Heidi Splete

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.

The U.S. Preventive Services Task Force has recommended that clinicians counsel fair-skinned young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet radiation to reduce their risk of skin cancer, in a draft recommendation statement that is available online.

The grade B recommendation applies to asymptomatic individuals who have fair skin, are aged 6 months to 24 years, and have no history of skin cancer; the recommendation is being issued because members of this population are at increased risk and are the subject of most of the existing research on skin cancer counseling, according to the USPSTF. The task force found a moderate net benefit when clinicians in a primary care setting offered behavioral counseling on skin cancer prevention to members of this population.

Wavebreakmedia/Thinkstock

The U.S. Preventive Services Task Force has recommended that clinicians counsel fair-skinned young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet radiation to reduce their risk of skin cancer, in a draft recommendation statement that is available online.

The grade B recommendation applies to asymptomatic individuals who have fair skin, are aged 6 months to 24 years, and have no history of skin cancer; the recommendation is being issued because members of this population are at increased risk and are the subject of most of the existing research on skin cancer counseling, according to the USPSTF. The task force found a moderate net benefit when clinicians in a primary care setting offered behavioral counseling on skin cancer prevention to members of this population.

Wavebreakmedia/Thinkstock

The U.S. Preventive Services Task Force has recommended that clinicians counsel fair-skinned young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet radiation to reduce their risk of skin cancer, in a draft recommendation statement that is available online.

The grade B recommendation applies to asymptomatic individuals who have fair skin, are aged 6 months to 24 years, and have no history of skin cancer; the recommendation is being issued because members of this population are at increased risk and are the subject of most of the existing research on skin cancer counseling, according to the USPSTF. The task force found a moderate net benefit when clinicians in a primary care setting offered behavioral counseling on skin cancer prevention to members of this population.

Wavebreakmedia/Thinkstock

Nearly four out of five health care personnel in the United States received a flu vaccination during the 2016-2017 flu season, but a majority of those working in long-term care settings were not vaccinated, based on data from an Internet survey of more than 2,000 individuals that was conducted by the Centers for Disease Control and Prevention.

A total of 78.6% of the survey’s respondents said they’d been vaccinated during the 2016-2017 season. Vaccination coverage for health care personnel overall has remained in the 77%-79% range in recent years, but that represents an increase from 64% in 2010-2011.

“As in previous seasons, the highest coverage was among HCP whose workplace had vaccination requirements,” noted Carla L. Black, PhD, of the CDC, and colleagues (MMWR Morb Mortal Wkly Rep. 2017 Sep 29;66[38]:1009-15). The researchers reviewed data collected from an Internet panel survey of 2,438 health care personnel between March 28, 2017, and April 19, 2017.

Physicians boasted the highest vaccination coverage in 2016-2017 (96%), followed by pharmacists (94%), nurses (93%), nurse practitioners and physician assistants (92%), other clinical providers (80%), nonclinical health care providers (74%), and aides and assistants (69%).

Flu vaccination rates were highest among HCPs working in a hospital setting (92%); 94% of survey respondents in hospitals reported either having a vaccination requirement at work or being provided at least 1 day of on-site vaccination.

Vaccination rates were lowest among health care personnel in long-term care settings (68%), where only 26% reported a workplace vaccination requirement. However, vaccination rates in long-term care rose to 90% when employers required vaccination.

The report’s findings were limited by several factors, including the use of a volunteer sample, the reliance on self-reports, and the potential differences between Internet survey results and population-based estimates of flu vaccination.

However, “in the absence of vaccination requirements, the findings in this study support the recommendations found in the Guide to Community Preventive Services, which include active promotion of on-site vaccination at no cost or low cost to increase influenza vaccination coverage among HCPs,” the researchers said.

The researchers had no financial conflicts to disclose.

[email protected]

Nearly four out of five health care personnel in the United States received a flu vaccination during the 2016-2017 flu season, but a majority of those working in long-term care settings were not vaccinated, based on data from an Internet survey of more than 2,000 individuals that was conducted by the Centers for Disease Control and Prevention.

A total of 78.6% of the survey’s respondents said they’d been vaccinated during the 2016-2017 season. Vaccination coverage for health care personnel overall has remained in the 77%-79% range in recent years, but that represents an increase from 64% in 2010-2011.

“As in previous seasons, the highest coverage was among HCP whose workplace had vaccination requirements,” noted Carla L. Black, PhD, of the CDC, and colleagues (MMWR Morb Mortal Wkly Rep. 2017 Sep 29;66[38]:1009-15). The researchers reviewed data collected from an Internet panel survey of 2,438 health care personnel between March 28, 2017, and April 19, 2017.

Physicians boasted the highest vaccination coverage in 2016-2017 (96%), followed by pharmacists (94%), nurses (93%), nurse practitioners and physician assistants (92%), other clinical providers (80%), nonclinical health care providers (74%), and aides and assistants (69%).

Flu vaccination rates were highest among HCPs working in a hospital setting (92%); 94% of survey respondents in hospitals reported either having a vaccination requirement at work or being provided at least 1 day of on-site vaccination.

Vaccination rates were lowest among health care personnel in long-term care settings (68%), where only 26% reported a workplace vaccination requirement. However, vaccination rates in long-term care rose to 90% when employers required vaccination.

The report’s findings were limited by several factors, including the use of a volunteer sample, the reliance on self-reports, and the potential differences between Internet survey results and population-based estimates of flu vaccination.

However, “in the absence of vaccination requirements, the findings in this study support the recommendations found in the Guide to Community Preventive Services, which include active promotion of on-site vaccination at no cost or low cost to increase influenza vaccination coverage among HCPs,” the researchers said.

