Damian McNamara

MIAMI BEACH – Green tea polyphenols taken daily provide minor symptomatic improvement for people with Parkinson's disease, particularly those with more severe disease at baseline, according to findings in a 12-month study. However, the green tea did not provide any disease-modifying effect.

The study lends some confirmation to observations in China of a dose-dependent protective effect of tea drinking against Parkinson's disease, Dr. Piu Chan reported at the congress.

The mechanism that could account for green tea's effects is unknown, but green tea is rich in flavonoids, which make up 30% of its dry weight. In addition, the most abundant compound in green tea, epigallocatechin gallate, protects against toxins in animal models and “may down-regulate expression of pro-apoptotic genes,” Dr. Chan said.

To determine the efficacy of green tea polyphenols for slowing progression of Parkinson's disease, he and his colleagues conducted a randomized, double-blind, placebo-controlled, and delayed-start study. They enrolled 410 untreated people with Parkinson's disease at 32 Chinese Parkinson Study Group sites. Patients were randomized to 0.4, 0.8, or 1.2 g of green tea polyphenols daily, or placebo. At 6 months, the placebo group switched to 1.2 g of green tea polyphenols daily as well. Two cups of green tea typically contain about 300 mg of polyphenols, Dr. Chan noted.

Patients were assessed in-person at baseline and at 3, 6, 9, and 12 months. They also kept a tea consumption diary. Change in Unified Parkinson Disease Rating Scale (UPDRS) score was the main outcome. Although a significant improvement in UPDRS scores was observed at 6 months for patients in each dosage group, they were no longer significantly different at 12 months compared with placebo.

Although green tea abstract was safe and well tolerated, there was “no obvious disease-modifying effect seen,” said Dr. Chan, director of the Beijing Institute of Geriatrics and Department of Neurology, Xuanwu Hospital of Capital University of Medical Sciences, Beijing.

MIAMI BEACH – Green tea polyphenols taken daily provide minor symptomatic improvement for people with Parkinson's disease, particularly those with more severe disease at baseline, according to findings in a 12-month study. However, the green tea did not provide any disease-modifying effect.

The study lends some confirmation to observations in China of a dose-dependent protective effect of tea drinking against Parkinson's disease, Dr. Piu Chan reported at the congress.

The mechanism that could account for green tea's effects is unknown, but green tea is rich in flavonoids, which make up 30% of its dry weight. In addition, the most abundant compound in green tea, epigallocatechin gallate, protects against toxins in animal models and “may down-regulate expression of pro-apoptotic genes,” Dr. Chan said.

To determine the efficacy of green tea polyphenols for slowing progression of Parkinson's disease, he and his colleagues conducted a randomized, double-blind, placebo-controlled, and delayed-start study. They enrolled 410 untreated people with Parkinson's disease at 32 Chinese Parkinson Study Group sites. Patients were randomized to 0.4, 0.8, or 1.2 g of green tea polyphenols daily, or placebo. At 6 months, the placebo group switched to 1.2 g of green tea polyphenols daily as well. Two cups of green tea typically contain about 300 mg of polyphenols, Dr. Chan noted.

Patients were assessed in-person at baseline and at 3, 6, 9, and 12 months. They also kept a tea consumption diary. Change in Unified Parkinson Disease Rating Scale (UPDRS) score was the main outcome. Although a significant improvement in UPDRS scores was observed at 6 months for patients in each dosage group, they were no longer significantly different at 12 months compared with placebo.

Although green tea abstract was safe and well tolerated, there was “no obvious disease-modifying effect seen,” said Dr. Chan, director of the Beijing Institute of Geriatrics and Department of Neurology, Xuanwu Hospital of Capital University of Medical Sciences, Beijing.

MIAMI BEACH – Green tea polyphenols taken daily provide minor symptomatic improvement for people with Parkinson's disease, particularly those with more severe disease at baseline, according to findings in a 12-month study. However, the green tea did not provide any disease-modifying effect.

The study lends some confirmation to observations in China of a dose-dependent protective effect of tea drinking against Parkinson's disease, Dr. Piu Chan reported at the congress.

The mechanism that could account for green tea's effects is unknown, but green tea is rich in flavonoids, which make up 30% of its dry weight. In addition, the most abundant compound in green tea, epigallocatechin gallate, protects against toxins in animal models and “may down-regulate expression of pro-apoptotic genes,” Dr. Chan said.

To determine the efficacy of green tea polyphenols for slowing progression of Parkinson's disease, he and his colleagues conducted a randomized, double-blind, placebo-controlled, and delayed-start study. They enrolled 410 untreated people with Parkinson's disease at 32 Chinese Parkinson Study Group sites. Patients were randomized to 0.4, 0.8, or 1.2 g of green tea polyphenols daily, or placebo. At 6 months, the placebo group switched to 1.2 g of green tea polyphenols daily as well. Two cups of green tea typically contain about 300 mg of polyphenols, Dr. Chan noted.

Patients were assessed in-person at baseline and at 3, 6, 9, and 12 months. They also kept a tea consumption diary. Change in Unified Parkinson Disease Rating Scale (UPDRS) score was the main outcome. Although a significant improvement in UPDRS scores was observed at 6 months for patients in each dosage group, they were no longer significantly different at 12 months compared with placebo.

Although green tea abstract was safe and well tolerated, there was “no obvious disease-modifying effect seen,” said Dr. Chan, director of the Beijing Institute of Geriatrics and Department of Neurology, Xuanwu Hospital of Capital University of Medical Sciences, Beijing.

SAN FRANCISCO  - "I've never seen a year like the past where there were so many pediatric derm studies," Dr. Robert Sidbury said.

New discoveries that support a genetic basis for alopecia areata; a mutation in a collagen gene that might mean greater susceptibility to vitiligo; and a promising report that stem cell transplantations can help children with epidermolysis bullosa are among the highlights that Dr. Sidbury shared at the seminar on women’s and pediatric dermatology sponsored by Skin Disease Education Foundation.

Epidermolysis Bullosa

One report offers some hope to children with recessive dystrophic epidermolysis bullosa (RDEB), an incurable blistering disease that is often deadly. The condition is associated with mutations of a gene that encodes for type VII collagen, said Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital and the University of Washington.

Researchers at the University of Minnesota, Minneapolis, found allogenic bone marrow stem cell transplantation without the mutation improved outcomes for children (N. Engl. J. Med. 2010:363:629-39).

Following immunomyeloablative chemotherapy, six children received stem cell transplantations (a seventh died from cardiomyopathy before the protocol started). All six experienced improved wound healing and had a substantial proportion of sustained donor cells in their skin. They also experienced decreased blister formation between 30 and 130 days post transplantation.

One child died at 183 days because of graft rejection and infection. The other five were alive at the time of publication, between 130 and 799 days following transplantation.

Future studies to determine the long-term benefits and risks of this therapy are warranted, the researchers wrote.

Dr. Sidbury was enthusiastic about this strategy to combat RDEB, but added, "We have to be cautious when the first reports like this come out. But this is about as exciting as any report that has come down the pike for this difficult-to-treat condition."

Alopecia Areata

Even though alopecia areata is among the most common autoimmune conditions, the etiology remains largely unknown. "I spin my wheels trying to explain the 'whys' [to patients]. In broad strokes, it is thought to be heritable," said Dr. Sidbury.

A recent genome-wide study lends additional support to the role of genetics (Nature 2010:466:113-7). "Genome-wide association studies are like throwing spaghetti at the wall, only the spaghetti is DNA, and you see what sticks," Dr. Sidbury said.

What stuck were 139 single-nucleotide polymorphisms significantly associated with alopecia areata. The researchers found these in a comparison of 1,054 affected people and 3,278 controls.

"Not surprisingly, there are genes that control targeted inflammation. We have always referred to alopecia areata as a swarm of bees around the follicle," Dr. Sidbury said. "What was really unusual was identification of a stress [induced] protein."

Dermatology researchers at Columbia University, New York, discovered this stress-induced protein, known as ULBP3, related to a cluster of genes on chromosome 6. They also found that people with active alopecia areata have greater expression of this protein in the dermal shaft of their scalp follicles, compared with controls.

Aberrant expression of these genes might induce or worsen alopecia areata in genetically-susceptible patients, Dr. Sidbury said. "So it seems there may be a danger signal that activates this ULBP3 protein and calls in all this [autoimmune] inflammation."

Dermatologists might soon have a more concrete answer for patients regarding the cause of alopecia areata if these results are borne out in future studies. "This does not mean we will have a therapy tomorrow, but maybe we will have a more targeted way to get rid of that inflammation in the future," he said.

Vitiligo

Genetic findings regarding another autoimmune condition, generalized vitiligo, were also published this year (N. Engl. J. Med. 2010: 362:1686-97).

Researchers in Colorado identified genetic alterations that may impart an increased susceptibility to generalized vitiligo. They did a genome-wide study and compared 1,514 vitiligo patients and 2,813 controls with similar ancestry. They found significant associations between vitiligo and specific single-nucleotide polymorphisms (SNPs) in genes that code for histocompatibility and immune processes, for example.

The location of several SNPs is the same for vitiligo and other autoimmune diseases, suggesting a common genetic etiology. They also discovered a more specific mediator of vitiligo, a loci that encodes for tyrosinase, which could be a target of future interventions. "I'm hopeful we’ll have better therapies in the future," Dr. Sidbury said.

SDEF and this news organization are owned by Elsevier. Dr. Sidbury had no relevant disclosures.

For information on counseling parents about food allergies in the atopic child, based on a fourth prominent study, read Damian McNamara's blog post on The Mole at www.skinandallergynews.com/views/the-mole-the-skin-allergy-news-blog.

SAN FRANCISCO  - "I've never seen a year like the past where there were so many pediatric derm studies," Dr. Robert Sidbury said.

