Ah ha…

Some medical practices are asking for appointment down payments…

In a Washington Post article, health writer Fran Kritz reports that some medical practices are asking for “down payments.” While “no one tracks the number of physician practices that require down payments…calls to practices in” Washington, DC, “and Maryland turned up 10 offices that either charge a hold fee in advance or require a credit card number that is billed if the patient doesn’t show up or cancels with little warning.” Meanwhile, Kritz writes, “An Internet search found scores of practices around the country, both primary-care doctors and specialists, that request a credit card number to hold an appointment.”

How many patients would make an appointment and not show up without any notices everyday in this practice ? 3-4 per day !  Of course, there are far more exciting things in life than going to see a dermatologist. But please just let us know if you could not make it.

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The Effects of Chronic Periodontitis and Its Treatment on the Subsequent Risk of Psoriasis

Keywords:

  • chronic periodontitis;
  • psoriasis;
  • autoimmune

Abstract

Background:  Although psoriasis and chronic periodontitis (CP) may share an underlying immune dysregulation as part of their pathologies, only one small-scaled cross-sectional pilot study has investigated the potential association between CP and psoriasis to date.

Objective:  This study aimed to investigate the subsequent risk for psoriasis following a diagnosis with CP by utilizing a cohort study design and population-based dataset in Taiwan.

Methods:  In total, 115,365 patients with CP were included in the study cohort and 115,365 patients without CP were included in the comparison cohort. We individually tracked each patient for a five-year period to identify those who had subsequently received a diagnosis of psoriasis. A Cox proportional hazards regression was performed to compute the five-year risk of subsequent psoriasis following a diagnosis of CP.

Results:  We found that the incidence rate of psoriasis during the five-year follow-up period was 1.88 (95% CI=1.77-1.99) per 1,000 person-years in patients with CP and 1.22 (95% CI=1.14-1.32) per 1,000 person-years in comparison patients. After censoring those who died during the follow-up period, and adjusting for monthly income and geographic region, compared with comparison patients, the HR of psoriasis for patients with CP was 1.52 (95% CI=1.38-1.70). Furthermore, the study subjects who had undergone a gingivectomy or periodontal flap operation only had a slightly higher adjusted risk of psoriasis than comparison patients (HR=1.26).

Conclusions:  This study detected an increased risk for psoriasis among patients suffering from CP. Treatment for CP attenuated, but did not nullify, the risk for subsequent psoriasis.

Keep your teeth healthy as it may affect your skin; especially if you have psoriasis.

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National Skin Cancer Action Week 15-21 November 2015

Each year Cancer Council Australia and the Australasian College of Dermatologists come together for National Skin Cancer Action Week.

With two in three Australians diagnosed with skin cancer by age 70, the week is a time when we remind Australians of the importance of sun protection and early skin cancer detection.

Our 2015 theme is ‘UV. It all adds up’, which will focus on the unintentional UV damage Australians can accumulate when they forget sun protection.

More than 2000 people in Australia die from skin cancer each year. Yet most skin cancers can be prevented by the use of good sun protection.

New data from Cancer Council’s National Sun Protection Survey will be unveiled during the week to reveal the latest trends in our sun protection behaviours.

National Skin Cancer Action Week is a great time to remind people to slip on sun-protective clothing, slop on SPF30 (or higher) broad-spectrum, water-resistant sunscreen, slap on a broad-brimmed hat, seek shade and slide on sunglasses.

A combination of these measures, along with getting to know your skin and regularly checking so you can pick up on any changes, are the keys to reducing your skin cancer risk.

You can find out more about skin cancer here.

SOURCE

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Long-term antibiotic acne treatment unlikely to cause bacterial resistance

Concerns about whether significant bacterial resistance could be caused by long-term acne treatment with antibiotics may be unfounded, suggest study results.

David Margolis (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues found that use of these antibiotics by acne patients successfully lowered the prevalence of colonization byStaphylococcus aureus with no significant increase in bacterial resistance.

The researchers carried out a cross-sectional survey of 83 acne patients with a mean age of 25.6 years, who visited a dermatology outpatient clinic. All participants filled out a comprehensive survey, underwent a visual examination for acne presence and severity, and had swabs taken from their nose and throat to test for S. aureus.

When patients with acne who were antibiotic users (n=52; oral and/or topical) were compared with nonusers (n=31), the risk for S. aureus colonization after 1-2 months of treatment was reduced by 84%. After 2 months, the reduction in risk for colonization was 48% lower in antibiotic users compared with nonusers.

Although 40% and 44% of the S. aureus isolates (obtained from 36 participants in total) were resistant to clindamycin and erythromycin, respectively, less than 10% showed resistance to tetracycline antibiotics, which, the researchers say are the most commonly used antibiotics to treat acne.

“The long-term use of oral antibiotics to treat acne is a common practice, which may have some untoward consequences,” write Margolis et al in the Archives of Dermatology.

The lay press have expressed concern about such consequences, which could include the creation of multidrug-resistant microbes. However, the results of this study suggest that long term treatment with tetracycline antibiotics is effective and only triggers a negligible level of resistance, say the authors.

“Future research should be conducted with respect to other organisms and antibiotics,” they conclude.