The researchers had no financial conflicts to disclose.

[email protected]

Nearly four out of five health care personnel in the United States received a flu vaccination during the 2016-2017 flu season, but a majority of those working in long-term care settings were not vaccinated, based on data from an Internet survey of more than 2,000 individuals that was conducted by the Centers for Disease Control and Prevention.

A total of 78.6% of the survey’s respondents said they’d been vaccinated during the 2016-2017 season. Vaccination coverage for health care personnel overall has remained in the 77%-79% range in recent years, but that represents an increase from 64% in 2010-2011.

“As in previous seasons, the highest coverage was among HCP whose workplace had vaccination requirements,” noted Carla L. Black, PhD, of the CDC, and colleagues (MMWR Morb Mortal Wkly Rep. 2017 Sep 29;66[38]:1009-15). The researchers reviewed data collected from an Internet panel survey of 2,438 health care personnel between March 28, 2017, and April 19, 2017.

Physicians boasted the highest vaccination coverage in 2016-2017 (96%), followed by pharmacists (94%), nurses (93%), nurse practitioners and physician assistants (92%), other clinical providers (80%), nonclinical health care providers (74%), and aides and assistants (69%).

Flu vaccination rates were highest among HCPs working in a hospital setting (92%); 94% of survey respondents in hospitals reported either having a vaccination requirement at work or being provided at least 1 day of on-site vaccination.

Vaccination rates were lowest among health care personnel in long-term care settings (68%), where only 26% reported a workplace vaccination requirement. However, vaccination rates in long-term care rose to 90% when employers required vaccination.

The report’s findings were limited by several factors, including the use of a volunteer sample, the reliance on self-reports, and the potential differences between Internet survey results and population-based estimates of flu vaccination.

However, “in the absence of vaccination requirements, the findings in this study support the recommendations found in the Guide to Community Preventive Services, which include active promotion of on-site vaccination at no cost or low cost to increase influenza vaccination coverage among HCPs,” the researchers said.

The researchers had no financial conflicts to disclose.

[email protected]

Infestation with Demodex mites was significantly more common in patients with rosacea compared with healthy controls, based on data from a meta-analysis of 1,513 adults with rosacea. The findings were published in the September issue of the Journal of the American Academy of Dermatology.

The cause of rosacea remains unclear and differs within subgroups, but previous studies have suggested an association between rosacea and the presence of Demodex mites, wrote Yin-Shuo Chang, MD, and Yu-Chen Huang, MD, both of Taipei Medical University, Taiwan (J Am Acad Dermatol. 2017; 77[3]:441-7).

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Courtesy RegionalDerm.com

Infestation with Demodex mites was significantly more common in patients with rosacea compared with healthy controls, based on data from a meta-analysis of 1,513 adults with rosacea. The findings were published in the September issue of the Journal of the American Academy of Dermatology.

The cause of rosacea remains unclear and differs within subgroups, but previous studies have suggested an association between rosacea and the presence of Demodex mites, wrote Yin-Shuo Chang, MD, and Yu-Chen Huang, MD, both of Taipei Medical University, Taiwan (J Am Acad Dermatol. 2017; 77[3]:441-7).

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Courtesy RegionalDerm.com

Infestation with Demodex mites was significantly more common in patients with rosacea compared with healthy controls, based on data from a meta-analysis of 1,513 adults with rosacea. The findings were published in the September issue of the Journal of the American Academy of Dermatology.

The cause of rosacea remains unclear and differs within subgroups, but previous studies have suggested an association between rosacea and the presence of Demodex mites, wrote Yin-Shuo Chang, MD, and Yu-Chen Huang, MD, both of Taipei Medical University, Taiwan (J Am Acad Dermatol. 2017; 77[3]:441-7).

M. Sand, et al/Head & face medicine/ISSN 1746-160X/CC BY 2.0

Courtesy RegionalDerm.com

Scabies hits hardest in tropical parts of the world, and children and teens are most affected by the condition, based on data from a global epidemiological assessment.

“Recognition of scabies on the global health agenda would increase awareness, education, and research into diagnosis, treatment, and prevention,” wrote Chante Karimkhani, MD, of the University of Colorado, Aurora, and her colleagues. To estimate the global impact of scabies, the researchers used the Global Burden of Disease (GBD) Study 2015, which included literature searches between 1980 and 2014 in both English and Spanish.

Michail_Petrov-96/Thinkstock

Scabies hits hardest in tropical parts of the world, and children and teens are most affected by the condition, based on data from a global epidemiological assessment.

“Recognition of scabies on the global health agenda would increase awareness, education, and research into diagnosis, treatment, and prevention,” wrote Chante Karimkhani, MD, of the University of Colorado, Aurora, and her colleagues. To estimate the global impact of scabies, the researchers used the Global Burden of Disease (GBD) Study 2015, which included literature searches between 1980 and 2014 in both English and Spanish.

Michail_Petrov-96/Thinkstock

Scabies hits hardest in tropical parts of the world, and children and teens are most affected by the condition, based on data from a global epidemiological assessment.

“Recognition of scabies on the global health agenda would increase awareness, education, and research into diagnosis, treatment, and prevention,” wrote Chante Karimkhani, MD, of the University of Colorado, Aurora, and her colleagues. To estimate the global impact of scabies, the researchers used the Global Burden of Disease (GBD) Study 2015, which included literature searches between 1980 and 2014 in both English and Spanish.

Michail_Petrov-96/Thinkstock

Don’t underestimate the importance of baseline lab tests before starting psoriasis patients on biologics, said April Armstrong, MD, of the University of Southern California, Los Angeles.