New discoveries that support a genetic basis for alopecia areata; a mutation in a collagen gene that might mean greater susceptibility to vitiligo; and a promising report that stem cell transplantations can help children with epidermolysis bullosa are among the highlights that Dr. Sidbury shared at the seminar on women’s and pediatric dermatology sponsored by Skin Disease Education Foundation.

Epidermolysis Bullosa

One report offers some hope to children with recessive dystrophic epidermolysis bullosa (RDEB), an incurable blistering disease that is often deadly. The condition is associated with mutations of a gene that encodes for type VII collagen, said Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital and the University of Washington.

Researchers at the University of Minnesota, Minneapolis, found allogenic bone marrow stem cell transplantation without the mutation improved outcomes for children (N. Engl. J. Med. 2010:363:629-39).

Following immunomyeloablative chemotherapy, six children received stem cell transplantations (a seventh died from cardiomyopathy before the protocol started). All six experienced improved wound healing and had a substantial proportion of sustained donor cells in their skin. They also experienced decreased blister formation between 30 and 130 days post transplantation.

One child died at 183 days because of graft rejection and infection. The other five were alive at the time of publication, between 130 and 799 days following transplantation.

Future studies to determine the long-term benefits and risks of this therapy are warranted, the researchers wrote.

Dr. Sidbury was enthusiastic about this strategy to combat RDEB, but added, "We have to be cautious when the first reports like this come out. But this is about as exciting as any report that has come down the pike for this difficult-to-treat condition."

Alopecia Areata

Even though alopecia areata is among the most common autoimmune conditions, the etiology remains largely unknown. "I spin my wheels trying to explain the 'whys' [to patients]. In broad strokes, it is thought to be heritable," said Dr. Sidbury.

A recent genome-wide study lends additional support to the role of genetics (Nature 2010:466:113-7). "Genome-wide association studies are like throwing spaghetti at the wall, only the spaghetti is DNA, and you see what sticks," Dr. Sidbury said.

What stuck were 139 single-nucleotide polymorphisms significantly associated with alopecia areata. The researchers found these in a comparison of 1,054 affected people and 3,278 controls.

"Not surprisingly, there are genes that control targeted inflammation. We have always referred to alopecia areata as a swarm of bees around the follicle," Dr. Sidbury said. "What was really unusual was identification of a stress [induced] protein."

Dermatology researchers at Columbia University, New York, discovered this stress-induced protein, known as ULBP3, related to a cluster of genes on chromosome 6. They also found that people with active alopecia areata have greater expression of this protein in the dermal shaft of their scalp follicles, compared with controls.

Aberrant expression of these genes might induce or worsen alopecia areata in genetically-susceptible patients, Dr. Sidbury said. "So it seems there may be a danger signal that activates this ULBP3 protein and calls in all this [autoimmune] inflammation."

Dermatologists might soon have a more concrete answer for patients regarding the cause of alopecia areata if these results are borne out in future studies. "This does not mean we will have a therapy tomorrow, but maybe we will have a more targeted way to get rid of that inflammation in the future," he said.

Vitiligo

Genetic findings regarding another autoimmune condition, generalized vitiligo, were also published this year (N. Engl. J. Med. 2010: 362:1686-97).

Researchers in Colorado identified genetic alterations that may impart an increased susceptibility to generalized vitiligo. They did a genome-wide study and compared 1,514 vitiligo patients and 2,813 controls with similar ancestry. They found significant associations between vitiligo and specific single-nucleotide polymorphisms (SNPs) in genes that code for histocompatibility and immune processes, for example.

The location of several SNPs is the same for vitiligo and other autoimmune diseases, suggesting a common genetic etiology. They also discovered a more specific mediator of vitiligo, a loci that encodes for tyrosinase, which could be a target of future interventions. "I'm hopeful we’ll have better therapies in the future," Dr. Sidbury said.

SDEF and this news organization are owned by Elsevier. Dr. Sidbury had no relevant disclosures.

For information on counseling parents about food allergies in the atopic child, based on a fourth prominent study, read Damian McNamara's blog post on The Mole at www.skinandallergynews.com/views/the-mole-the-skin-allergy-news-blog.

SAN FRANCISCO  - "I've never seen a year like the past where there were so many pediatric derm studies," Dr. Robert Sidbury said.

New discoveries that support a genetic basis for alopecia areata; a mutation in a collagen gene that might mean greater susceptibility to vitiligo; and a promising report that stem cell transplantations can help children with epidermolysis bullosa are among the highlights that Dr. Sidbury shared at the seminar on women’s and pediatric dermatology sponsored by Skin Disease Education Foundation.

Epidermolysis Bullosa

One report offers some hope to children with recessive dystrophic epidermolysis bullosa (RDEB), an incurable blistering disease that is often deadly. The condition is associated with mutations of a gene that encodes for type VII collagen, said Dr. Sidbury, chief of the division of dermatology at Seattle Children’s Hospital and the University of Washington.

Researchers at the University of Minnesota, Minneapolis, found allogenic bone marrow stem cell transplantation without the mutation improved outcomes for children (N. Engl. J. Med. 2010:363:629-39).

Following immunomyeloablative chemotherapy, six children received stem cell transplantations (a seventh died from cardiomyopathy before the protocol started). All six experienced improved wound healing and had a substantial proportion of sustained donor cells in their skin. They also experienced decreased blister formation between 30 and 130 days post transplantation.

One child died at 183 days because of graft rejection and infection. The other five were alive at the time of publication, between 130 and 799 days following transplantation.

Future studies to determine the long-term benefits and risks of this therapy are warranted, the researchers wrote.

Dr. Sidbury was enthusiastic about this strategy to combat RDEB, but added, "We have to be cautious when the first reports like this come out. But this is about as exciting as any report that has come down the pike for this difficult-to-treat condition."

Alopecia Areata

Even though alopecia areata is among the most common autoimmune conditions, the etiology remains largely unknown. "I spin my wheels trying to explain the 'whys' [to patients]. In broad strokes, it is thought to be heritable," said Dr. Sidbury.

A recent genome-wide study lends additional support to the role of genetics (Nature 2010:466:113-7). "Genome-wide association studies are like throwing spaghetti at the wall, only the spaghetti is DNA, and you see what sticks," Dr. Sidbury said.

What stuck were 139 single-nucleotide polymorphisms significantly associated with alopecia areata. The researchers found these in a comparison of 1,054 affected people and 3,278 controls.

"Not surprisingly, there are genes that control targeted inflammation. We have always referred to alopecia areata as a swarm of bees around the follicle," Dr. Sidbury said. "What was really unusual was identification of a stress [induced] protein."

Dermatology researchers at Columbia University, New York, discovered this stress-induced protein, known as ULBP3, related to a cluster of genes on chromosome 6. They also found that people with active alopecia areata have greater expression of this protein in the dermal shaft of their scalp follicles, compared with controls.

Aberrant expression of these genes might induce or worsen alopecia areata in genetically-susceptible patients, Dr. Sidbury said. "So it seems there may be a danger signal that activates this ULBP3 protein and calls in all this [autoimmune] inflammation."

Dermatologists might soon have a more concrete answer for patients regarding the cause of alopecia areata if these results are borne out in future studies. "This does not mean we will have a therapy tomorrow, but maybe we will have a more targeted way to get rid of that inflammation in the future," he said.

Vitiligo

Genetic findings regarding another autoimmune condition, generalized vitiligo, were also published this year (N. Engl. J. Med. 2010: 362:1686-97).

Researchers in Colorado identified genetic alterations that may impart an increased susceptibility to generalized vitiligo. They did a genome-wide study and compared 1,514 vitiligo patients and 2,813 controls with similar ancestry. They found significant associations between vitiligo and specific single-nucleotide polymorphisms (SNPs) in genes that code for histocompatibility and immune processes, for example.

The location of several SNPs is the same for vitiligo and other autoimmune diseases, suggesting a common genetic etiology. They also discovered a more specific mediator of vitiligo, a loci that encodes for tyrosinase, which could be a target of future interventions. "I'm hopeful we’ll have better therapies in the future," Dr. Sidbury said.

SDEF and this news organization are owned by Elsevier. Dr. Sidbury had no relevant disclosures.

For information on counseling parents about food allergies in the atopic child, based on a fourth prominent study, read Damian McNamara's blog post on The Mole at www.skinandallergynews.com/views/the-mole-the-skin-allergy-news-blog.

SAN FRANCISCO – Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at the seminar sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site (

www.nva.org

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution.

On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, said Dr. Edwards. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy is the most important intervention, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain.

Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Most of the medications mentioned in this article are “off label” for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at the seminar sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site (

www.nva.org

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution.

On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, said Dr. Edwards. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy is the most important intervention, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain.

Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Most of the medications mentioned in this article are “off label” for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at the seminar sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site (

www.nva.org

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution.

On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, said Dr. Edwards. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy is the most important intervention, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain.

Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Most of the medications mentioned in this article are “off label” for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Get the word out to your skin of color patients that effective treatments for melasma are available, Dr. Valerie D. Callender advised.

Dermatologists can do a great service by increasing awareness about therapeutic options for melasma, she said. Although melasma is “a pretty common condition” – affecting an estimated 5 million American women – only 2%-6% seek treatment from a physician (Arch. Dermatol. 1995;131:1453-7).

Melasma, also known as “dyschromia,” was second only to acne on a list of the most common diagnoses list in a study of 1,412 patients at a hospital-based dermatology practice (Cutis 2007: 80:387-94).

“Not only do they have melasma, they may not know there is treatment available,” Dr. Callender said at the seminar, sponsored by Skin Disease Education Foundation (SDEF).

