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Journal of Drugs in Dermatology : JDD Jul 2024To understand the prevalence and types of publications addressing darker skin types within the existing evidence base for sunscreen use. Evidence Review: PubMed... (Review)
Review
BACKGROUND
To understand the prevalence and types of publications addressing darker skin types within the existing evidence base for sunscreen use. Evidence Review: PubMed was searched from 1988, the time point at which the first skin of color (SOC) article was identified, through December 2022 using PubMed's Medical Subject Headings terms and keyword searches in title and abstract, with and without terms for SOC and ethnicity. Identified articles were reviewed for relevance, de-duplicated, and categorized; results are summarized.
FINDINGS
Of the 5927 articles on sunscreen overall, only 314 (5.3%) articles addressed SOC, with the majority published since 2007 and representing only 4% to 7% of total publications annually except in 2022 when the proportion of SOC articles was 23.5%. Of the articles on SOC, many reported sunscreen knowledge and patient behaviors (29%), but very few reported clinical trials (5%). The 3 conditions most often discussed were melasma, post-inflammatory hyperpigmentation, and dyschromia. South Asian ethnicities (India, Pakistan, Bangladesh) had the highest representation within the literature, followed by Hispanics.
CONCLUSIONS AND RELEVANCE
Although it was assumed there would be fewer papers discussing the use of sunscreen in darker skin types, the scale of the disparity revealed by this study is stark. The increase in a number of articles in 2022 suggests an increasing focus on SOC, but further discussion of the issues presented here will help the SOC community address gaps in the evidence base and better inform discussions on sunscreen and photoprotection between clinicians and patients.J Drugs Dermatol. 2024;23(7):575-577. doi:10.36849/JDD.8250.
Topics: Humans; Sunscreening Agents; Skin Pigmentation; Health Knowledge, Attitudes, Practice; Ultraviolet Rays
PubMed: 38954618
DOI: 10.36849/JDD.8250 -
Journal of Drugs in Dermatology : JDD Jul 2024We present a case of a patient with a 10-year history of blue-black macules and patches on the face and an associated history of skin-lightening cream usage. The skin...
We present a case of a patient with a 10-year history of blue-black macules and patches on the face and an associated history of skin-lightening cream usage. The skin lightening cream contained hydroquinone, which is often associated with exogenous ochronosis (EO). Interestingly, the biopsy did not show characteristic findings of ochronosis, confusing the final diagnosis, however discontinuing the skin-lightening creams halted the progression of the patient's skin lesions supporting a diagnosis of EO. EO presents as asymptomatic hyperpigmentation after using products containing hydroquinone. This condition is most common in Black populations, likely due to the increased use of skin care products and bleaching cream containing hydroquinone in these populations. Topical hydroquinone is FDA-approved to treat melasma, chloasma, freckles, senile lentigines, and hyperpigmentation and is available by prescription only in the US and Canada. However, with the increased use of skin-lightening creams in certain populations, it is important for dermatologists to accurately recognize the clinical features of exogenous ochronosis to differentiate it from similar dermatoses. An earlier diagnosis can prevent the progression to severe presentations with papules and nodules. We summarize the clinical presentations diagnostic features, and treatment pearls, concluding with a discussion of the differential diagnoses. J Drugs Dermatol. 2024;23(7):567-568. doi:10.36849/JDD.8248.
Topics: Humans; Ochronosis; Hyperpigmentation; Hydroquinones; Diagnosis, Differential; Lichen Planus; Female; Skin Lightening Preparations; Facial Dermatoses; Middle Aged; Skin Cream
PubMed: 38954615
DOI: 10.36849/JDD.8248 -
Journal of Drugs in Dermatology : JDD Jul 2024Despite the widespread interest in dermatology on TikTok, studies have shown most related videos are not produced by board-certified dermatologists (BCDs) or other...