Keep class-specific considerations in mind when collecting baseline lab data to help support the success of biologics in treating psoriasis, Dr. Armstrong said at the annual Coastal Dermatology Symposium.

• Ustekinumab: Baseline HIV or pregnancy test, and a TB evaluation at baseline as well as annual monitoring.
• Etanercept, adalimumab, infliximab: Baseline TB evaluation and screening hepatitis panel, liver function tests, and blood count, with option to add pregnancy test or HIV test. A liver function test/hepatitis panel is indicated annually, and TB should be monitored annually. Be cautious about using this class of drugs in patients with heart failure, and verify the absence of demyelinating disease in patients prior to prescribing this class of drugs.
• Guselkumab: Baseline TB evaluation, possible pregnancy or HIV tests, followed by annual TB evaluation.
• Secukinumab, ixekizumab, and brodalumab: Baseline TB evaluation, consider HIV or pregnancy tests, followed by annual TB evaluation. Be cautious about using this class of drugs in patients with ulcerative colitis or Crohn’s disease; assess and counsel for increased risk of suicidality when considering brodalumab.

Beyond the general considerations, several other factors can help maximize success with particular biologics, Dr. Armstrong said at the meeting, which is jointly presented by the University of Louisville and Global Academy for Medical Education.

The number of injections given in the first year, which range from 5 (ustekinumab) to 64 (etanercept) is an important consideration for some patients, Dr. Armstrong noted; the number of injections for the remaining biologics are guselkumab, 8; ixekizumab, 17; brodalumab and adalimumab, both 27, and secukinumab, 32. In addition, the IL-17 inhibitors carry some risk of oral candidiasis and inflammatory bowel disease.

This publication and the Global Academy for Medical Education are owned by Frontline Medical News.

Dr. Armstrong disclosed relationships with multiple companies including AbbVie, Janssen, Novartis, Lilly, Regeneron, Sanofi, Modernizing Medicine, and Valeant.

[email protected]

Don’t underestimate the importance of baseline lab tests before starting psoriasis patients on biologics, said April Armstrong, MD, of the University of Southern California, Los Angeles.

Keep class-specific considerations in mind when collecting baseline lab data to help support the success of biologics in treating psoriasis, Dr. Armstrong said at the annual Coastal Dermatology Symposium.

• Ustekinumab: Baseline HIV or pregnancy test, and a TB evaluation at baseline as well as annual monitoring.
• Etanercept, adalimumab, infliximab: Baseline TB evaluation and screening hepatitis panel, liver function tests, and blood count, with option to add pregnancy test or HIV test. A liver function test/hepatitis panel is indicated annually, and TB should be monitored annually. Be cautious about using this class of drugs in patients with heart failure, and verify the absence of demyelinating disease in patients prior to prescribing this class of drugs.
• Guselkumab: Baseline TB evaluation, possible pregnancy or HIV tests, followed by annual TB evaluation.
• Secukinumab, ixekizumab, and brodalumab: Baseline TB evaluation, consider HIV or pregnancy tests, followed by annual TB evaluation. Be cautious about using this class of drugs in patients with ulcerative colitis or Crohn’s disease; assess and counsel for increased risk of suicidality when considering brodalumab.

Beyond the general considerations, several other factors can help maximize success with particular biologics, Dr. Armstrong said at the meeting, which is jointly presented by the University of Louisville and Global Academy for Medical Education.

The number of injections given in the first year, which range from 5 (ustekinumab) to 64 (etanercept) is an important consideration for some patients, Dr. Armstrong noted; the number of injections for the remaining biologics are guselkumab, 8; ixekizumab, 17; brodalumab and adalimumab, both 27, and secukinumab, 32. In addition, the IL-17 inhibitors carry some risk of oral candidiasis and inflammatory bowel disease.

This publication and the Global Academy for Medical Education are owned by Frontline Medical News.

Dr. Armstrong disclosed relationships with multiple companies including AbbVie, Janssen, Novartis, Lilly, Regeneron, Sanofi, Modernizing Medicine, and Valeant.

[email protected]

Don’t underestimate the importance of baseline lab tests before starting psoriasis patients on biologics, said April Armstrong, MD, of the University of Southern California, Los Angeles.

Keep class-specific considerations in mind when collecting baseline lab data to help support the success of biologics in treating psoriasis, Dr. Armstrong said at the annual Coastal Dermatology Symposium.

• Ustekinumab: Baseline HIV or pregnancy test, and a TB evaluation at baseline as well as annual monitoring.
• Etanercept, adalimumab, infliximab: Baseline TB evaluation and screening hepatitis panel, liver function tests, and blood count, with option to add pregnancy test or HIV test. A liver function test/hepatitis panel is indicated annually, and TB should be monitored annually. Be cautious about using this class of drugs in patients with heart failure, and verify the absence of demyelinating disease in patients prior to prescribing this class of drugs.
• Guselkumab: Baseline TB evaluation, possible pregnancy or HIV tests, followed by annual TB evaluation.
• Secukinumab, ixekizumab, and brodalumab: Baseline TB evaluation, consider HIV or pregnancy tests, followed by annual TB evaluation. Be cautious about using this class of drugs in patients with ulcerative colitis or Crohn’s disease; assess and counsel for increased risk of suicidality when considering brodalumab.

Beyond the general considerations, several other factors can help maximize success with particular biologics, Dr. Armstrong said at the meeting, which is jointly presented by the University of Louisville and Global Academy for Medical Education.