Melasma, an acquired hypermelanosis, often affects sun-exposed areas of the face, neck, and forearms, making it difficult for patients to cloak their condition. A centrofacial presentation is featured in more than half of patients.

Another reason to increase treatment awareness is that melasma has a significant psychosocial impact, Dr. Callender said. “We know from quality of life studies that these women are really suffering,” she commented. Reductions in emotional well-being, social interaction, and recreation and leisure activities are reported (Br. J. Dermatol. 2003;149:572-7).

“Melasma can be emotionally and psychologically devastating,” Dr. Callender said. A study of 300 people with melasma in Brazil found 65% of patients were bothered all or most of the time, 55% were frustrated, and 43% felt unattractive because of their condition (Br. J. Dermatol. 2006;156:13-20).

Melasma can be generalized or localized, and disproportionately affects women. Hormonal changes from oral contraceptives, hormone therapy, and pregnancy are among the etiologies. Genetics, ultraviolet and visible light exposure, and thyroid dysfunction are other known causes. Only about 10% of patients are men,” said Dr. Callender, a dermatologist in private practice in Washington, D.C.

Effective medications for melasma include hydroquinone, tretinoin, and azelaic acid, often prescribed in combination. “We recommend a 3%-4% prescription [of hydroquinone],” Dr. Callender said. Higher-strength formulations are available from compounding pharmacies, but carry a great risk of adverse events. For example, concentrations as high as 8%-10% used in Africa are associated with exogenous ochronosis (where the affected skin gets darker instead or lighter). “Know the safety behind whichever hydroquinone form you choose, and monitor patients closely,” she said.

Chemical peels are sometimes recommended for melasma in combination with hydroquinone, Dr. Callender said.

Regarding safe and effective laser treatment for melasma, “we’re not there yet,” she said. One recent, small study indicates that fractional photothermolysis could hold some promise (Dermatol. Surg. 2010;36:1273-80). After two to seven treatments, five of the eight female patients in the study had a 50% clinical improvement or greater. Of note, there was no reported postinflammatory hyperpigmentation, which has been a limitation of laser therapy for this condition, Dr. Callender said.

Patient education about chronicity is another important goal of counseling. “Melasma is chronic and can come back,” Dr. Callender said. “It is most important to talk to your patients about maintenance therapy.”

Researchers are still searching for the optimal strategy to prevent melasma recurrence. For example, relapses were common in a study that assessed maintenance therapy with a triple-drug combination treatment of hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (J. Am. Acad. Dermatol. 2010:62:962-7). In this open-label study, 70 patients applied this combination product daily for 6 weeks and then switched to twice-weekly application. A total of 21 patients relapsed and had to return to the daily treatment. “Maybe two times a week is not enough. Maybe three times a week would be better,” Dr. Callender said.

Emphasize the ongoing importance of sun avoidance. “They can finish treatment, go out in the sun for 1 hour, and it comes back,” she said. Advise patients to use sun protection with SPF-30 and “make sure the product you recommend is opaque and does not give a grayish tint to skin of color.” Also, Dr. Callender said she routinely tests for vitamin D levels and recommends patients take supplements as indicated.

She is a consultant and researcher for Allergan Inc., Galderma, Intendis, Medicis Pharmaceutical Corp., and Procter & Gamble.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Get the word out to your skin of color patients that effective treatments for melasma are available, Dr. Valerie D. Callender advised.

Dermatologists can do a great service by increasing awareness about therapeutic options for melasma, she said. Although melasma is “a pretty common condition” – affecting an estimated 5 million American women – only 2%-6% seek treatment from a physician (Arch. Dermatol. 1995;131:1453-7).

Melasma, also known as “dyschromia,” was second only to acne on a list of the most common diagnoses list in a study of 1,412 patients at a hospital-based dermatology practice (Cutis 2007: 80:387-94).

“Not only do they have melasma, they may not know there is treatment available,” Dr. Callender said at the seminar, sponsored by Skin Disease Education Foundation (SDEF).

Melasma, an acquired hypermelanosis, often affects sun-exposed areas of the face, neck, and forearms, making it difficult for patients to cloak their condition. A centrofacial presentation is featured in more than half of patients.

Another reason to increase treatment awareness is that melasma has a significant psychosocial impact, Dr. Callender said. “We know from quality of life studies that these women are really suffering,” she commented. Reductions in emotional well-being, social interaction, and recreation and leisure activities are reported (Br. J. Dermatol. 2003;149:572-7).

“Melasma can be emotionally and psychologically devastating,” Dr. Callender said. A study of 300 people with melasma in Brazil found 65% of patients were bothered all or most of the time, 55% were frustrated, and 43% felt unattractive because of their condition (Br. J. Dermatol. 2006;156:13-20).

Melasma can be generalized or localized, and disproportionately affects women. Hormonal changes from oral contraceptives, hormone therapy, and pregnancy are among the etiologies. Genetics, ultraviolet and visible light exposure, and thyroid dysfunction are other known causes. Only about 10% of patients are men,” said Dr. Callender, a dermatologist in private practice in Washington, D.C.

Effective medications for melasma include hydroquinone, tretinoin, and azelaic acid, often prescribed in combination. “We recommend a 3%-4% prescription [of hydroquinone],” Dr. Callender said. Higher-strength formulations are available from compounding pharmacies, but carry a great risk of adverse events. For example, concentrations as high as 8%-10% used in Africa are associated with exogenous ochronosis (where the affected skin gets darker instead or lighter). “Know the safety behind whichever hydroquinone form you choose, and monitor patients closely,” she said.

Chemical peels are sometimes recommended for melasma in combination with hydroquinone, Dr. Callender said.

Regarding safe and effective laser treatment for melasma, “we’re not there yet,” she said. One recent, small study indicates that fractional photothermolysis could hold some promise (Dermatol. Surg. 2010;36:1273-80). After two to seven treatments, five of the eight female patients in the study had a 50% clinical improvement or greater. Of note, there was no reported postinflammatory hyperpigmentation, which has been a limitation of laser therapy for this condition, Dr. Callender said.

Patient education about chronicity is another important goal of counseling. “Melasma is chronic and can come back,” Dr. Callender said. “It is most important to talk to your patients about maintenance therapy.”

Researchers are still searching for the optimal strategy to prevent melasma recurrence. For example, relapses were common in a study that assessed maintenance therapy with a triple-drug combination treatment of hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (J. Am. Acad. Dermatol. 2010:62:962-7). In this open-label study, 70 patients applied this combination product daily for 6 weeks and then switched to twice-weekly application. A total of 21 patients relapsed and had to return to the daily treatment. “Maybe two times a week is not enough. Maybe three times a week would be better,” Dr. Callender said.

Emphasize the ongoing importance of sun avoidance. “They can finish treatment, go out in the sun for 1 hour, and it comes back,” she said. Advise patients to use sun protection with SPF-30 and “make sure the product you recommend is opaque and does not give a grayish tint to skin of color.” Also, Dr. Callender said she routinely tests for vitamin D levels and recommends patients take supplements as indicated.

She is a consultant and researcher for Allergan Inc., Galderma, Intendis, Medicis Pharmaceutical Corp., and Procter & Gamble.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Get the word out to your skin of color patients that effective treatments for melasma are available, Dr. Valerie D. Callender advised.

Dermatologists can do a great service by increasing awareness about therapeutic options for melasma, she said. Although melasma is “a pretty common condition” – affecting an estimated 5 million American women – only 2%-6% seek treatment from a physician (Arch. Dermatol. 1995;131:1453-7).

Melasma, also known as “dyschromia,” was second only to acne on a list of the most common diagnoses list in a study of 1,412 patients at a hospital-based dermatology practice (Cutis 2007: 80:387-94).

“Not only do they have melasma, they may not know there is treatment available,” Dr. Callender said at the seminar, sponsored by Skin Disease Education Foundation (SDEF).

Melasma, an acquired hypermelanosis, often affects sun-exposed areas of the face, neck, and forearms, making it difficult for patients to cloak their condition. A centrofacial presentation is featured in more than half of patients.

Another reason to increase treatment awareness is that melasma has a significant psychosocial impact, Dr. Callender said. “We know from quality of life studies that these women are really suffering,” she commented. Reductions in emotional well-being, social interaction, and recreation and leisure activities are reported (Br. J. Dermatol. 2003;149:572-7).

“Melasma can be emotionally and psychologically devastating,” Dr. Callender said. A study of 300 people with melasma in Brazil found 65% of patients were bothered all or most of the time, 55% were frustrated, and 43% felt unattractive because of their condition (Br. J. Dermatol. 2006;156:13-20).

Melasma can be generalized or localized, and disproportionately affects women. Hormonal changes from oral contraceptives, hormone therapy, and pregnancy are among the etiologies. Genetics, ultraviolet and visible light exposure, and thyroid dysfunction are other known causes. Only about 10% of patients are men,” said Dr. Callender, a dermatologist in private practice in Washington, D.C.

Effective medications for melasma include hydroquinone, tretinoin, and azelaic acid, often prescribed in combination. “We recommend a 3%-4% prescription [of hydroquinone],” Dr. Callender said. Higher-strength formulations are available from compounding pharmacies, but carry a great risk of adverse events. For example, concentrations as high as 8%-10% used in Africa are associated with exogenous ochronosis (where the affected skin gets darker instead or lighter). “Know the safety behind whichever hydroquinone form you choose, and monitor patients closely,” she said.

Chemical peels are sometimes recommended for melasma in combination with hydroquinone, Dr. Callender said.

Regarding safe and effective laser treatment for melasma, “we’re not there yet,” she said. One recent, small study indicates that fractional photothermolysis could hold some promise (Dermatol. Surg. 2010;36:1273-80). After two to seven treatments, five of the eight female patients in the study had a 50% clinical improvement or greater. Of note, there was no reported postinflammatory hyperpigmentation, which has been a limitation of laser therapy for this condition, Dr. Callender said.