Despite the widespread interest in dermatology on TikTok, studies have shown most related videos are not produced by board-certified dermatologists (BCDs) or other health professionals. To see if this trend extended to sun protection, we examined TikTok videos associated with sun safety to determine the proportion produced by BCDs. From August 25, 2023, to August 27, 2023, investigators input the following hashtags into the TikTok search bar: #sunscreen, #sunprotection, #spf, #skincancer, and #skinprotection. The top 100 videos in each category were analyzed and categorized based on the content creator. Additionally, we assessed whether videos explicitly addressed skin of color (SOC). Of the analyzed videos, only 16.6% originated from BCDs. Beauty bloggers/bloggers were the most prevalent creators in this category (38.7%), followed by patients/consumers (33.7%). Only 2.8% of the videos pertained to SOC patients. This highlights a gap in the type of educational content generated by dermatologists on TikTok, with sun safety being a potential subject to target within social media. Additionally, the small representation of videos addressing SOC patients underscores the need for more diverse and inclusive educational skincare content on TikTok.J Drugs Dermatol. 2024;23(7):571-574. doi:10.36849/JDD.8179.
Topics: Humans; Cross-Sectional Studies; Sunscreening Agents; Social Media; Sunburn; Dermatology; Video Recording; Sunlight; Skin Pigmentation; Dermatologists; Skin Neoplasms; Patient Education as Topic
PubMed: 38954614
DOI: 10.36849/JDD.8179 -
Journal of Drugs in Dermatology : JDD Jul 2024Melasma is a chronic pigmentary disorder. In this study, an innovative cream combining cysteamine and tranexamic acid (TXA) was assessed. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Melasma is a chronic pigmentary disorder. In this study, an innovative cream combining cysteamine and tranexamic acid (TXA) was assessed.
OBJECTIVE
To evaluate the safety, efficacy, and patient satisfaction of a novel nano-formulated cysteamine and TXA combination cream in treating subjects with epidermal melasma.
METHODS
Fifty (50) randomized subjects participated and received cysteamine and TXA combination cream. The cream was applied for 30 minutes daily for a 3-month duration. Treatment effectiveness, safety, patient satisfaction, and adherence were evaluated.
RESULTS
A continuous improvement in melasma was observed, with modified Melasma Area and Severity Index (mMASI) scores improving by 40%, 57%, and 63% at 30, 60, and 90 days, respectively. The primary endpoint of a decrease in mMASI scores was met, with 91% of participants experiencing melasma improvement. Patient Satisfaction and Patient Adherence scores indicated satisfaction. Convenience exhibited the strongest correlation with patient adherence. Conclusion: Nano-formulated cysteamine and TXA combination cream showed significant efficacy in decreasing mMASI score while demonstrating a strong safety profile and patient satisfaction. J Drugs Dermatol. 2024;23(7):529-537. doi:10.36849/JDD.7765R1.
Topics: Humans; Melanosis; Cysteamine; Tranexamic Acid; Female; Patient Satisfaction; Adult; Treatment Outcome; Middle Aged; Medication Adherence; Male; Skin Cream; Administration, Cutaneous; Severity of Illness Index; Drug Combinations; Nanoparticles; Young Adult
PubMed: 38954613
DOI: 10.36849/JDD.7765 -
Journal of Drugs in Dermatology : JDD Jul 2024Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of mycosis fungoides (MF), a type of cutaneous T-cell lymphoma. MFPP primarily affects the palms and...
Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of mycosis fungoides (MF), a type of cutaneous T-cell lymphoma. MFPP primarily affects the palms and soles of the feet and is often misdiagnosed as dyshidrotic eczema due to its similar clinical presentation. This case report presents a middle-aged woman with MFPP whose initial presentation was mistaken for dyshidrotic eczema. Despite treatment with topical corticosteroids, the patient's lesions persisted, prompting further investigations that led to the diagnosis of MFPP. The patient was initiated on betamethasone dipropionate ointment and hydroxyzine for pruritus management, with a pivotal referral to oncology for comprehensive evaluation. This case highlights the importance of considering MFPP in the differential diagnosis of persistent eczematous lesions on the palms and soles, especially when treatment with topical corticosteroids is ineffective. J Drugs Dermatol. 2024;23(7):569-570. doi:10.36849/JDD.8474.
Topics: Humans; Female; Mycosis Fungoides; Diagnosis, Differential; Middle Aged; Eczema, Dyshidrotic; Skin Neoplasms; Betamethasone
PubMed: 38954612
DOI: 10.36849/JDD.8474 -
Journal of Drugs in Dermatology : JDD Jul 2024Poor melanoma outcomes in people of color (POC) are attributed to a variety of factors, including healthcare literacy, socioeconomic status, and healthcare access...