The number of injections given in the first year, which range from 5 (ustekinumab) to 64 (etanercept) is an important consideration for some patients, Dr. Armstrong noted; the number of injections for the remaining biologics are guselkumab, 8; ixekizumab, 17; brodalumab and adalimumab, both 27, and secukinumab, 32. In addition, the IL-17 inhibitors carry some risk of oral candidiasis and inflammatory bowel disease.

This publication and the Global Academy for Medical Education are owned by Frontline Medical News.

Dr. Armstrong disclosed relationships with multiple companies including AbbVie, Janssen, Novartis, Lilly, Regeneron, Sanofi, Modernizing Medicine, and Valeant.

[email protected]

The pathogenesis theories and treatment approaches to psoriasis have evolved over the past 3 decades, and the latest treatments continue to show safety and effectiveness, according to Alan Menter, MD, chairman of dermatology at Baylor University Medical Center, Dallas.

Before the 1980s, psoriasis was seen as a disease of keratinocyte dysfunction, with treatments that included methotrexate, UVB, and retinoids, Dr. Menter said in a presentation at the annual Coastal Dermatology Symposium. In the 1980s, it was considered an immunologic disease, and then an interleukin (IL)–12/Th1–mediated disease, with anti-CD2, anti-CD11a, and tumor necrosis factor–alpha blocker treatments from 1990 to 2004.

The pathogenesis theories and treatment approaches to psoriasis have evolved over the past 3 decades, and the latest treatments continue to show safety and effectiveness, according to Alan Menter, MD, chairman of dermatology at Baylor University Medical Center, Dallas.

Before the 1980s, psoriasis was seen as a disease of keratinocyte dysfunction, with treatments that included methotrexate, UVB, and retinoids, Dr. Menter said in a presentation at the annual Coastal Dermatology Symposium. In the 1980s, it was considered an immunologic disease, and then an interleukin (IL)–12/Th1–mediated disease, with anti-CD2, anti-CD11a, and tumor necrosis factor–alpha blocker treatments from 1990 to 2004.

The pathogenesis theories and treatment approaches to psoriasis have evolved over the past 3 decades, and the latest treatments continue to show safety and effectiveness, according to Alan Menter, MD, chairman of dermatology at Baylor University Medical Center, Dallas.

Before the 1980s, psoriasis was seen as a disease of keratinocyte dysfunction, with treatments that included methotrexate, UVB, and retinoids, Dr. Menter said in a presentation at the annual Coastal Dermatology Symposium. In the 1980s, it was considered an immunologic disease, and then an interleukin (IL)–12/Th1–mediated disease, with anti-CD2, anti-CD11a, and tumor necrosis factor–alpha blocker treatments from 1990 to 2004.

Acne remains “an equal opportunity annoyance,” according to Hilary E. Baldwin, MD, of Rutgers Robert Wood Johnson Medical School, Newark, NJ.

However, acne medications also work equally well across age, gender, and skin type groups, and new systemic and topical options are emerging, said Dr. Baldwin, who serves as medical director of The Acne Treatment and Research Center in Morristown, NJ.

Several products that entered the market in 2016 have demonstrated success, she said in a presentation on acne at the annual Coastal Dermatology Symposium. She cited data on dapsone 7.5% gel (Aczone) applied daily, which showed significant improvements in moderate facial acne and lesion counts compared with vehicle.

A noteworthy new potential acne treatment combines 200 mg doxycycline with topical adapalene 0.3%/benzoyl peroxide 2.5%, Dr. Baldwin said. In a small but promising 12-week open-label study of patients aged 12 years and older with severe facial acne considered candidates for isotretinoin, inflammatory, noninflammatory, and overall total lesion counts reduced significantly from baseline, she said.

Other acne treatments in the pipeline include a nitric oxide gel, a topical sebum inhibitor, and minocycline gel and foam formulations.

Sarecycline, a tetracycline class antibiotic, has generated some excitement after a phase 2 dose ranging study presented at the 2017 American Academy of Dermatology’s annual meeting showed significant improvement in inflammatory lesion counts among acne patients who received 1.5 mg/kg or 3 mg/kg once a day compared with placebo patients, after 12 weeks. Noninflammatory lesion counts were not significantly improved compared with placebo. Potential advantages of sarecycline include improved efficacy with fewer side effects and possibly, a lower risk of antibiotic resistance, Dr. Baldwin said. Phase 3 study results of the 1.5 mg/kg dose are pending.

Data on the potential role of diet in acne continue to evolve, she noted. A recent study of 225 teens with acne suggested that skim and/or low-fat dairy products are associated with acne and that reducing consumption of these products might help (J Am Acad Dermatol. 2016 Aug;75[2]:318-22). Another small study of 64 adults involving a nutritional survey showed that those with moderate to severe acne consumed significantly more carbohydrates than did those without acne, an indication that clinicians could consider recommending that acne patients reduce their carbohydrate intake to see whether it makes a difference.

The symposium was jointly presented by the University of Louisville and Global Academy for Medical Education. This publication and Global Academy for Medical Education are both owned by Frontline Medical News. Dr. Baldwin is a speaker and advisor for Allergan, Galderma, and Valeant; and is an investigator for Dermira, Galderma, Novan, and Valeant.

[email protected]

Acne remains “an equal opportunity annoyance,” according to Hilary E. Baldwin, MD, of Rutgers Robert Wood Johnson Medical School, Newark, NJ.

However, acne medications also work equally well across age, gender, and skin type groups, and new systemic and topical options are emerging, said Dr. Baldwin, who serves as medical director of The Acne Treatment and Research Center in Morristown, NJ.