Patient education about chronicity is another important goal of counseling. “Melasma is chronic and can come back,” Dr. Callender said. “It is most important to talk to your patients about maintenance therapy.”

Researchers are still searching for the optimal strategy to prevent melasma recurrence. For example, relapses were common in a study that assessed maintenance therapy with a triple-drug combination treatment of hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.01% (J. Am. Acad. Dermatol. 2010:62:962-7). In this open-label study, 70 patients applied this combination product daily for 6 weeks and then switched to twice-weekly application. A total of 21 patients relapsed and had to return to the daily treatment. “Maybe two times a week is not enough. Maybe three times a week would be better,” Dr. Callender said.

Emphasize the ongoing importance of sun avoidance. “They can finish treatment, go out in the sun for 1 hour, and it comes back,” she said. Advise patients to use sun protection with SPF-30 and “make sure the product you recommend is opaque and does not give a grayish tint to skin of color.” Also, Dr. Callender said she routinely tests for vitamin D levels and recommends patients take supplements as indicated.

She is a consultant and researcher for Allergan Inc., Galderma, Intendis, Medicis Pharmaceutical Corp., and Procter & Gamble.

SDEF and this news organization are owned by Elsevier.

ATLANTA - Vaccination of U.S. infants 19 months to 35 months remains high at 90% or greater for routine immunizations, according to results of the 2009 National Immunization Survey released by the Centers for Disease Control and Prevention.

This means vaccine coverage in 2009 for poliovirus; measles, mumps, and rubella; hepatitis B; and varicella met or exceeded the 90% goal set by the government's National Healthy People 2010 initiative.

In addition, vaccine coverage increased in 2009, compared with 2008, for newly recommended immunizations, including the birth dose of hepatitis B (61%, up from 55%) and hepatitis A (47%, up from 40%), according to the results of this population-based survey published in Morbidity and Mortality Weekly Report (2010;59:1171–7).

At the same time, this survey of vaccinations for 17,313 children nationwide revealed less than 1% of young children born between January 2006 and July 2008 received no vaccinations.

"Today's report is generally very reassuring, despite concerns we've seen in the past about whether parents are continuing to have their children vaccinated, and despite some resurgences in vaccine-preventable diseases in particular areas, today's national report provides good news," Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the CDC, said during a telebriefing.

Despite the encouraging numbers, there is a need for clinicians to provide ongoing parent education, Dr. Schuchat said.

Some substantial variation in vaccine coverage between states was again revealed by this annual survey, suggesting there is still work to be done in some communities.

Dr. Schuchat addressed the outbreak of pertussis cases in California, responsible for nine infant deaths since January 2010. The coverage in California for four doses of DTaP, the pertussis-containing baby shot, was 83%, according to state records.

"We don't think it's the coverage level in that babies and toddlers that is leading to that pertussis challenge in California." Instead, "we think the challenge with those pertussis cases is the increasing vaccination of teens and adults," she said, although "it continues to be important for babies and toddlers to get their DTaP doses."

The CDC strongly recommends everyone aged 11 years and older, particularly new parents and those in close contact with young children, receive the vaccination against pertussis. Dr. Schuchat said, "The situation in California is serious, and we are working together with the California health department to really promote uptake of the pertussis vaccine for teens and adults."

The survey showed national coverage for MMR vaccinations experienced "a significant but not large" drop from 92% in 2008 to 90% in 2009.

"That might be a warning sign of larger drops to come or a small change that, because our survey is so large, was statistically significant," Dr. Schuchat said. Even though national coverage numbers are 90%, "you can still have large pockets of susceptible children." She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common.

She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common. "Those two examples [pertussis and measles] show that we cannot let our guard down."

The survey also revealed a substantial drop in coverage for one vaccine, Haemophilus influenzae B (Hib). A total of 84% of children aged 19–35 months received the three recommended doses in the survey. This represents a decrease of more than 6 percentage points vs. 2008 that "really just reflects the national shortage" of this vaccine between December 2007 and September 2009, Dr. Schuchat said.

Other survey findings indicate that 44% of children received full coverage for the rotavirus vaccine during infancy. This is the first national survey data to report adoption of the rotavirus vaccine since its U.S. licensure in 2006.

"That is really good uptake of this vaccine," Dr. Schuchat said.

In addition, 80% of infants received the recommended four or more doses that comprise full coverage for pneumococcal conjugate vaccination. This figure is comparable to coverage reported for other immunizations that require four doses to complete, according to the report.

The 2009 National Immunization Survey was a telephone survey of vaccinations for U.S. households with children born between January 2006 and July 2008. The CDC report is also based on 17,313 vaccination records provided by health care providers for the families contacted for the survey.

ATLANTA - Vaccination of U.S. infants 19 months to 35 months remains high at 90% or greater for routine immunizations, according to results of the 2009 National Immunization Survey released by the Centers for Disease Control and Prevention.

This means vaccine coverage in 2009 for poliovirus; measles, mumps, and rubella; hepatitis B; and varicella met or exceeded the 90% goal set by the government's National Healthy People 2010 initiative.

In addition, vaccine coverage increased in 2009, compared with 2008, for newly recommended immunizations, including the birth dose of hepatitis B (61%, up from 55%) and hepatitis A (47%, up from 40%), according to the results of this population-based survey published in Morbidity and Mortality Weekly Report (2010;59:1171–7).

At the same time, this survey of vaccinations for 17,313 children nationwide revealed less than 1% of young children born between January 2006 and July 2008 received no vaccinations.

"Today's report is generally very reassuring, despite concerns we've seen in the past about whether parents are continuing to have their children vaccinated, and despite some resurgences in vaccine-preventable diseases in particular areas, today's national report provides good news," Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the CDC, said during a telebriefing.

Despite the encouraging numbers, there is a need for clinicians to provide ongoing parent education, Dr. Schuchat said.

Some substantial variation in vaccine coverage between states was again revealed by this annual survey, suggesting there is still work to be done in some communities.

Dr. Schuchat addressed the outbreak of pertussis cases in California, responsible for nine infant deaths since January 2010. The coverage in California for four doses of DTaP, the pertussis-containing baby shot, was 83%, according to state records.

"We don't think it's the coverage level in that babies and toddlers that is leading to that pertussis challenge in California." Instead, "we think the challenge with those pertussis cases is the increasing vaccination of teens and adults," she said, although "it continues to be important for babies and toddlers to get their DTaP doses."

The CDC strongly recommends everyone aged 11 years and older, particularly new parents and those in close contact with young children, receive the vaccination against pertussis. Dr. Schuchat said, "The situation in California is serious, and we are working together with the California health department to really promote uptake of the pertussis vaccine for teens and adults."

The survey showed national coverage for MMR vaccinations experienced "a significant but not large" drop from 92% in 2008 to 90% in 2009.

"That might be a warning sign of larger drops to come or a small change that, because our survey is so large, was statistically significant," Dr. Schuchat said. Even though national coverage numbers are 90%, "you can still have large pockets of susceptible children." She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common.

She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common. "Those two examples [pertussis and measles] show that we cannot let our guard down."

The survey also revealed a substantial drop in coverage for one vaccine, Haemophilus influenzae B (Hib). A total of 84% of children aged 19–35 months received the three recommended doses in the survey. This represents a decrease of more than 6 percentage points vs. 2008 that "really just reflects the national shortage" of this vaccine between December 2007 and September 2009, Dr. Schuchat said.

Other survey findings indicate that 44% of children received full coverage for the rotavirus vaccine during infancy. This is the first national survey data to report adoption of the rotavirus vaccine since its U.S. licensure in 2006.

"That is really good uptake of this vaccine," Dr. Schuchat said.

In addition, 80% of infants received the recommended four or more doses that comprise full coverage for pneumococcal conjugate vaccination. This figure is comparable to coverage reported for other immunizations that require four doses to complete, according to the report.

The 2009 National Immunization Survey was a telephone survey of vaccinations for U.S. households with children born between January 2006 and July 2008. The CDC report is also based on 17,313 vaccination records provided by health care providers for the families contacted for the survey.

ATLANTA - Vaccination of U.S. infants 19 months to 35 months remains high at 90% or greater for routine immunizations, according to results of the 2009 National Immunization Survey released by the Centers for Disease Control and Prevention.

This means vaccine coverage in 2009 for poliovirus; measles, mumps, and rubella; hepatitis B; and varicella met or exceeded the 90% goal set by the government's National Healthy People 2010 initiative.

In addition, vaccine coverage increased in 2009, compared with 2008, for newly recommended immunizations, including the birth dose of hepatitis B (61%, up from 55%) and hepatitis A (47%, up from 40%), according to the results of this population-based survey published in Morbidity and Mortality Weekly Report (2010;59:1171–7).

At the same time, this survey of vaccinations for 17,313 children nationwide revealed less than 1% of young children born between January 2006 and July 2008 received no vaccinations.

"Today's report is generally very reassuring, despite concerns we've seen in the past about whether parents are continuing to have their children vaccinated, and despite some resurgences in vaccine-preventable diseases in particular areas, today's national report provides good news," Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the CDC, said during a telebriefing.

Despite the encouraging numbers, there is a need for clinicians to provide ongoing parent education, Dr. Schuchat said.

Some substantial variation in vaccine coverage between states was again revealed by this annual survey, suggesting there is still work to be done in some communities.

Dr. Schuchat addressed the outbreak of pertussis cases in California, responsible for nine infant deaths since January 2010. The coverage in California for four doses of DTaP, the pertussis-containing baby shot, was 83%, according to state records.