BACKGROUND
Poor melanoma outcomes in people of color (POC) are attributed to a variety of factors, including healthcare literacy, socioeconomic status, and healthcare access barriers. Methods: We designed a survey to determine if visual and audio media (VAM) would increase POC's understanding of the need for sunscreen and their willingness to use it. Patients recruited at a dermatology clinic were asked to watch a 2.5-minute video on sun protection and complete a pre- and post-survey assessing their knowledge.
RESULTS
Forty-one (41) patients were recruited, 43.9% of whom identified as POC and 31.7% as Hispanic or Latino. In the post-survey, 100% of participants agreed that daily sunscreen use helps prevent sun-related risks, compared to 68% before (P<.0001). 71% of the participants intended to use sunscreen daily after watching the video, compared to 24% who did so before (P<.0001). One-hundred percent (100%) of Black participants in the post-survey agreed that sunscreen wear helps prevent risks associated with sun exposure, compared to 46% in the pre-survey (P= 0.0052); no significant difference among White participants (80% vs 100%; P=0.1121).
LIMITATIONS
Small sample size, no long-term follow-up.
CONCLUSIONS
This study demonstrates the persistence of health disparities and the effectiveness of VAM in enhancing Black patients' healthcare literacy. J Drugs Dermatol. 2024;23(7):525-528. doi:10.36849/JDD.7821.
Topics: Humans; Sunscreening Agents; Female; Male; Adult; Middle Aged; Health Knowledge, Attitudes, Practice; Hispanic or Latino; Surveys and Questionnaires; Skin Neoplasms; Health Literacy; Black or African American; Melanoma; Aged; Patient Education as Topic; Video Recording; Young Adult
PubMed: 38954611
DOI: 10.36849/JDD.7821 -
JAMA Network Open Jul 2024
Topics: Humans; Anti-Bacterial Agents; beta-Lactams; Infusions, Intravenous; beta Lactam Antibiotics
PubMed: 38954420
DOI: 10.1001/jamanetworkopen.2024.18196 -
JAMA Network Open Jul 2024Current evidence is conflicting for associations of extended-infusion β-lactam (EI-BL) therapy with clinical outcomes.
IMPORTANCE
Current evidence is conflicting for associations of extended-infusion β-lactam (EI-BL) therapy with clinical outcomes.
OBJECTIVE
To investigate the association of EI-BL therapy with survival, adverse events, and emergence of antibiotic resistance in adults with gram-negative bloodstream infections (GN-BSI).
DESIGN, SETTING, AND PARTICIPANTS
This cohort study of consecutive adults with GN-BSI admitted to 24 United States hospitals between January 1, 2019, and December 31, 2019, receiving EI-BL were compared with adults with GN-BSI receiving the same agents as intermittent infusion β-lactam (II-BL; ≤1-hour infusions). Statistical analysis was performed from January to October 2023.
EXPOSURES
EI-BL (ie, ≥3-hour infusion).
MAIN OUTCOMES AND MEASURES
EI-BL and II-BL groups underwent 1:3 nearest-neighbor propensity score matching (PSM) without replacement. Multivariable regression was applied to the PSM cohort to investigate outcomes, all censored at day 90. The primary outcome was mortality; secondary outcomes included antibiotic adverse events and emergence of resistance (≥4-fold increase in the minimum inhibitory concentration of the β-lactam used to treat the index GN-BSI).
RESULTS
Among the 4861 patients included, 2547 (52.4%) were male; and the median (IQR) age was 67 (55-77) years. There were 352 patients in the EI-BL 1:3 PSM group, and 1056 patients in the II-BL 1:3 PSM group. Among 1408 PSM patients, 373 (26.5%) died by day 90. The odds of mortality were lower in the EI-BL group (adjusted odds ratio [aOR], 0.71 [95% CI, 0.52-0.97]). In a stratified analysis, a survival benefit was only identified in patients with severe illness or elevated minimum inhibitory concentrations (ie, in the intermediate range for the antibiotic administered). There were increased odds of catheter complications (aOR, 3.14 [95% CI, 1.66-5.96]) and antibiotic discontinuation because of adverse events (eg, acute kidney injury, cytopenias, seizures) in the EI-BL group (aOR, 3.66 [95% CI, 1.68-7.95]). Emergence of resistance was similar in the EI-BL and II-BL groups at 2.9% vs 7.2%, respectively (P = .35).