Several products that entered the market in 2016 have demonstrated success, she said in a presentation on acne at the annual Coastal Dermatology Symposium. She cited data on dapsone 7.5% gel (Aczone) applied daily, which showed significant improvements in moderate facial acne and lesion counts compared with vehicle.

A noteworthy new potential acne treatment combines 200 mg doxycycline with topical adapalene 0.3%/benzoyl peroxide 2.5%, Dr. Baldwin said. In a small but promising 12-week open-label study of patients aged 12 years and older with severe facial acne considered candidates for isotretinoin, inflammatory, noninflammatory, and overall total lesion counts reduced significantly from baseline, she said.

Other acne treatments in the pipeline include a nitric oxide gel, a topical sebum inhibitor, and minocycline gel and foam formulations.

Sarecycline, a tetracycline class antibiotic, has generated some excitement after a phase 2 dose ranging study presented at the 2017 American Academy of Dermatology’s annual meeting showed significant improvement in inflammatory lesion counts among acne patients who received 1.5 mg/kg or 3 mg/kg once a day compared with placebo patients, after 12 weeks. Noninflammatory lesion counts were not significantly improved compared with placebo. Potential advantages of sarecycline include improved efficacy with fewer side effects and possibly, a lower risk of antibiotic resistance, Dr. Baldwin said. Phase 3 study results of the 1.5 mg/kg dose are pending.

Data on the potential role of diet in acne continue to evolve, she noted. A recent study of 225 teens with acne suggested that skim and/or low-fat dairy products are associated with acne and that reducing consumption of these products might help (J Am Acad Dermatol. 2016 Aug;75[2]:318-22). Another small study of 64 adults involving a nutritional survey showed that those with moderate to severe acne consumed significantly more carbohydrates than did those without acne, an indication that clinicians could consider recommending that acne patients reduce their carbohydrate intake to see whether it makes a difference.

The symposium was jointly presented by the University of Louisville and Global Academy for Medical Education. This publication and Global Academy for Medical Education are both owned by Frontline Medical News. Dr. Baldwin is a speaker and advisor for Allergan, Galderma, and Valeant; and is an investigator for Dermira, Galderma, Novan, and Valeant.

[email protected]

Acne remains “an equal opportunity annoyance,” according to Hilary E. Baldwin, MD, of Rutgers Robert Wood Johnson Medical School, Newark, NJ.

However, acne medications also work equally well across age, gender, and skin type groups, and new systemic and topical options are emerging, said Dr. Baldwin, who serves as medical director of The Acne Treatment and Research Center in Morristown, NJ.

Several products that entered the market in 2016 have demonstrated success, she said in a presentation on acne at the annual Coastal Dermatology Symposium. She cited data on dapsone 7.5% gel (Aczone) applied daily, which showed significant improvements in moderate facial acne and lesion counts compared with vehicle.

A noteworthy new potential acne treatment combines 200 mg doxycycline with topical adapalene 0.3%/benzoyl peroxide 2.5%, Dr. Baldwin said. In a small but promising 12-week open-label study of patients aged 12 years and older with severe facial acne considered candidates for isotretinoin, inflammatory, noninflammatory, and overall total lesion counts reduced significantly from baseline, she said.

Other acne treatments in the pipeline include a nitric oxide gel, a topical sebum inhibitor, and minocycline gel and foam formulations.

Sarecycline, a tetracycline class antibiotic, has generated some excitement after a phase 2 dose ranging study presented at the 2017 American Academy of Dermatology’s annual meeting showed significant improvement in inflammatory lesion counts among acne patients who received 1.5 mg/kg or 3 mg/kg once a day compared with placebo patients, after 12 weeks. Noninflammatory lesion counts were not significantly improved compared with placebo. Potential advantages of sarecycline include improved efficacy with fewer side effects and possibly, a lower risk of antibiotic resistance, Dr. Baldwin said. Phase 3 study results of the 1.5 mg/kg dose are pending.

Data on the potential role of diet in acne continue to evolve, she noted. A recent study of 225 teens with acne suggested that skim and/or low-fat dairy products are associated with acne and that reducing consumption of these products might help (J Am Acad Dermatol. 2016 Aug;75[2]:318-22). Another small study of 64 adults involving a nutritional survey showed that those with moderate to severe acne consumed significantly more carbohydrates than did those without acne, an indication that clinicians could consider recommending that acne patients reduce their carbohydrate intake to see whether it makes a difference.

The symposium was jointly presented by the University of Louisville and Global Academy for Medical Education. This publication and Global Academy for Medical Education are both owned by Frontline Medical News. Dr. Baldwin is a speaker and advisor for Allergan, Galderma, and Valeant; and is an investigator for Dermira, Galderma, Novan, and Valeant.

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Prescribing systemic antibiotics for acne remains a common clinical practice, despite recommendations to reduce antibiotic use, according to an extensive database review. The results were published in the Journal of the American Academy of Dermatology.

“Despite ... recent recommendations regarding the importance of antibiotic stewardship and appropriate use of antibiotics in patients with acne, it is unclear whether there have been any significant changes in practice patterns,” wrote John S. Barbieri, MD, and his coauthors in the departments of dermatology, and biostatistics and epidemiology, at the University of Pennsylvania, Philadelphia (J Am Acad Dermatol. 2017;77[3]:456-63).

To assess prescribing practices, the researchers reviewed data from the OptumInsight Clinformatics Data Mart, which included medical and pharmacy claims for approximately 12-14 million annual covered lives. The study population included 572,630 individuals with at least two acne claims who were aged 12-40 years at the start of treatment.