"We don't think it's the coverage level in that babies and toddlers that is leading to that pertussis challenge in California." Instead, "we think the challenge with those pertussis cases is the increasing vaccination of teens and adults," she said, although "it continues to be important for babies and toddlers to get their DTaP doses."

The CDC strongly recommends everyone aged 11 years and older, particularly new parents and those in close contact with young children, receive the vaccination against pertussis. Dr. Schuchat said, "The situation in California is serious, and we are working together with the California health department to really promote uptake of the pertussis vaccine for teens and adults."

The survey showed national coverage for MMR vaccinations experienced "a significant but not large" drop from 92% in 2008 to 90% in 2009.

"That might be a warning sign of larger drops to come or a small change that, because our survey is so large, was statistically significant," Dr. Schuchat said. Even though national coverage numbers are 90%, "you can still have large pockets of susceptible children." She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common.

She added that measles outbreaks in 2008 affected communities in which certain schools had a large number of children who were unvaccinated when the virus was imported from other countries where infection is still very common. "Those two examples [pertussis and measles] show that we cannot let our guard down."

The survey also revealed a substantial drop in coverage for one vaccine, Haemophilus influenzae B (Hib). A total of 84% of children aged 19–35 months received the three recommended doses in the survey. This represents a decrease of more than 6 percentage points vs. 2008 that "really just reflects the national shortage" of this vaccine between December 2007 and September 2009, Dr. Schuchat said.

Other survey findings indicate that 44% of children received full coverage for the rotavirus vaccine during infancy. This is the first national survey data to report adoption of the rotavirus vaccine since its U.S. licensure in 2006.

"That is really good uptake of this vaccine," Dr. Schuchat said.

In addition, 80% of infants received the recommended four or more doses that comprise full coverage for pneumococcal conjugate vaccination. This figure is comparable to coverage reported for other immunizations that require four doses to complete, according to the report.

The 2009 National Immunization Survey was a telephone survey of vaccinations for U.S. households with children born between January 2006 and July 2008. The CDC report is also based on 17,313 vaccination records provided by health care providers for the families contacted for the survey.

Major Finding: A 14% increased likelihood of high psychological distress was linked with each hour fewer than 8 slept, on average, per night among young adults.

Data Source: Prospective cohort study of responses from 19,648 young adults surveyed at baseline and from 2,937 resurveyed 12–18 months later.

Disclosures: There was no industry support for the study. Dr. Nicholas Glozier is on the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Coauthor Dr. Ian Hickie formerly served as CEO and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects funded by drug industry partners. The others reported no conflicts.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation — a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night — after they controlled for possible confounders. Sleeping 8–9 hours per night is recommended.

A total of 19,648 Australians (aged 17–24 years) reported their sleep hours for the previous month in a survey of registered drivers.

Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the fewer than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine.

Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7–8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139–45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12–18 months later.

They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline.

In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). The risk was most pronounced among those who reported an average 5 hours or fewer of sleep (RR, 3.25), compared with the other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted.

Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new-onset psychological distress by asking about sleep duration.

Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use).

Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration.

Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97–106).

High psychological distress was more common among females (40%, compared with 28% of males). It was also higher among those who reported unemployment (33% vs. 28% of those employed); drug use (45% vs. 32%); harmful alcohol use (38% vs. 32%); high sensation-seeking behavior (44% vs. 22%), and recent deliberate self-harm (70% vs. 31%).

The researchers controlled for these potential confounders in the study.

Predictors of persistent distress included initial symptom severity, older age, and recent attempts at self-harm.

The authors termed presence of elevated distress at baseline and follow-up as “persistent,” but said that taking measurements at only two time points is a potential limitation.

In addition, the cohort was derived from driving registration records and might not be representative of the entire population of 17- to 24-year-olds.

Major Finding: A 14% increased likelihood of high psychological distress was linked with each hour fewer than 8 slept, on average, per night among young adults.

Data Source: Prospective cohort study of responses from 19,648 young adults surveyed at baseline and from 2,937 resurveyed 12–18 months later.

Disclosures: There was no industry support for the study. Dr. Nicholas Glozier is on the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Coauthor Dr. Ian Hickie formerly served as CEO and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects funded by drug industry partners. The others reported no conflicts.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation — a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night — after they controlled for possible confounders. Sleeping 8–9 hours per night is recommended.

A total of 19,648 Australians (aged 17–24 years) reported their sleep hours for the previous month in a survey of registered drivers.

Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the fewer than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine.

Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7–8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139–45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12–18 months later.

They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline.

In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). The risk was most pronounced among those who reported an average 5 hours or fewer of sleep (RR, 3.25), compared with the other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted.

Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new-onset psychological distress by asking about sleep duration.

Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use).

Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration.

Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97–106).

High psychological distress was more common among females (40%, compared with 28% of males). It was also higher among those who reported unemployment (33% vs. 28% of those employed); drug use (45% vs. 32%); harmful alcohol use (38% vs. 32%); high sensation-seeking behavior (44% vs. 22%), and recent deliberate self-harm (70% vs. 31%).

The researchers controlled for these potential confounders in the study.

Predictors of persistent distress included initial symptom severity, older age, and recent attempts at self-harm.

The authors termed presence of elevated distress at baseline and follow-up as “persistent,” but said that taking measurements at only two time points is a potential limitation.

In addition, the cohort was derived from driving registration records and might not be representative of the entire population of 17- to 24-year-olds.

Major Finding: A 14% increased likelihood of high psychological distress was linked with each hour fewer than 8 slept, on average, per night among young adults.

Data Source: Prospective cohort study of responses from 19,648 young adults surveyed at baseline and from 2,937 resurveyed 12–18 months later.

Disclosures: There was no industry support for the study. Dr. Nicholas Glozier is on the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Coauthor Dr. Ian Hickie formerly served as CEO and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects funded by drug industry partners. The others reported no conflicts.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation — a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night — after they controlled for possible confounders. Sleeping 8–9 hours per night is recommended.

A total of 19,648 Australians (aged 17–24 years) reported their sleep hours for the previous month in a survey of registered drivers.

Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the fewer than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine.

Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7–8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139–45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12–18 months later.

They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline.

In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). The risk was most pronounced among those who reported an average 5 hours or fewer of sleep (RR, 3.25), compared with the other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted.

Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new-onset psychological distress by asking about sleep duration.

Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use).

Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration.

Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97–106).

High psychological distress was more common among females (40%, compared with 28% of males). It was also higher among those who reported unemployment (33% vs. 28% of those employed); drug use (45% vs. 32%); harmful alcohol use (38% vs. 32%); high sensation-seeking behavior (44% vs. 22%), and recent deliberate self-harm (70% vs. 31%).

The researchers controlled for these potential confounders in the study.

Predictors of persistent distress included initial symptom severity, older age, and recent attempts at self-harm.

The authors termed presence of elevated distress at baseline and follow-up as “persistent,” but said that taking measurements at only two time points is a potential limitation.

In addition, the cohort was derived from driving registration records and might not be representative of the entire population of 17- to 24-year-olds.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation – a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night – after they controlled for possible confounders. Sleeping 8-9 hours per night is recommended.

A total of 19,648 Australians (aged 17-24 years) reported their sleep hours for the previous month in a survey of registered drivers. Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the less than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine. Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7-8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139-45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12-18 months later. They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline. In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). Risk was most pronounced among those reporting an average 5 hours or fewer of sleep (RR, 3.25), compared with other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted. Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new onset psychological distress by asking about sleep duration. Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use). Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration. Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97-106).

Disclosures: There was no industry support for the study. Dr. Glozier is a member of the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Dr. Ian Hickie, one of the investigators, formerly served as chief executive officer and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects supported by numerous drug industry partners. The other authors reported no relevant disclosures.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation – a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night – after they controlled for possible confounders. Sleeping 8-9 hours per night is recommended.

A total of 19,648 Australians (aged 17-24 years) reported their sleep hours for the previous month in a survey of registered drivers. Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the less than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine. Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7-8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139-45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12-18 months later. They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline. In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). Risk was most pronounced among those reporting an average 5 hours or fewer of sleep (RR, 3.25), compared with other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted. Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new onset psychological distress by asking about sleep duration. Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use). Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration. Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97-106).

Disclosures: There was no industry support for the study. Dr. Glozier is a member of the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Dr. Ian Hickie, one of the investigators, formerly served as chief executive officer and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects supported by numerous drug industry partners. The other authors reported no relevant disclosures.

Young adults who report sleeping fewer hours per night on average than do their counterparts are at elevated risk for persistent or new-onset psychological distress, according to results of a large, prospective cohort study.

Researchers found a linear correlation – a 14% greater risk for higher psychological distress for each hour slept fewer than 8, on average, per night – after they controlled for possible confounders. Sleeping 8-9 hours per night is recommended.

A total of 19,648 Australians (aged 17-24 years) reported their sleep hours for the previous month in a survey of registered drivers. Researchers found almost one-third (32.5%) had high baseline levels of psychological distress (defined as a score greater than 21 on the K10 (Kessler Psychological Distress Scale), a 10-item instrument that screens for feeling “tired out for no reason,” nervous, hopeless, restless, or depressed during the previous 4 weeks.

Psychological distress was most acute among the less than 2% of young adults who reported sleeping an average 5 hours or fewer per night, representing a group that might benefit the most from an intervention to improve their sleep routine. Another 18% reported sleeping an average 7 hours or fewer per night, and 30% reported sleeping 7-8 hours each night.

The full findings of the study were published in the September issue of the journal Sleep (2010;33:1139-45).

Lead researcher Dr. Nicholas Glozier and his associates also resurveyed a random sample of 2,937 respondents 12-18 months later. They found that high levels of distress persisted for 32% of the 945 who were initially distressed at baseline. In addition, 12% of those with no initial elevated distress (239 of 1992 respondents) had new-onset distress 1 year later, reported Dr. Glozier, who is on the psychological medicine faculty at the Brain and Mind Research Institute at the University of Sydney.