MedWire

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An itchy lumpy rash…

 

This is known as lichen planus, a very itchy inflammatory (as in non-cancerous, not infectious) condition. The cause is unknown most of the time but it could be due to allergy to some medications. It is most commonly located on the wrists but the spots may even be found inside the mouth sometimes ! Consult your Dermatologist.lichen planus

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Childhood eczema predicts adult asthma…

Children with eczema are at increased risk for developing allergic asthma as adults, particularly if they also suffer from hayfever, a study has found.

The results show that children with both eczema and hayfever are nine times more likely to have allergic asthma in their 40s than those without these conditions.

“The implications of this study are that prevention and rigorous treatment of childhood with eczema and hayfever may prevent the persistence and development of asthma,” said lead researcher Pamela Martin, from the University of Melbourne in Australia.

The researchers monitored 1320 individuals from the age of 6-7 years up to the age of 44 years, of whom 70% had allergic asthma as adults.

The combination of childhood eczema and hayfever predicted the development of allergic asthma in adulthood and also the persistence of childhood asthma into adult allergic asthma.

Overall, the researchers estimate that 20-30% of allergic asthma seen in the adults in their study could be attributed to a history of childhood eczema and hayfever.

“In this study, we can see that childhood eczema, particularly when hayfever also occurs, is a very strong predictor of who will suffer from allergic asthma in adult life,” said Martin.

The team concludes in the Journal of Allergy and Clinical Immunology: “Our findings have important clinical implications for the potential prevention of asthma in adult life through efforts to prevent or ameliorate eczema and [hayfever] in childhood.”

MedWire (www.medwire-news.md)

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BUT not all melanomas are irregular in shape and colour… (Take some helpful selfies !)

An early melanoma may be perfectly circular, uniformly black in colour and only a few mm  wide. Just a BLACK DOT !

That’s why you should check your skin at least monthly to look for “NEW” spots.

Take some “selfies” of your own skin to help pick the newbies (which may end up being badies) !

That’s also why you should see a real expert (i.e. a Dermatologist) to tell the bad (malignant) from the good (benign) ones to avoid unnecessary surgery and scars.

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First melanoma this week…

What does a melanoma look like ? What you should watch out for ?

Irregular shape (not round or oval)

Irregular colour (different shades of brown or red)

melanoma a 20150209 melanoma b 20150309

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Does Elidel (a form of non-steroidal cream) for eczema cause cancer in children ?

A lot of parents of children with eczema (atopic dermatitis) have steroid-phobia (so are some Chemists and Doctors, dare I say)  and would avoid using topical steroid at any cost (including their children’s un-necessary suffering).

Elide creaml is marketed as an eczema treatment free of steroid.

The following is by Mary Wu Chang, MD Reviewing  Margolis DJ et al., JAMA Dermatol 2015 Feb 18; 

One of the largest prospective, longitudinal studies ever conducted in dermatology indicates NO increased risk.

Atopic dermatitis (AD or eczema ) affects up to 20% of children, but treatment options are limited. The topical calcineurin inhibitors (TCIs) tacrolimus and pimecrolimus (Elidel is the commercial name) were approved in 2000 and 2001 respectively for AD therapy. Systemic use of TCIs has been associated with increased malignancy risk, especially skin cancer and lymphoma. A black-box warning was added to topical pimecrolimus labeling in 2005.

The Pediatric Eczema Elective Registry (PEER) is an ongoing, nationwide longitudinal cohort study started in 2004 to gather post-marketing data in patients who used pimecrolimus cream for at least 42 days of the 180 preceding enrollment. Subsequent treatment is not required, and AD management is dictated by the patient’s physician. The primary outcome is onset of any malignancy after enrollment; participants are queried every 6 months about malignancy.

As of May 2014, five malignancies were reported in 7457 children enrolled and followed for 26,792 person-years (2 leukemias, 1 osteosarcoma, 2 lymphomas, no skin cancers). The overall rate of malignancy was 18.7/100,000 person-years. The standardized incidence ratio for all malignancies based on age-standardized SEER population was 1.2 (95% confidence interval, 0.5–2.8), a statistically insignificant risk. The authors conclude that increased malignancy risk is unlikely to be associated with topical pimecrolimus as used in the PEER cohort.

Comment

Topical calcineurin inhibitors such as Elidel were heavily marketed when they first came to market and were a welcome alternative to topical corticosteroids. The rapid rise in prescriptions coupled with malignancy concerns led to the black-box warning, which swung the pendulum to the other extreme. Physicians, pharmacists, and parents became afraid to use TCIs despite the lack of evidence associating them with malignancy. The PEER registry, one of the largest prospective, longitudinal studies ever conducted in dermatology, is nearing completion. Thus far, malignancy is no more frequent in this cohort than in the general pediatric population, a reassuring conclusion.

 

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Viagra and the risk of melanoma

From the Dermatologist’s forum :

“Just wondering what you tell patients about the melanoma risk with Viagra use? I’ve had 2 patients in the last week asking about it. The study was quite a decent prospective one but still the only one to my knowledge.

http://www.ncbi.nlm.nih.gov/m/pubmed/24710960/ ”

“This was mentioned at the World Congress of Skin Cancer in Edinburgh in September this year with no firm conclusion drawn. However the presenter also mentioned the result of a survey: 60+% of men thought it was worth the risk while 98% of women agreed it was worth the risk!!”

Just repeating, 98% of women agreed (that it was worth the risk) !

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