The number of courses of spironolactone prescribed for acne per 100 female patients treated by dermatologists increased by 291% during the study period, from 2.08 to 8.13. Among nondermatologists, the number of spironolactone courses prescribed per 100 female patients increased from 1.43 to 4.09 over the same period, a 186% increase.

Overall, the number of oral antibiotic courses increased from 26.24 to 27.08 per 100 patients among dermatologists, and from 19.99 to 22.48 per 100 patients among nondermatologists. The median length of treatment on oral antibiotics was 126 days for patients being treated by dermatologists and 129 days among patients treated by nondermatologists.

The use of spironolactone “remains relatively uncommon” compared with oral antibiotics, the researchers pointed out, noting that the 2013 data show that for every course of spironolactone, there were 2.8 courses of oral antibiotics prescribed by dermatologists and 4.6 courses prescribed by nondermatologists.

Other prescribing trends during the time period among dermatologists included a drop in the number of combined oral contraceptive courses per 100 female patients, from 34.31 to 30.74 (and an increase from 31.70 to 32.13 among nondermatologists); and a drop in the number of isotretinoin courses prescribed per 100 patients, from 5.43 to 5.35 (and a drop from 2.24 to1.45 among nondermatologists).

“Given the importance of judicious use of oral antibiotics to prevent potential complications, increasing the use of concomitant topical retinoids and additional work to identify those patients who would benefit most from alternative agents such as spironolactone, combined oral contraceptive pills, or isotretinoin represent potential opportunities to improve the care of patients with acne,” they concluded.

The findings were limited by several factors including the retrospective nature of the study and lack of data on combination therapy, severity of illness, and treatment outcomes, they said.

The researchers had no financial conflicts to disclose. There was no funding source.

Prescribing systemic antibiotics for acne remains a common clinical practice, despite recommendations to reduce antibiotic use, according to an extensive database review. The results were published in the Journal of the American Academy of Dermatology.

“Despite ... recent recommendations regarding the importance of antibiotic stewardship and appropriate use of antibiotics in patients with acne, it is unclear whether there have been any significant changes in practice patterns,” wrote John S. Barbieri, MD, and his coauthors in the departments of dermatology, and biostatistics and epidemiology, at the University of Pennsylvania, Philadelphia (J Am Acad Dermatol. 2017;77[3]:456-63).

To assess prescribing practices, the researchers reviewed data from the OptumInsight Clinformatics Data Mart, which included medical and pharmacy claims for approximately 12-14 million annual covered lives. The study population included 572,630 individuals with at least two acne claims who were aged 12-40 years at the start of treatment.

The number of courses of spironolactone prescribed for acne per 100 female patients treated by dermatologists increased by 291% during the study period, from 2.08 to 8.13. Among nondermatologists, the number of spironolactone courses prescribed per 100 female patients increased from 1.43 to 4.09 over the same period, a 186% increase.

Overall, the number of oral antibiotic courses increased from 26.24 to 27.08 per 100 patients among dermatologists, and from 19.99 to 22.48 per 100 patients among nondermatologists. The median length of treatment on oral antibiotics was 126 days for patients being treated by dermatologists and 129 days among patients treated by nondermatologists.

The use of spironolactone “remains relatively uncommon” compared with oral antibiotics, the researchers pointed out, noting that the 2013 data show that for every course of spironolactone, there were 2.8 courses of oral antibiotics prescribed by dermatologists and 4.6 courses prescribed by nondermatologists.

Other prescribing trends during the time period among dermatologists included a drop in the number of combined oral contraceptive courses per 100 female patients, from 34.31 to 30.74 (and an increase from 31.70 to 32.13 among nondermatologists); and a drop in the number of isotretinoin courses prescribed per 100 patients, from 5.43 to 5.35 (and a drop from 2.24 to1.45 among nondermatologists).

“Given the importance of judicious use of oral antibiotics to prevent potential complications, increasing the use of concomitant topical retinoids and additional work to identify those patients who would benefit most from alternative agents such as spironolactone, combined oral contraceptive pills, or isotretinoin represent potential opportunities to improve the care of patients with acne,” they concluded.

The findings were limited by several factors including the retrospective nature of the study and lack of data on combination therapy, severity of illness, and treatment outcomes, they said.

The researchers had no financial conflicts to disclose. There was no funding source.

Prescribing systemic antibiotics for acne remains a common clinical practice, despite recommendations to reduce antibiotic use, according to an extensive database review. The results were published in the Journal of the American Academy of Dermatology.

“Despite ... recent recommendations regarding the importance of antibiotic stewardship and appropriate use of antibiotics in patients with acne, it is unclear whether there have been any significant changes in practice patterns,” wrote John S. Barbieri, MD, and his coauthors in the departments of dermatology, and biostatistics and epidemiology, at the University of Pennsylvania, Philadelphia (J Am Acad Dermatol. 2017;77[3]:456-63).

To assess prescribing practices, the researchers reviewed data from the OptumInsight Clinformatics Data Mart, which included medical and pharmacy claims for approximately 12-14 million annual covered lives. The study population included 572,630 individuals with at least two acne claims who were aged 12-40 years at the start of treatment.

The number of courses of spironolactone prescribed for acne per 100 female patients treated by dermatologists increased by 291% during the study period, from 2.08 to 8.13. Among nondermatologists, the number of spironolactone courses prescribed per 100 female patients increased from 1.43 to 4.09 over the same period, a 186% increase.

Overall, the number of oral antibiotic courses increased from 26.24 to 27.08 per 100 patients among dermatologists, and from 19.99 to 22.48 per 100 patients among nondermatologists. The median length of treatment on oral antibiotics was 126 days for patients being treated by dermatologists and 129 days among patients treated by nondermatologists.