Again, a linear association was found between shorter sleep duration and likelihood for onset of psychological distress (relative risk, 1.12). Risk was most pronounced among those reporting an average 5 hours or fewer of sleep (RR, 3.25), compared with other participants.

This is the first prospective study to link shorter sleep duration in young adults with increased psychological distress, the researchers noted. Interestingly, there was no increased risk of psychological distress at any time in the study among those who reported sleeping an average 9 hours or more per night.

Based on these findings, clinicians could potentially identify young adults who are at elevated risk for persistent or new onset psychological distress by asking about sleep duration. Also, because young adulthood is a time when elevated psychological distress could develop into depression and many other psychiatric conditions, short sleep duration could be an important marker for early intervention, the authors wrote.

The authors acknowledged the difficulty associated with any populationwide effort to improve sleep (such as reducing late-night television viewing, computer gaming, and Internet use). Instead, they recommend that clinicians identify and focus their efforts on young adults who are at highest risk: those who report current distress or extremely short sleep duration. Other researchers demonstrated an association between short sleep duration and later bedtimes with depressed mood and suicidal ideation among adolescents (Sleep 2010;33:97-106).

Disclosures: There was no industry support for the study. Dr. Glozier is a member of the Sanofi-Aventis advisory board and is a speaker for CSL Laboratories. Dr. Ian Hickie, one of the investigators, formerly served as chief executive officer and clinical adviser for Beyondblue, the Australian National Depression Initiative, and has led projects supported by numerous drug industry partners. The other authors reported no relevant disclosures.

Major Finding: Men with history of an adolescent suicide attempt are more likely to commit intimate partner violence as young adults.

Data Source: Annual assessments of 153 men participating in the Oregon Youth Study from age 10 years to 32 years. Researchers also assessed reports from 59 female partners during observed couple interactions.

Disclosures: Dr. Kerr said he did not have any relevant disclosures.

ORLANDO – Adolescent suicide attempt history is associated with increased likelihood of intimate partner violence when a male becomes a young adult, according to a long-term, prospective study of 153 men.

The findings suggest that prevention or intervention efforts for adolescents who attempt suicide might improve subsequent relationship outcomes, said David C. R. Kerr, Ph.D.

A paucity of research exists on associations between teenage suicidal behavior and relational distress, partner aggression, or relationship instability in young adulthood, Dr. Kerr said at the meeting.

Suicidal behavior might reflect underlying traits, such as impulsivity or aggression, he said, and these traits could manifest as maladaptive behaviors during romantic relationships. “Intimate relationships can be a source of significant conflict and profound emotional distress.”

Impulsive or reactive aggression during intense negative affect or when someone is highly negatively aroused seems to be important, said Dr. Kerr, research associate at Oregon Social Learning Center at Oregon State University, Eugene.

Dr. Kerr and his associate Deborah Capaldi, Ph.D., assessed regular surveys of males beginning when they were aged 10 years. Participants in the Oregon Youth Study were re-assessed annually up to age 32 years. Findings were not solely based on self-reports, because they are not always trustworthy, Dr. Kerr said. “Batterers may report mental health symptoms as a way to deny responsibility.” In addition, he said, suicidal threats/behaviors might be considered a form of control over intimate partners.

Annual reports from 59 female partners starting when the men reached age 18 years also were assessed. Couples also were observed in interaction tasks meant to generate some conflict.

A total 19 of the 153 males (12%) had a lifetime suicide attempt history.

In order to assess physical injury, only partners were asked during five interviews (from ages 20 to 32 years) if they had ever been injured by the man. “Close to 27% reported an injury of some form,” Dr. Kerr said.

“An unmediated link between youth suicide attempt and adult partner aggression and violence supports the role of impulsive, undercontrolled aggression in intimate partner violence,” Dr. Kerr said. “It suggests intimate partner violence is not solely a calculated, instrumental behavior.”

Adolescent aggression also predicted negative relationship outcomes in young adulthood in the study.

The research revealed that 25 men, or 16%, had been arrested one or more times for domestic violence. However, “The numbers were too small regarding domestic violence arrests to make conclusions,” Dr. Kerr said.

Suicide attempt in adolescence also predicted relationship instability or “some measure of how many break-ups they had.” This instability was measured during six interviews between ages 24 and 32 years.

Interestingly, adolescent suicide attempts and aggression were not significantly associated with later relationship satisfaction, Dr. Kerr said.

This study is the first to evaluate an at-risk community sample. The Oregon Youth Study cohort includes boys identified as being at risk for neighborhood delinquency from entire fourth-grade classrooms.

About 75% of participants were from working class families, and 90% were white. Other studies in the literature focused primarily on juvenile justice system–based reports, which may not be representative, Dr. Kerr said.

The findings add to a growing understanding of negative outcomes for youth who attempt suicide, Dr. Kerr said. These negative consequences can extend to intimate partners, and additional prevention and treatment approaches may be needed. He added that cognitive therapy with behavioral and emotional regulation skills for adolescents who attempt suicide might be beneficial, for example.

Major Finding: Men with history of an adolescent suicide attempt are more likely to commit intimate partner violence as young adults.

Data Source: Annual assessments of 153 men participating in the Oregon Youth Study from age 10 years to 32 years. Researchers also assessed reports from 59 female partners during observed couple interactions.

Disclosures: Dr. Kerr said he did not have any relevant disclosures.

ORLANDO – Adolescent suicide attempt history is associated with increased likelihood of intimate partner violence when a male becomes a young adult, according to a long-term, prospective study of 153 men.

The findings suggest that prevention or intervention efforts for adolescents who attempt suicide might improve subsequent relationship outcomes, said David C. R. Kerr, Ph.D.

A paucity of research exists on associations between teenage suicidal behavior and relational distress, partner aggression, or relationship instability in young adulthood, Dr. Kerr said at the meeting.

Suicidal behavior might reflect underlying traits, such as impulsivity or aggression, he said, and these traits could manifest as maladaptive behaviors during romantic relationships. “Intimate relationships can be a source of significant conflict and profound emotional distress.”

Impulsive or reactive aggression during intense negative affect or when someone is highly negatively aroused seems to be important, said Dr. Kerr, research associate at Oregon Social Learning Center at Oregon State University, Eugene.

Dr. Kerr and his associate Deborah Capaldi, Ph.D., assessed regular surveys of males beginning when they were aged 10 years. Participants in the Oregon Youth Study were re-assessed annually up to age 32 years. Findings were not solely based on self-reports, because they are not always trustworthy, Dr. Kerr said. “Batterers may report mental health symptoms as a way to deny responsibility.” In addition, he said, suicidal threats/behaviors might be considered a form of control over intimate partners.

Annual reports from 59 female partners starting when the men reached age 18 years also were assessed. Couples also were observed in interaction tasks meant to generate some conflict.

A total 19 of the 153 males (12%) had a lifetime suicide attempt history.

In order to assess physical injury, only partners were asked during five interviews (from ages 20 to 32 years) if they had ever been injured by the man. “Close to 27% reported an injury of some form,” Dr. Kerr said.

“An unmediated link between youth suicide attempt and adult partner aggression and violence supports the role of impulsive, undercontrolled aggression in intimate partner violence,” Dr. Kerr said. “It suggests intimate partner violence is not solely a calculated, instrumental behavior.”

Adolescent aggression also predicted negative relationship outcomes in young adulthood in the study.

The research revealed that 25 men, or 16%, had been arrested one or more times for domestic violence. However, “The numbers were too small regarding domestic violence arrests to make conclusions,” Dr. Kerr said.

Suicide attempt in adolescence also predicted relationship instability or “some measure of how many break-ups they had.” This instability was measured during six interviews between ages 24 and 32 years.

Interestingly, adolescent suicide attempts and aggression were not significantly associated with later relationship satisfaction, Dr. Kerr said.

This study is the first to evaluate an at-risk community sample. The Oregon Youth Study cohort includes boys identified as being at risk for neighborhood delinquency from entire fourth-grade classrooms.

About 75% of participants were from working class families, and 90% were white. Other studies in the literature focused primarily on juvenile justice system–based reports, which may not be representative, Dr. Kerr said.

The findings add to a growing understanding of negative outcomes for youth who attempt suicide, Dr. Kerr said. These negative consequences can extend to intimate partners, and additional prevention and treatment approaches may be needed. He added that cognitive therapy with behavioral and emotional regulation skills for adolescents who attempt suicide might be beneficial, for example.

Major Finding: Men with history of an adolescent suicide attempt are more likely to commit intimate partner violence as young adults.

Data Source: Annual assessments of 153 men participating in the Oregon Youth Study from age 10 years to 32 years. Researchers also assessed reports from 59 female partners during observed couple interactions.

Disclosures: Dr. Kerr said he did not have any relevant disclosures.

ORLANDO – Adolescent suicide attempt history is associated with increased likelihood of intimate partner violence when a male becomes a young adult, according to a long-term, prospective study of 153 men.

The findings suggest that prevention or intervention efforts for adolescents who attempt suicide might improve subsequent relationship outcomes, said David C. R. Kerr, Ph.D.

A paucity of research exists on associations between teenage suicidal behavior and relational distress, partner aggression, or relationship instability in young adulthood, Dr. Kerr said at the meeting.

Suicidal behavior might reflect underlying traits, such as impulsivity or aggression, he said, and these traits could manifest as maladaptive behaviors during romantic relationships. “Intimate relationships can be a source of significant conflict and profound emotional distress.”

Impulsive or reactive aggression during intense negative affect or when someone is highly negatively aroused seems to be important, said Dr. Kerr, research associate at Oregon Social Learning Center at Oregon State University, Eugene.