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with GN-BSI, EI-BL therapy was associated with reduced mortality for patients with severe illness or those infected with nonsusceptible organisms; potential advantages in other groups remain unclear and need to be balanced with potential adverse events. The subsequent emergence of resistance warrants investigation in a larger cohort.
Topics: Humans; Male; Female; Middle Aged; Gram-Negative Bacterial Infections; Anti-Bacterial Agents; beta-Lactams; Aged; Bacteremia; Infusions, Intravenous; Cohort Studies; United States; Adult; Retrospective Studies
PubMed: 38954416
DOI: 10.1001/jamanetworkopen.2024.18234 -
Biodegradation Jul 2024Evaluating industrial wastes in the system with minimum preprocessing and generation economically valuable products from them have critical importance. In this regard,...
Evaluating industrial wastes in the system with minimum preprocessing and generation economically valuable products from them have critical importance. In this regard, especially cheap, wieldy, and readily available catalysts have been researched to increase variety of useful products in pyrolysis systems, to reduce process time, and to increase quality and diversity of products. Therefore, in this study, marble sludge (named K1) was evaluated as catalyst at different dosages (10%, 20%, 30%, 50%) and pyrolysis temperatures (300, 500, 700 °C) in olive pomace (OP) pyrolysis and; the potential green applications of produced new biochars at new usage areas with different purposes based on characteristics were investigated. ANOVA test results showed that temperature and catalysts ratio had significant effect on pyrolysis product yields since significance value for K1 and temperature was lower than 0.05 for pyrolysis products. OP-K1 biochars had alkaline properties and high earth metal quantities. Moreover, increment in K1 ratio and temperature resulted in decrement of the biochar surface acidity. Therefore, it can be indicated that these biochars can have a potential usage for anaerobic digestion processes, lithium-ion batteries, and direct carbon solid oxide fuel cell (DC-SOFC) but further electrochemical property test should be performed. Moreover, produced biochars can be alternative fuels in some processes instead of coal since they have low S content and high heat values. Consequently, it is foreseen that produced biochars will have an important place in the development of potential usage areas with a new and environmentally friendly approach in different areas apart from the conventional uses of catalytic pyrolysis chars.
PubMed: 38954367
DOI: 10.1007/s10532-024-10088-z -
Hepatology International Jul 2024The management of severe immune-related hepatotoxicity (irH) needs to be further optimized. This study aims to analyze the clinical characteristics of severe irH;...
BACKGROUND
The management of severe immune-related hepatotoxicity (irH) needs to be further optimized. This study aims to analyze the clinical characteristics of severe irH; improve the therapeutic strategy, especially salvage treatment in steroid-refractory irH; and determine the safety of immune checkpoint inhibitor (ICPi)-rechallenge.
METHODS
This multicenter retrospective study included patients who developed severe irH and those without irH after immunotherapy between May 2019 and June 2023. Propensity score matching was used to match these two cohorts with similar baseline characteristics.
RESULTS
Among 5,326 patients receiving ICPis, 51 patients developed severe irH. irH occurred after a median duration of 36 days and a median of two doses after the first ICPi administration. Patients receiving PD-L1 inhibitors faced a lower risk of developing severe irH. A higher dose of glucocorticoids (GCS) was administered to grade 4 irH than grade 3 irH. For steroid-sensitive patients, grade 4 irH individuals received a higher dosage of GCS than those with grade 3 irH, with no difference in time to resolution. Meanwhile, a significantly higher dose of GCS plus immunosuppression was needed in the steroid-refractory group. Liver biopsy of the steroid-refractory patients exhibited heterogeneous histological features. Twelve patients were retreated with ICPi. No irH reoccurred after a median follow-up of 9.3 months.
CONCLUSION
irH requires multidimensional evaluation. PD-L1 inhibitors correlated with a lower risk of severe irH. Grade 4 irH demands a higher dose of GCS than recommended. Pathology may guide the salvage treatment for steroid-refractory irH. ICPi rechallenge in severe irH is feasible and safe.
PubMed: 38954360
DOI: 10.1007/s12072-024-10688-0