Sexual dysfunction with 5-alpha reductase inhibitors for androgenetic alopecia
A study published in JAAD evaluated the risk of sexual dysfunction in patients using 5-alpha reductase inhibitors (5-ARIs) for androgenetic alopecia. Of 10,585 5-ARI exposed patients, 289 (3%) experienced sexual dysfunction. When analyzing by dosage/agent, the only significant risk increase found was patients with AGA on finasteride 5 mg vs. no 5-ARI.
Although sexual dysfunction was initially observed more frequently in the 5-ARI cohort, this association lost significance after controlling for potentially confounding comorbidities, including nicotine use, diabetes, obesity, hypertension, and mood and anxiety disorders.
Dermatologists discuss the latest clinical guidance for managing hirsutism. Read more.
DermWorld Insights and Inquiries: Acne necrotica — A real head-scratcher
I sympathize with new residents in dermatology coming to grips with difficult terms and concepts that are essential in practice. As a novice, I recall struggling with the concept of acne necrotica (AN), dreading that I would never understand this disorder. I was intrigued by the colloquial term “tycoon’s scalp,” but otherwise have not given this disorder much thought throughout my career, mostly because I never understood it. I am not alone. Some recent publications have piqued my curiosity to see if the landscape of AN has become clearer. Keep reading!
Benzoyl peroxide in acne: Risk of acute myeloid leukemia?
A research letter published in JAAD evaluated whether benzoyl peroxide (BPO) use among acne patients is associated with increased odds of developing acute myeloid leukemia (AML). AML was diagnosed in 0.012% of acne patients with a BPO prescription compared to 0.017% without recorded BPO or use. The authors also assessed the diagnosis of acne as a surrogate for BPO exposure. AML was diagnosed in 0.015% of acne patients compared to 0.052% of those without acne. The authors concluded that neither a diagnosis with acne nor exposure to prescription BPO for treating acne was associated with significantly elevated odds of developing AML.
Short contact lidocaine-prilocaine vs. lidocaine-tetracaine for cutaneous pain relief
A study published in JAAD assessed the effectiveness of short-contact (30-minute application) topical lidocaine-tetracaine topical anesthetic (LTTA) and lidocaine-prilocaine topical anesthetic (LPTA) for pain relief prior to laser treatment. Participants were pretreated with 2.5%-2.5% LPTA, 7%-7% LTTA, or placebo under occlusion on the right and left forehead, cheek, and upper inner arm. After 30 minutes, the topical preparations were removed, and the six areas were treated with Q-switched 532 nm laser. Participants were asked to complete a pain survey for each treated site after laser treatment.
[Read more about the lidocaine shortage inDermWorld.]
Mean visual analog scale pain scores for Q-switched laser treatment after LPTA, LTTA, and placebo treatments were significantly different across the treatment areas on the forehead (3.3 vs. 2.4 vs. 5.0, cheek (2.2 vs. 1.9 vs. 7.1, and arm (4.1 vs. 2.6 vs. 4.8). LTTA was significantly different from placebo in terms of patient-reported pain at all three anatomic sites, and LPTA was only significantly different than placebo on the cheek. The authors conclude that “LTTA provided adequate pain relief at all three anatomic sites, while LPTA only provided adequate pain relief on the cheek. Although LTTA is more expensive than LPTA, its effectiveness at more anatomic sites compared to placebo may make the extra expense worthwhile in select cases.”
Benefits and harmful effects of treating patients with AD
A systematic review and network meta-analysis published in the Journal of Allergy and Clinical Immunology synthesized the benefits and harms of systemic treatments for atopic dermatitis (AD). The study included 149 randomized trials. High-dose upadacitinib was found to be the most effective in five of six patient-important outcomes. High-dose abrocitinib and low-dose upadacitinib were the most effective in two outcomes. Janus kinase inhibitors were associated with the highest incidence of adverse events. Dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and were among the safest.
Dermatologists discuss the influx of new JAK inhibitors in dermatology and how they are breaking new ground for the specialty. Read more.
The 2024 Quality Payment Program (QPP) exception applications are open until Dec. 31, 2024, 8 p.m. ET. There are two exceptions available, allowing clinicians to indicate the reason they’re unable to report data for one or more Merit-based Incentive Payment System (MIPS) performance categories: the Promoting Interoperability Performance Category Hardship exception and the Extreme and Uncontrollable Circumstances exception. Apply on the QPP Exception Applications website.
For applications related to the Change Healthcare Cyberattack in late February, select “Ransom/Malware” as the event type and confirm its relevance. CMS will not accept COVID-19-related applications for the 2024 performance year as the public health emergency ended on May 11, 2023.
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