Dr. Kerr and his associate Deborah Capaldi, Ph.D., assessed regular surveys of males beginning when they were aged 10 years. Participants in the Oregon Youth Study were re-assessed annually up to age 32 years. Findings were not solely based on self-reports, because they are not always trustworthy, Dr. Kerr said. “Batterers may report mental health symptoms as a way to deny responsibility.” In addition, he said, suicidal threats/behaviors might be considered a form of control over intimate partners.

Annual reports from 59 female partners starting when the men reached age 18 years also were assessed. Couples also were observed in interaction tasks meant to generate some conflict.

A total 19 of the 153 males (12%) had a lifetime suicide attempt history.

In order to assess physical injury, only partners were asked during five interviews (from ages 20 to 32 years) if they had ever been injured by the man. “Close to 27% reported an injury of some form,” Dr. Kerr said.

“An unmediated link between youth suicide attempt and adult partner aggression and violence supports the role of impulsive, undercontrolled aggression in intimate partner violence,” Dr. Kerr said. “It suggests intimate partner violence is not solely a calculated, instrumental behavior.”

Adolescent aggression also predicted negative relationship outcomes in young adulthood in the study.

The research revealed that 25 men, or 16%, had been arrested one or more times for domestic violence. However, “The numbers were too small regarding domestic violence arrests to make conclusions,” Dr. Kerr said.

Suicide attempt in adolescence also predicted relationship instability or “some measure of how many break-ups they had.” This instability was measured during six interviews between ages 24 and 32 years.

Interestingly, adolescent suicide attempts and aggression were not significantly associated with later relationship satisfaction, Dr. Kerr said.

This study is the first to evaluate an at-risk community sample. The Oregon Youth Study cohort includes boys identified as being at risk for neighborhood delinquency from entire fourth-grade classrooms.

About 75% of participants were from working class families, and 90% were white. Other studies in the literature focused primarily on juvenile justice system–based reports, which may not be representative, Dr. Kerr said.

The findings add to a growing understanding of negative outcomes for youth who attempt suicide, Dr. Kerr said. These negative consequences can extend to intimate partners, and additional prevention and treatment approaches may be needed. He added that cognitive therapy with behavioral and emotional regulation skills for adolescents who attempt suicide might be beneficial, for example.

SAN FRANCISCO – It falls into a dermatologist's realm of responsibility to help women with psoriasis overcome treatment barriers and improve their psychosocial well-being, according to Dr. Jennifer C. Cather.

Women often are the main caregivers for their families and thus may put their family's health care needs before their own, Dr. Cather noted at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation. Dermatologists should stress to these patients the importance of making their medical needs a priority.

"I see many women who have gone untreated or undertreated for many years despite being under the care of a dermatologist, or even several other dermatologists, before arriving in our office. It is important for women to make their own health a priority and then to seek out a dermatologist with whom they can frankly discuss the range of therapeutic options and their correlating implications," Dr. Cather said in an interview.

"The reality is that, however complicated it is to treat psoriasis, the complications of not treating the disease can often be much worse," said Dr. Cather, medical director at Modern Dermatology and Modern Research Associates, Dallas.

Although the prevalence of psoriasis is approximately the same by gender, the condition has a greater psychosocial impact on women than on men, multiple surveys have indicated. For example, 20% of women vs. 12% of men reported their psoriasis was a "very large problem in their everyday lives," the National Psoriasis Foundation discovered when they asked 4,725 people from 2004 to 2009 ("Report on the Psycho-Social Impacts of Psoriasis").

In addition, women reported a higher symptom burden than did men. Women were 17% more likely to report itching; 16% more likely to report physical irritation; and 24% more likely to report pain associated with their psoriasis, compared with men, according to the online report.

Other researchers discovered a statistically significant reduction in quality of life for women with psoriasis versus men, based on a survey of 266 psoriasis patients (J. Am. Acad. Dermatol. 2004:51:704-8).

"Wearing a chronic disease on the outside of your body is a real struggle in a society as focused on appearance as ours is," Dr. Cather said. The average age of psoriasis onset is between 15 and 35 years, a time when many women are making important choices about their future. The impact of low self-esteem associated with this condition can have far reaching implications.

Therefore, it is important for dermatologists to take the time to assess the patient's well-being. In addition to measurement of affected body surface area, inflammatory burden, joint involvement, and other medical issues using validated instruments, ask women some simple questions, Dr. Cather said. Examples include: "How is your psoriasis today?" and "Is the cost of your therapy worth it?"

"We need to understand how each patient is experiencing the disease and whether he or she is satisfied with the treatment option we have selected," Dr. Cather said. "Satisfied patients are compliant with the treatment regimen and have a greater chance of success over the long term."

Photo courtesy Dr. Jennifer C. Cather

The good news is that systemic medication can make a big difference in the lives of women affected by psoriasis. Tumor necrosis factor (TNF) antagonists are the treatment of choice for Dr. Cather when patients present with psoriasis and psoriatic arthritis. These agents can have a synergistic benefit when given with methotrexate, she said.

Interestingly, women with higher body mass index tend to respond better to monoclonal antibody treatments, Dr. Cather said. Also, keep in mind that psoriasis treatment needs may change for a particular woman throughout her life.

Photo courtesy Dr. Jennifer C. Cather

Dr. Cather presented several cases of women who responded well to systemic therapy. These included a young teenage girl whose plaques cleared following treatment with etanercept; and an older teenage girl – treated previously with adalimumab, efalizumab, and cyclosporine A – who responded to two injections of ustekinumab 45 mg. She also presented the case of a 55-year-old woman previously prescribed methotrexate and etanercept. The patient’s subsequent treatment with adalimumab has been "life changing"; her psoriasis has been clear since 2003.

Begin with a thorough physical examination, including a total body skin evaluation, and medical history, Dr. Cather said. Physical exam also can include a Pap smear, mammogram, and colonoscopy. Ask women about their history of malignancy, infections, and vaccinations. Inquire about their social history as well, she recommended.

A complete blood count, comprehensive metabolic panel, and high-sensitivity C-reaction protein assay are recommended laboratory tests. A screen for hepatitis B and C, HIV infection, and tuberculosis (repeated annually) can be helpful in the differential diagnosis.

In terms of future research, Dr. Cather said:"In our clinic, we are currently exploring the incorporation of more formal validated quality-of-life measures to dig deeper into how psoriasis is impacting life decisions and productivity."

Disclosures: Dr. Cather disclosed that she is a consultant for and on the speaker’s bureau of Abbott Laboratories and Centocor Inc. She also is a researcher for Amgen, Celgene Corp., and Pfizer.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – It falls into a dermatologist's realm of responsibility to help women with psoriasis overcome treatment barriers and improve their psychosocial well-being, according to Dr. Jennifer C. Cather.

Women often are the main caregivers for their families and thus may put their family's health care needs before their own, Dr. Cather noted at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation. Dermatologists should stress to these patients the importance of making their medical needs a priority.

"I see many women who have gone untreated or undertreated for many years despite being under the care of a dermatologist, or even several other dermatologists, before arriving in our office. It is important for women to make their own health a priority and then to seek out a dermatologist with whom they can frankly discuss the range of therapeutic options and their correlating implications," Dr. Cather said in an interview.

"The reality is that, however complicated it is to treat psoriasis, the complications of not treating the disease can often be much worse," said Dr. Cather, medical director at Modern Dermatology and Modern Research Associates, Dallas.

Although the prevalence of psoriasis is approximately the same by gender, the condition has a greater psychosocial impact on women than on men, multiple surveys have indicated. For example, 20% of women vs. 12% of men reported their psoriasis was a "very large problem in their everyday lives," the National Psoriasis Foundation discovered when they asked 4,725 people from 2004 to 2009 ("Report on the Psycho-Social Impacts of Psoriasis").

In addition, women reported a higher symptom burden than did men. Women were 17% more likely to report itching; 16% more likely to report physical irritation; and 24% more likely to report pain associated with their psoriasis, compared with men, according to the online report.

Other researchers discovered a statistically significant reduction in quality of life for women with psoriasis versus men, based on a survey of 266 psoriasis patients (J. Am. Acad. Dermatol. 2004:51:704-8).

"Wearing a chronic disease on the outside of your body is a real struggle in a society as focused on appearance as ours is," Dr. Cather said. The average age of psoriasis onset is between 15 and 35 years, a time when many women are making important choices about their future. The impact of low self-esteem associated with this condition can have far reaching implications.

Therefore, it is important for dermatologists to take the time to assess the patient's well-being. In addition to measurement of affected body surface area, inflammatory burden, joint involvement, and other medical issues using validated instruments, ask women some simple questions, Dr. Cather said. Examples include: "How is your psoriasis today?" and "Is the cost of your therapy worth it?"

"We need to understand how each patient is experiencing the disease and whether he or she is satisfied with the treatment option we have selected," Dr. Cather said. "Satisfied patients are compliant with the treatment regimen and have a greater chance of success over the long term."

Photo courtesy Dr. Jennifer C. Cather

The good news is that systemic medication can make a big difference in the lives of women affected by psoriasis. Tumor necrosis factor (TNF) antagonists are the treatment of choice for Dr. Cather when patients present with psoriasis and psoriatic arthritis. These agents can have a synergistic benefit when given with methotrexate, she said.

Interestingly, women with higher body mass index tend to respond better to monoclonal antibody treatments, Dr. Cather said. Also, keep in mind that psoriasis treatment needs may change for a particular woman throughout her life.

