Petroleum jelly: Safety, myths, and misconceptions
A review article published in JAAD explores the history of petrolatum and how it is manufactured as well as how its biologic properties make it a great moisturizer. The authors also discuss data on its potential for flammability, allergenicity, carcinogenicity, and comedogenicity — dispelling misconceptions about petrolatum as a cause of acne.
According to the study’s authors petrolatum remains one of the most widely used topical agents with benefits including upregulation in antimicrobial peptides, skin barrier repair, and hydration. It is a useful moisturizer for individuals with sensitive skin because it does not cause burning or stinging when applied, has low allergenic potential, and does not have potentially allergic preservatives. It may increase the risk of cutaneous infection, however, if used in preterm neonates.
[Pediatric dermatologists share clues for distinguishing contact dermatitis from atopic dermatitis and discuss noteworthy allergens in DermWorld.]
Human studies have reported benefits to using petrolatum on wounds. One study compared petrolatum to bacitracin for infection prevention and allergic contact dermatitis at the surgical site and found no significant differences in healing outcomes between the two groups. The petrolatum had a lower incidence of ACD, however. Petrolatum has also been found to be beneficial for patients undergoing narrow band UVB treatment as it can increase transmission of UV radiation resulting in better therapeutic efficacy in psoriasis patients.
Several studies have reported that petrolatum is comedogenic due to its physical properties; however, none of those studies have provided references to support this claim. Petrolatum was initially reported to be comedogenic when mild comedogenicity resulted when it was continuously applied under occlusion for six weeks; however, in a subsequent study the same authors reported improvements in acne papules with petrolatum use.
DermWorld Insights and Inquiries: Reflections on reflectance confocal microscopy for diagnosing benign lichenoid keratoses
At the inception of my dermatology residency in July 1980 I read a brief article titled, “Benign Lichenoid Keratosis” (BLK) by Detlef Goette and thought to myself, “Remember this — I’ll probably see this lesion now and then.” That proved to be the understatement of my career. Clinically, BLKs may resemble a basal cell carcinoma, actinic keratosis, Bowen’s disease, or an amelanotic melanoma. How many thousands of biopsies have I performed because of my uncertainty of the diagnosis of a BLK? Dermatologists are intimately familiar with BLKs, aka lichenoid keratoses or lichen planus-like keratoses. It is hard to fathom that these lesions were new and controversial, being introduced to the dermatology world in 1966 in two articles — a year prior to Super Bowl I when the Green Bay Packers trounced the Kansas City Chiefs. Keep reading!
Managing CLE with JAK inhibitors
A research letter published in JAAD summarized the effectiveness and safety outcomes of JAK inhibitor (JAKi) therapies in treating cutaneous lupus erythematosus (CLE). A total of 13 studies involving 33 patients were included in the review. A total of 33 JAKi uses with outcomes were documented, with filgotinib (51.5%) as the most used JAKi, followed by tofactinib (18.2%), baricitinib (15.2%), ruxolitinib (12.1%), and upadacitinib (3%).
[Promising therapeutic developments for cutaneous lupus erythematosus: Interfering with interferon. Read more.]
CLASI-A scores were measured in 75.8% of cases (25/33), with all patients achieving clinically significant improvement (mean 15.4-point reduction) from baseline. CLE recurrence data with follow-up were available in 97% of patients, with CLE recurrence in one case (6.3%). Treatment-related adverse events occurred in 11 patients (30.3%), all developing mild infections and requiring no intervention. No JAKi treatment discontinuation was reported in any cases.
Find out what’s new in treating connective tissue disease in DermWorld.
Homelessness associated with increased rates of skin conditions
A study published in the British Journal of Dermatology examined the association between homelessness and diagnosed skin conditions, prescribed medication, and type of consultation. According to the study authors, those experiencing homelessness had higher rates of developing skin conditions compared with the general population — and this risk increased after contact with a homeless shelter. Results showed that 15% of the cohort received a skin diagnosis and 0.7% experienced at least one episode of homelessness. Those who experienced homelessness exhibited a 2.3-times higher incidence rate ratio for any diagnosed skin condition. Of the diagnoses most probable among those experiencing homelessness, infections of the skin and sub-cutaneous tissue were the highest at 14%, followed by erysipelas (7.6%), and ulcers (4.3%), whereas the probability was low for impetigo (0.4%) and scabies (0.2%).
[How can dermatologists provide improved access to care for patients with housing instability? Read more.]
Those who experienced homelessness had a 2.5-fold higher rate of non-dermatologic consultations resulting in a diagnosed skin condition compared with those who did not experience homelessness. Additionally, homelessness was also associated with a 3-fold higher rate of receiving any skin diagnosis in an emergency room consultation. Those with homeless shelter contact experienced a 2.9% increased rate of skin condition diagnoses compared with individuals without homeless shelter contact.
Read about considerations for dermatologists when treating patients experiencing homelessness in DermWorld.
Occupational contact allergy: Trends in sensitization
An article published in Contact Dermatitis presented sensitization frequencies to the most relevant allergens of the European baseline series in patients with occupational contact dermatitis (OCD) and compared sensitization profiles of different occupations. In the study, the patch test results of more than 16,000 patients diagnosed with OCD were analyzed to determine trends in contact sensitization.
Rubber chemical accelerators (thiurams, carbamates, benzothiazoles) and epoxy resins were associated with at least a doubled risk of OCD. The highest rates of OCD were found among patients working in the metal, agricultural, and fishery industries followed by building and construction, health care, and food and service. After a decline from 2014 onward, the risks of acquiring an occupation-related sensitization to methyl(chloro)isothiazolinone (MCI/MI) and especially to methylisothiazolinone (MI) seem to be increasing again.
Treatment recommendations for acne-associated hyperpigmentation
A systematic review published in JAAD sought to reach Delphi consensus on evidence-based treatment recommendations for acne-induced macular hyperpigmentation (AMH) in patients with skin of color. An agreement that topical retinoids and benzoyl peroxide were first-line therapies was reached. Hydroquinone, azelaic acid, chemical peels, and/or antioxidant therapy could be added to improve pigmentation outcomes. The authors conclude that to effectively treat AMH, physicians should use combination anti-acne therapy, counsel patients to avoid excoriation, apply medicine to the entire face, use sun protection, and optimize the role of makeup.
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