Is there an association between low-dose methotrexate and melanoma?
Authors of a study published in JAMA Dermatology explore whether exposure to low-dose methotrexate is associated with a higher risk of developing cutaneous melanoma. This systematic review and meta-analysis included 16,642 cases of melanoma. Compared with unexposed individuals, study participants with methotrexate exposure had a 15% increased risk of melanoma.
However, the risk associated with methotrexate exposure may not translate to a significant association at a population level since the number needed to harm was estimated to be large — even in populations with high melanoma incidence rates. The authors find that although low-dose methotrexate may be associated with higher risk of malignant melanoma, the true effect could be considered negligible.
Dermatologists explore the possible reasons for the discrepancy between melanoma incidence and mortality trends inDermWorld.
DermWorld Insights and Inquiries: Optimizing the dermatologist-patient encounter
My celebration of the USA bicentennial on July 4, 1976, was a glorious affair. I had taken my first plane flight at age 21 to visit Boston, culminating with Arthur Fieldler and the Boston Pops performing Tchaikovsky’s 1812 Overture accompanied by pyrotechnics dazzling the Charles River’s sky. What a memory! When I returned to medical school, my first patient encounter during my psychiatry rotation was an inconsolable middle-aged man who was distraught and tearful. When he could finally express what was troubling him — that he would not be alive for the tricentennial — I instantaneously realized that I could not be a psychiatrist as I summoned all my energy to hold back my laughter. No, I needed to find a discipline where the data was visible and objective. Dermatology fit the bill when I was subsequently introduced to the specialty. Ultimately, though, the last laugh is on me. Little did I understand that to be an effective dermatologist you need to be a good psychiatrist and a superb psychologist. Keep reading!
FDA approves first treatment for prurigo nodularis
Last week, the FDA approved dupilumab for treatment of adults with prurigo nodularis (PN). Dupilumab is the first FDA-approved treatment for PN. Safety and effectiveness of dupilumab to treat PN among adults were evaluated in two clinical trials. Each trial evaluated 300 mg administered every two weeks following an initial dose of 600 mg with treatment lasting for 24 weeks.
Effectiveness was assessed primarily by the proportion of subjects whose pruritus improved by more than four points on the Worst Itch Numeric Rating Scale, the proportion of subjects who achieved a score of 0 or 1 on Investigator’s Global Assessment PN-stage scale, and the proportion of subjects who achieved a response on both scales at week 24.
The most common side effects include injection site reactions, herpes simplex virus infections, common cold, muscle pain, diarrhea, and throat pain.
Understanding and treating chronic itch. Read more in DermWorld.
A study published in Dermatologic Surgery surveyed 177 dermatologic surgeons regarding their practices with respect to antibiotic prophylaxis, anticoagulation, activity restrictions, and antiseptic choice. Systemic antibiotic prophylaxis was prescribed preoperatively by 96%. Most surgeons rarely prescribed postoperative antibiotics, although when prescribed, it was often cephalexin 500 mg two to three times daily, followed by doxycycline 100 mg twice daily for seven days for procedures below the knee or on the lip, ear, or scalp.
One-third of the respondents held preventative aspirin, whereas very few (3%-5%) held anticoagulants. Preventative aspirin, NSAIDs, and supplements known to have anticoagulant effect were more commonly held. There was a range of responses regarding practices of checking the international normalized ratio preoperatively, antiseptic choice, and recommendations for activity restrictions. There is a need for more comprehensive, updated, and standardized guidelines for perioperative practice in dermatologic surgery, according to the study authors.
Dermatologists discuss approaches to managing patients on anticoagulants during the perioperative period in DermWorld.
Tacrolimus for treating oral lichen planus
A retrospective cohort published in the Journal of the European Academy of Dermatology and Venereology evaluated the effectiveness of compounded tacrolimus 0.03% mouthwash for the treatment of patients with oral lichen planus. Complete or major remission was noted in 28% of patients at three months, 62% of patients at six months, and 88% of patients at 12 months. The percentage of patients reporting no impairment was 16% at three months, 48% at six months, and 71% at 12 months. According to the authors, topical tacrolimus can be an effective second-line therapy for oral lichen planus refractory to potent topical corticosteroids with regular follow-up necessary to recognize possible squamous cell carcinoma.
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Beginning Oct. 6, 2022, HHS’s information blocking requirements shift to the entire electronic protected health information (EHI). After Oct. 6, physicians and other actors will be responsible for the access, exchange, or use of the full EHI requirement and no longer limited to just the USCDI. Learn more.
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