluteal dermatosis — The term ‘senile’ is getting old and should be retired
As my patients and I get older, inevitably I think more about geriatric dermatology. There is a disorder I have seen on the gluteal region in mostly thin, older, sedentary patients — my recommendations of off-loading pressure and using mild keratolytics have been reasonable. What I have been unable to provide patients is a name for this condition, likening it to early pressure ulcers, which they are not. It is always reassuring for patients when their disease has a name — increasingly the term “senile gluteal dermatosis” (SGD) has been utilized for this disorder. Honestly, it is better to have a name, rather than none. However, I am not keen on this appellation. I will explain why later in this commentary and will offer an alternative. Keep reading!
Overuse of antifungal treatments could be driving drug-resistant disease
According to new research published in the CDC’s Morbidity and Mortality Weekly Report, the overuse of topical antifungals may be contributing to increasing drug-resistant disease. The report cites drug-resistant forms of ringworm — a form of dermatophytosis — as one of the biggest emerging threats.
[The emergence of Trichophyton indotineae as a global phenomenon. Read more.]
In addition to the outbreak in Southeast Asia, cases of ringworm resistant to drugs have been spotted in 11 U.S. states, according to the report. The researchers believe that antifungal topical creams are being overprescribed. They looked at 2021 Medicare Part D data and found that 6.5 million prescriptions for creams containing antifungals, such as ketoconazole, nystatin, and clotrimazole-betamethasone, were prescribed that year. While primary care doctors wrote the largest percentage of these prescriptions, dermatologists and podiatrists had much higher rates on a prescription-per-doctor basis. In 2021, 10% of antifungal prescribers prescribed nearly one half of these medications.
[Reliable, rapid identification of terbinafine resistance in dermatophytic nail and skin infections. Read more.]
The large volume of topical antifungal prescriptions and the rise of emerging resistant fungal skin infections worldwide highlight the need to evaluate current practices for prescribing and using topical antifungals (including those combined with corticosteroids). The report highlights a need for clinicians to go beyond visual diagnosis and confirm suspected fungal skin infections whenever possible before prescribing.
Dermatologist nail experts discuss onychomycosis as well as increasing resistance to anti-fungal therapies. Read more.
Atypical cutaneous findings of hand-foot-mouth disease
A systematic review published in Pediatric Dermatologyanalyzed data from 85 studies comprising 1,359 pediatric patients with hand-foot-mouth disease (HFMD). The most commonly reported morphologies include vesicles (53%), papules (49%), and bullae (36%), whereas the least common morphologies included eczema herpeticum–like lesions (19%), purpuric/petechial lesions (7%), and Gianotti Crosti–like lesions (4%). Common atypical sites included the arms and/or legs (47%), face (45%), and trunk (27%). Overall, 16% of all patients received treatment, commonly with acyclovir, intravenous antibiotics, and topical steroids.
Safety of biologic therapy in combination with methotrexate in patients with psoriasis
A study published in the British Journal of Dermatology assessed whether combining biologic drugs (TNF, IL-17, and IL-23 inhibitors) with methotrexate in managing patients with moderate-to-severe psoriasis increased the risk of adverse events or serious adverse events compared with biologic monotherapy. The study found that compared with biologic monotherapy, combination treatment with biologic drugs and methotrexate did not significantly increase the overall risk of adverse events or serious adverse events of any treatment group. There was no increased total number of infections or serious infections with patients receiving combined therapy, but a TNF inhibitor plus methotrexate was associated with an increased incidence of gastrointestinal AEs.
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