The use of spironolactone “remains relatively uncommon” compared with oral antibiotics, the researchers pointed out, noting that the 2013 data show that for every course of spironolactone, there were 2.8 courses of oral antibiotics prescribed by dermatologists and 4.6 courses prescribed by nondermatologists.

Other prescribing trends during the time period among dermatologists included a drop in the number of combined oral contraceptive courses per 100 female patients, from 34.31 to 30.74 (and an increase from 31.70 to 32.13 among nondermatologists); and a drop in the number of isotretinoin courses prescribed per 100 patients, from 5.43 to 5.35 (and a drop from 2.24 to1.45 among nondermatologists).

“Given the importance of judicious use of oral antibiotics to prevent potential complications, increasing the use of concomitant topical retinoids and additional work to identify those patients who would benefit most from alternative agents such as spironolactone, combined oral contraceptive pills, or isotretinoin represent potential opportunities to improve the care of patients with acne,” they concluded.

The findings were limited by several factors including the retrospective nature of the study and lack of data on combination therapy, severity of illness, and treatment outcomes, they said.

The researchers had no financial conflicts to disclose. There was no funding source.

Clinicians can consult a diagram to plan treatment of hypertension in diabetes patients as part of the new American Diabetes Association guidelines.

“Diabetes and Hypertension: A Position Statement by the American Diabetes Association” was published in the September 2017 issue of Diabetes Care, and online on Aug. 22. The statement updates the ADA’s previous statement on hypertension and diabetes published in 2003.

vitapix/Thinkstock

“Numerous studies have shown that antihypertensive therapy reduces ASCVD [atherosclerotic cardiovascular disease] events, heart failure, and microvascular complications in people with diabetes,” wrote Ian H. de Boer, MD, of the University of Washington, Seattle, and his colleagues.

The statement is a collaboration between nine diabetes experts from the United States, Europe, and Australia whose specialties include endocrinology, nephrology, cardiology, and internal medicine (Diabetes Care. 2017 Sep.;40:1273-84).

The statement recommends that diabetes patients have their blood pressure checked at every routine clinical visit and that those with an elevated blood pressure on a clinical visit (defined as office-based measurements of 140/90 mm Hg and higher) have multiple measurements, including on a separate day to confirm the diagnosis.

In addition, during the initial evaluation, and then periodically, diabetes patients should be assessed for orthostatic hypotension “to individualize blood pressure goals, select the most appropriate antihypertensive agents, and minimize adverse effects of antihypertensive therapy,” according to the recommendations.

For most patients with diabetes and hypertension, the goal should be a blood pressure below 140/90 mm Hg, and even lower targets may be appropriate for patients at high cardiovascular disease risk, the researchers said.

The guidelines include recommendations for managing hypertension and diabetes through lifestyle modifications such as increasing physical activity, achieving and maintaining a healthy weight, and following a healthy diet with minimal sodium intake and an emphasis on fruits, vegetables, and low-fat dairy products.

The guidelines also emphasize the need for caution when treating older adults who are taking multiple medications. “Systolic blood pressure should be the main target of treatment,” for adults aged 65 years and older with diabetes and hypertension, the authors said.

In addition, the guidelines provide direction for clinicians treating pregnant women. “During pregnancy, treatment with ACE inhibitors, ARBs [angiotensin receptor blockers], or spironolactone is contraindicated, as [these medications] may cause fetal damage,” the authors wrote. Pregnant women with preexisting hypertension or with mild gestational hypertension with systolic blood pressure below 160 mm Hg, a diastolic blood pressure below 105 mm Hg, and no sign of end-organ damage need not take antihypertensive medications, they said. For pregnant women who require antihypertensive treatment, the aim should be a systolic blood pressure between 120 mm Hg and 160 mm Hg and a diastolic blood pressure between 80 mm Hg and 105 mm Hg.

The authors concluded that there currently is insufficient evidence to support blood pressure medication for diabetes patients without hypertension.

The recommendations reference several key clinical trials that compared intensive and standard hypertension treatment strategies: the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, the ADVANCE BP (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation – Blood Pressure) trial, the HOT (Hypertension Optimal Treatment) trial, and SPRINT (the Systolic Blood Pressure Intervention Trial).

Lead author Dr. de Boer reported serving as a consultant for Boehringer Ingelheim and Ironwood Pharmaceuticals, and his institution has received research equipment and supplies from Medtronic and Abbott. Study coauthors disclosed relationships with multiple companies including Merck, Abbott, Pfizer, and AstraZeneca.

Clinicians can consult a diagram to plan treatment of hypertension in diabetes patients as part of the new American Diabetes Association guidelines.

“Diabetes and Hypertension: A Position Statement by the American Diabetes Association” was published in the September 2017 issue of Diabetes Care, and online on Aug. 22. The statement updates the ADA’s previous statement on hypertension and diabetes published in 2003.

vitapix/Thinkstock

“Numerous studies have shown that antihypertensive therapy reduces ASCVD [atherosclerotic cardiovascular disease] events, heart failure, and microvascular complications in people with diabetes,” wrote Ian H. de Boer, MD, of the University of Washington, Seattle, and his colleagues.

The statement is a collaboration between nine diabetes experts from the United States, Europe, and Australia whose specialties include endocrinology, nephrology, cardiology, and internal medicine (Diabetes Care. 2017 Sep.;40:1273-84).

The statement recommends that diabetes patients have their blood pressure checked at every routine clinical visit and that those with an elevated blood pressure on a clinical visit (defined as office-based measurements of 140/90 mm Hg and higher) have multiple measurements, including on a separate day to confirm the diagnosis.