Photo courtesy Dr. Jennifer C. Cather

Dr. Cather presented several cases of women who responded well to systemic therapy. These included a young teenage girl whose plaques cleared following treatment with etanercept; and an older teenage girl – treated previously with adalimumab, efalizumab, and cyclosporine A – who responded to two injections of ustekinumab 45 mg. She also presented the case of a 55-year-old woman previously prescribed methotrexate and etanercept. The patient’s subsequent treatment with adalimumab has been "life changing"; her psoriasis has been clear since 2003.

Begin with a thorough physical examination, including a total body skin evaluation, and medical history, Dr. Cather said. Physical exam also can include a Pap smear, mammogram, and colonoscopy. Ask women about their history of malignancy, infections, and vaccinations. Inquire about their social history as well, she recommended.

A complete blood count, comprehensive metabolic panel, and high-sensitivity C-reaction protein assay are recommended laboratory tests. A screen for hepatitis B and C, HIV infection, and tuberculosis (repeated annually) can be helpful in the differential diagnosis.

In terms of future research, Dr. Cather said:"In our clinic, we are currently exploring the incorporation of more formal validated quality-of-life measures to dig deeper into how psoriasis is impacting life decisions and productivity."

Disclosures: Dr. Cather disclosed that she is a consultant for and on the speaker’s bureau of Abbott Laboratories and Centocor Inc. She also is a researcher for Amgen, Celgene Corp., and Pfizer.

SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – It falls into a dermatologist's realm of responsibility to help women with psoriasis overcome treatment barriers and improve their psychosocial well-being, according to Dr. Jennifer C. Cather.

Women often are the main caregivers for their families and thus may put their family's health care needs before their own, Dr. Cather noted at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation. Dermatologists should stress to these patients the importance of making their medical needs a priority.

"I see many women who have gone untreated or undertreated for many years despite being under the care of a dermatologist, or even several other dermatologists, before arriving in our office. It is important for women to make their own health a priority and then to seek out a dermatologist with whom they can frankly discuss the range of therapeutic options and their correlating implications," Dr. Cather said in an interview.

"The reality is that, however complicated it is to treat psoriasis, the complications of not treating the disease can often be much worse," said Dr. Cather, medical director at Modern Dermatology and Modern Research Associates, Dallas.

Although the prevalence of psoriasis is approximately the same by gender, the condition has a greater psychosocial impact on women than on men, multiple surveys have indicated. For example, 20% of women vs. 12% of men reported their psoriasis was a "very large problem in their everyday lives," the National Psoriasis Foundation discovered when they asked 4,725 people from 2004 to 2009 ("Report on the Psycho-Social Impacts of Psoriasis").

In addition, women reported a higher symptom burden than did men. Women were 17% more likely to report itching; 16% more likely to report physical irritation; and 24% more likely to report pain associated with their psoriasis, compared with men, according to the online report.

Other researchers discovered a statistically significant reduction in quality of life for women with psoriasis versus men, based on a survey of 266 psoriasis patients (J. Am. Acad. Dermatol. 2004:51:704-8).

"Wearing a chronic disease on the outside of your body is a real struggle in a society as focused on appearance as ours is," Dr. Cather said. The average age of psoriasis onset is between 15 and 35 years, a time when many women are making important choices about their future. The impact of low self-esteem associated with this condition can have far reaching implications.

Therefore, it is important for dermatologists to take the time to assess the patient's well-being. In addition to measurement of affected body surface area, inflammatory burden, joint involvement, and other medical issues using validated instruments, ask women some simple questions, Dr. Cather said. Examples include: "How is your psoriasis today?" and "Is the cost of your therapy worth it?"

"We need to understand how each patient is experiencing the disease and whether he or she is satisfied with the treatment option we have selected," Dr. Cather said. "Satisfied patients are compliant with the treatment regimen and have a greater chance of success over the long term."

Photo courtesy Dr. Jennifer C. Cather

The good news is that systemic medication can make a big difference in the lives of women affected by psoriasis. Tumor necrosis factor (TNF) antagonists are the treatment of choice for Dr. Cather when patients present with psoriasis and psoriatic arthritis. These agents can have a synergistic benefit when given with methotrexate, she said.

Interestingly, women with higher body mass index tend to respond better to monoclonal antibody treatments, Dr. Cather said. Also, keep in mind that psoriasis treatment needs may change for a particular woman throughout her life.

Photo courtesy Dr. Jennifer C. Cather

Dr. Cather presented several cases of women who responded well to systemic therapy. These included a young teenage girl whose plaques cleared following treatment with etanercept; and an older teenage girl – treated previously with adalimumab, efalizumab, and cyclosporine A – who responded to two injections of ustekinumab 45 mg. She also presented the case of a 55-year-old woman previously prescribed methotrexate and etanercept. The patient’s subsequent treatment with adalimumab has been "life changing"; her psoriasis has been clear since 2003.

Begin with a thorough physical examination, including a total body skin evaluation, and medical history, Dr. Cather said. Physical exam also can include a Pap smear, mammogram, and colonoscopy. Ask women about their history of malignancy, infections, and vaccinations. Inquire about their social history as well, she recommended.

A complete blood count, comprehensive metabolic panel, and high-sensitivity C-reaction protein assay are recommended laboratory tests. A screen for hepatitis B and C, HIV infection, and tuberculosis (repeated annually) can be helpful in the differential diagnosis.

In terms of future research, Dr. Cather said:"In our clinic, we are currently exploring the incorporation of more formal validated quality-of-life measures to dig deeper into how psoriasis is impacting life decisions and productivity."

Disclosures: Dr. Cather disclosed that she is a consultant for and on the speaker’s bureau of Abbott Laboratories and Centocor Inc. She also is a researcher for Amgen, Celgene Corp., and Pfizer.

SDEF and this news organization are owned by Elsevier.

Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site for more information.

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution. On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, Dr. Edwards said. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy are the most important interventions, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain. Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Disclosures: Most of the medications mentioned in this article are "off label" for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site for more information.

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution. On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, Dr. Edwards said. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy are the most important interventions, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain. Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Disclosures: Most of the medications mentioned in this article are "off label" for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.

Although identification of the cause of a woman's vulvar pain can be a challenge, once vulvodynia is diagnosed there are many management strategies that can provide relief, according to Dr. Libby Edwards.

Women who present with vulvar pain may describe burning, stinging, aching, irritation, soreness, tingling, or tearing sensations. These painful symptoms generally point to herpes simplex virus infection or vulvodynia, Dr. Edwards said at a seminar on women's and pediatric dermatology sponsored by Skin Disease Education Foundation.

Making the Diagnosis

One diagnostic tip is to distinguish vulvar pain from vulvar itch because the etiologies are usually different. Rule out a yeast infection when patients report acute itching, for example. In contrast, if the itch is more chronic, the woman might have lichen simplex chronicus or, less commonly, lichen sclerosus, she noted.

Skin disease, infection, and specific types of neuropathic pain (such as pudendal neuralgia and postherpetic neuropathy) are other considerations in the differential diagnosis, said Dr. Edwards, chief of dermatology at Carolinas Medical Center, Charlotte, N.C.

Consider skin diseases like lichen planus and desquamative inflammatory vaginitis. Also, if a skin eruption from postherpetic neuralgia is suspected, remember it occurs only with herpes zoster and not simplex virus infections.

Vulvodynia is a symptom, often multifactorial, and not a disease, Dr. Edwards said. Not surprisingly, psychological dysfunction is a prominent feature for some women.

Diagnose the extent of a woman's vulvodynia because surgical excision is indicated for only a subset of patients – those with vestibulodynia or vulvar vestibulitis syndrome. Pain arises only when provoked, versus other localized conditions such as clitorodynia or hemivulvodynia where pain can occur spontaneously as well.

By exclusion, generalized pain is not localized and can be migratory. For more information on localized versus generalized vulvodynia, Dr. Edwards recommended the European Association of Urology guidelines for diagnosis, therapy, and follow-up of patients with chronic pelvic pain (Eur. Urol. 2004;46:681-9).

Treatment Recommendations

Both general and specific strategies are important for the management of vulvodynia, Dr. Edwards said. For example, instruct the patient to avoid irritants, overwashing the area, and excessive use of topical medications. Educate patients using written materials or handouts and refer them to the National Vulvodynia Association Web site for more information.

Xylocaine (lidocaine) jelly 2% or Xylocaine ointment 5%, as needed, can provide relief, Dr. Edwards said. The 5% ointment can be applied to the vestibule overnight with occlusion (using a cotton ball) to break the pain cycle.

Other topical agents to consider include estrogen, nitroglycerin, and amitriptyline 2%/baclofen 2% in an aqueous solution. On the other hand, avoid topical testosterone preparations, corticosteroids, and anticandidal medications (unless a yeast infection is confirmed), Dr. Edwards advised.

Specific oral medications with efficacy for vulvodynia relief include gabapentin and other anticonvulsants, venlafaxine, and pregabalin.

Women with vulvodynia might also benefit from injections of alpha-interferon, corticosteroids, or botulinum toxin, Dr. Edwards said. Nerve blocks may also provide relief.

Although there are many management strategies, a combination of physical therapy and oral medication to treat neuropathy are the most important interventions, Dr. Edwards said. The patient should be referred to a physical therapist with expertise in pelvic floor therapy.

Approximately 80% of patients improve substantially, although a complete response can take 7-8 months, she said. Regular exercise can optimize outcomes for most women.

Although the description of vulvodynia has changed many times since the late 1970s, the current consensus is that it involves pelvic floor dysfunction that triggers neuropathic pain. Poor pelvic floor muscle strength, high resting tension, and irritability of muscles can each contribute to the painful sensations. In addition, many women have urinary tract symptoms or comorbid conditions such as irritable bowel syndrome.

Disclosures: Most of the medications mentioned in this article are "off label" for vulvodynia. Dr. Edwards said she had no relevant disclosures.

SDEF and this news organization are owned by Elsevier.