Spironolactone: Risk of breast, gynecologic malignancies?
Authors of a JAAD study examined whether spironolactone exposure for acne, hair loss, and/or hirsutism indications is associated with increased breast and/or gynecologic tumor risk. Demographics and history of breast/gynecologic benign and malignant tumor diagnoses were collected for women with spironolactone exposure for dermatologic indications as well as an unexposed group without spironolactone exposure who presented for gynecology visits. There was a five-year follow up after first spironolactone exposure.
[Read about potassium monitoring in women on spironolactone inDermWorld Weekly.]
A total of 420 and 3,272 women with and without spironolactone exposure were included with a median dose of 100 mg. Among patients with a benign tumor, malignant tumor, or breast or uterine cancers, spironolactone exposure was not a risk factor. Daily use of spironolactone did not impact tumor development.
DermWorld Insights and Inquiries: Always another worry for patients with hidradenitis suppurativa — Amyloid A amyloidosis
My introduction to hidradenitis suppurativa (HS) was as a first-year dermatology resident on the inpatient dermatology service at Van Etten Hospital in the Bronx, caring for a most unfortunate woman with HS; she had secondarily infected pyoderma gangrenosum with a repugnant odor and a fungating anal squamous cell carcinoma (SCC) tracking up her spinal cord. Had this patient been my initial exposure to dermatology, you would not be reading this editorial, as I would have chosen internal medicine. Aside from SCC and systemic infections, amyloid A amyloidosis (AA, aka secondary AA amyloidosis, SAA) is a rare, but potentially life-threatening complication. Proteinuria is the first clinical manifestation in almost 95% of patients with AA, whereas 50% present with nephrotic syndrome.Keep reading!
FDA approves spesolimab for the treatment of generalized pustular psoriasis
The FDA has approved spesolimab-sbzo injection for the treatment of generalized pustular psoriasis (GPP) in adults and pediatric patients 12 years of age and older weighing at least 40 kg.
Spesolimab is a novel, humanized selective IgG1 antibody that binds to IL-36 receptor, a key part of a signaling pathway shown to be involved in the cause of GPP. The approval was based on the positive results of a 48-week clinical trial that showed the treatment significantly reduced the risk of GPP flares by 84%, compared with placebo. In the trial with 123 patients, no flares were observed after week 4 of spesolimab subcutaneous treatment in the high-dose group. Spesolimab was associated with an increased incidence of injection site reaction, urinary tract infection, arthralgia, and pruritus.
Refractory keloids: Combined bleomycin and triamcinolone injection
A study published in Dermatologic Surgery evaluated the efficacy of intralesional bleomycin and triamcinolone in treating patients with refractory keloids. In total, 33 patients with resistant keloids were enrolled in this study. A mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) was injected intralesionally into the keloids every 4 to 6 weeks for a maximum of six cycles.
[Treating keloids, hypertrophic scars with dupilumab. Read more.]
All patients experienced improvement after treatment, with significant decreases in the Japan Scar Scale compared with baseline. Overall, 78.8% of the keloids showed an excellent response (75–100% flattening), and 21.2% showed a fair response (25–75% flattening). The adverse effects included ulceration, hyperpigmentation, hypopigmentation, secondary infection, and telangiectasis.
Read about the latest advances in laser technology and learn how to navigate the research and acquisition process inDermWorld.
Delusions of parasitosis: Biometric, pharmaceutical associations
An article published in JAAD examined hypotheses that vulnerability to delusions of parasitosis (DOP) emerges when multiple factors combine, including age, sex, and medications. The researchers conducted a retrospective case control study of 34 patients with DOP (27 women and seven men) and compared these data to an age matched control group of 53 women presenting with a dermatitis above the clavicle from a general dermatology practice between the years of 2012 and 2020. Statistical significance was found between cases and controls with polypharmacy (five or more drugs), attention deficit hyperactivity disorder medications, selective serotonin reuptake inhibitors, opioids, and gabapentin. The study suggests that pharmaceutical trends may contribute to increased DOP prevalence.
Battling bugs that aren't there: Dermatologists embrace empathy, antipsychotics to help patients with psychocutaneous disease. Read more.
FDA warns consumers to avoid certain topical pain relief products
The FDA is warning consumers not to use certain over-the-counter analgesic products that are marketed for topical use to relieve pain before, during, or after cosmetic procedures, such as microdermabrasion, laser hair removal, tattooing, and piercing. The agency has issued letters to six companies for marketing these products in violation of federal law.
Some of the products contain lidocaine at concentrations higher than what is permitted for over-the-counter, topical pain relief products. These products are applied in ways that could lead to increased absorption of the drug product through the skin, it may lead to serious injury such as irregular heartbeat, seizures, and breathing difficulties. The products may also interact with medications or dietary supplements.
The FDA is aware of reports of adverse events related to these products and encourages consumers and health care professionals to report any adverse events with use of any drug to the MedWatch Adverse Event Reporting program.
AMA survey: Change Healthcare cyberattack disruption
Since the Change Healthcare cyberattack in February and resulting system outages, the American Medical Association (AMA) has urged federal and state regulators to support physician practices with financial assistance and flexibilities in administrative requirements. To assess the current level of workflow disruptions and financial impact on practices, the AMA has an 11-question survey that will be used to inform ongoing advocacy efforts on this issue. Please complete the survey by Friday, March 29.
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