In addition, during the initial evaluation, and then periodically, diabetes patients should be assessed for orthostatic hypotension “to individualize blood pressure goals, select the most appropriate antihypertensive agents, and minimize adverse effects of antihypertensive therapy,” according to the recommendations.

For most patients with diabetes and hypertension, the goal should be a blood pressure below 140/90 mm Hg, and even lower targets may be appropriate for patients at high cardiovascular disease risk, the researchers said.

The guidelines include recommendations for managing hypertension and diabetes through lifestyle modifications such as increasing physical activity, achieving and maintaining a healthy weight, and following a healthy diet with minimal sodium intake and an emphasis on fruits, vegetables, and low-fat dairy products.

The guidelines also emphasize the need for caution when treating older adults who are taking multiple medications. “Systolic blood pressure should be the main target of treatment,” for adults aged 65 years and older with diabetes and hypertension, the authors said.

In addition, the guidelines provide direction for clinicians treating pregnant women. “During pregnancy, treatment with ACE inhibitors, ARBs [angiotensin receptor blockers], or spironolactone is contraindicated, as [these medications] may cause fetal damage,” the authors wrote. Pregnant women with preexisting hypertension or with mild gestational hypertension with systolic blood pressure below 160 mm Hg, a diastolic blood pressure below 105 mm Hg, and no sign of end-organ damage need not take antihypertensive medications, they said. For pregnant women who require antihypertensive treatment, the aim should be a systolic blood pressure between 120 mm Hg and 160 mm Hg and a diastolic blood pressure between 80 mm Hg and 105 mm Hg.

The authors concluded that there currently is insufficient evidence to support blood pressure medication for diabetes patients without hypertension.

The recommendations reference several key clinical trials that compared intensive and standard hypertension treatment strategies: the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, the ADVANCE BP (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation – Blood Pressure) trial, the HOT (Hypertension Optimal Treatment) trial, and SPRINT (the Systolic Blood Pressure Intervention Trial).

Lead author Dr. de Boer reported serving as a consultant for Boehringer Ingelheim and Ironwood Pharmaceuticals, and his institution has received research equipment and supplies from Medtronic and Abbott. Study coauthors disclosed relationships with multiple companies including Merck, Abbott, Pfizer, and AstraZeneca.

Clinicians can consult a diagram to plan treatment of hypertension in diabetes patients as part of the new American Diabetes Association guidelines.

“Diabetes and Hypertension: A Position Statement by the American Diabetes Association” was published in the September 2017 issue of Diabetes Care, and online on Aug. 22. The statement updates the ADA’s previous statement on hypertension and diabetes published in 2003.

vitapix/Thinkstock

“Numerous studies have shown that antihypertensive therapy reduces ASCVD [atherosclerotic cardiovascular disease] events, heart failure, and microvascular complications in people with diabetes,” wrote Ian H. de Boer, MD, of the University of Washington, Seattle, and his colleagues.

The statement is a collaboration between nine diabetes experts from the United States, Europe, and Australia whose specialties include endocrinology, nephrology, cardiology, and internal medicine (Diabetes Care. 2017 Sep.;40:1273-84).

The statement recommends that diabetes patients have their blood pressure checked at every routine clinical visit and that those with an elevated blood pressure on a clinical visit (defined as office-based measurements of 140/90 mm Hg and higher) have multiple measurements, including on a separate day to confirm the diagnosis.

In addition, during the initial evaluation, and then periodically, diabetes patients should be assessed for orthostatic hypotension “to individualize blood pressure goals, select the most appropriate antihypertensive agents, and minimize adverse effects of antihypertensive therapy,” according to the recommendations.

For most patients with diabetes and hypertension, the goal should be a blood pressure below 140/90 mm Hg, and even lower targets may be appropriate for patients at high cardiovascular disease risk, the researchers said.

The guidelines include recommendations for managing hypertension and diabetes through lifestyle modifications such as increasing physical activity, achieving and maintaining a healthy weight, and following a healthy diet with minimal sodium intake and an emphasis on fruits, vegetables, and low-fat dairy products.

The guidelines also emphasize the need for caution when treating older adults who are taking multiple medications. “Systolic blood pressure should be the main target of treatment,” for adults aged 65 years and older with diabetes and hypertension, the authors said.

In addition, the guidelines provide direction for clinicians treating pregnant women. “During pregnancy, treatment with ACE inhibitors, ARBs [angiotensin receptor blockers], or spironolactone is contraindicated, as [these medications] may cause fetal damage,” the authors wrote. Pregnant women with preexisting hypertension or with mild gestational hypertension with systolic blood pressure below 160 mm Hg, a diastolic blood pressure below 105 mm Hg, and no sign of end-organ damage need not take antihypertensive medications, they said. For pregnant women who require antihypertensive treatment, the aim should be a systolic blood pressure between 120 mm Hg and 160 mm Hg and a diastolic blood pressure between 80 mm Hg and 105 mm Hg.

The authors concluded that there currently is insufficient evidence to support blood pressure medication for diabetes patients without hypertension.

The recommendations reference several key clinical trials that compared intensive and standard hypertension treatment strategies: the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, the ADVANCE BP (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation – Blood Pressure) trial, the HOT (Hypertension Optimal Treatment) trial, and SPRINT (the Systolic Blood Pressure Intervention Trial).

Lead author Dr. de Boer reported serving as a consultant for Boehringer Ingelheim and Ironwood Pharmaceuticals, and his institution has received research equipment and supplies from Medtronic and Abbott. Study coauthors disclosed relationships with multiple companies including Merck, Abbott, Pfizer, and AstraZeneca.