Sharon Worcester

RHODES, GREECE — Terbinafine is superior to placebo and comparable with other antifungal agents for the treatment of tinea pedis, Dr. Hans Christian Korting reported in a poster at the 15th Congress of European Academy of Dermatology and Venereology.

The finding is based on a meta-analysis of 19 randomized controlled trials including more than 2,300 patients. Various formulations of terbinafine, including cream, gel, and a new film-forming solution that requires only a single application, were compared with placebo or another antifungal.

The mycologic cure rate with terbi- nafine was significantly higher than with placebo (pooled relative risk 3.173), and tended to be higher, though not significantly, than with other antifungal agents (pooled relative risk 1.034), said Dr. Korting of Ludwig-Maximilians University in Munich, Germany.

There were no statistically significant differences in cure rates among the various terbinafine formulations. No conflicts of interest were disclosed.

RHODES, GREECE — Terbinafine is superior to placebo and comparable with other antifungal agents for the treatment of tinea pedis, Dr. Hans Christian Korting reported in a poster at the 15th Congress of European Academy of Dermatology and Venereology.

The finding is based on a meta-analysis of 19 randomized controlled trials including more than 2,300 patients. Various formulations of terbinafine, including cream, gel, and a new film-forming solution that requires only a single application, were compared with placebo or another antifungal.

The mycologic cure rate with terbi- nafine was significantly higher than with placebo (pooled relative risk 3.173), and tended to be higher, though not significantly, than with other antifungal agents (pooled relative risk 1.034), said Dr. Korting of Ludwig-Maximilians University in Munich, Germany.

There were no statistically significant differences in cure rates among the various terbinafine formulations. No conflicts of interest were disclosed.

RHODES, GREECE — Terbinafine is superior to placebo and comparable with other antifungal agents for the treatment of tinea pedis, Dr. Hans Christian Korting reported in a poster at the 15th Congress of European Academy of Dermatology and Venereology.

The finding is based on a meta-analysis of 19 randomized controlled trials including more than 2,300 patients. Various formulations of terbinafine, including cream, gel, and a new film-forming solution that requires only a single application, were compared with placebo or another antifungal.

The mycologic cure rate with terbi- nafine was significantly higher than with placebo (pooled relative risk 3.173), and tended to be higher, though not significantly, than with other antifungal agents (pooled relative risk 1.034), said Dr. Korting of Ludwig-Maximilians University in Munich, Germany.

There were no statistically significant differences in cure rates among the various terbinafine formulations. No conflicts of interest were disclosed.

ATLANTA – A biopsychosocial approach may offer the most effective way to manage chronic pain in patients with a comorbid mood or substance use disorder without compromising recovery processes, Martin D. Cheatle, Ph.D., said at the Southeastern conference on alcohol and drug addiction.

The key is treating the whole patient, and treating the disorders concurrently rather than sequentially. A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse, and the effects of depression and anxiety on pain and treatment outcomes, and vice versa, also have to be considered, said Dr. Cheatle of the Behavioral Medicine Center, Reading (Pa.) Hospital and Medical Center.

The biopsychosocial model involves the use of evidence-based medication management along with cognitive-behavioral therapy and an exercise/physical therapy program with a goal of empowering the patient to take charge of the pain. Relaxation and thought focus techniques, and development of adaptive resources such as coping skills, strength, and stamina can help in providing that empowerment.

Also key to success is community support via a network of specially trained primary care doctors and specialists working together in the patient's interest.

Programs incorporating this approach have been shown to improve treatment outcomes, promote return to gainful employment, reduce pain, and increase functionality. For example, a study of 123 patients at the Behavioral Medicine Center showed that from admission to 1.5 years following completion of a 3-week residential behaviorally based pain program including rehabilitation and group cognitive-behavioral therapy, the use of opioids, benzodiazepines, nonsteroidal anti-inflammatories, and antidepressants dropped dramatically, and the use of over-the-counter treatments for pain increased.

The frequency of walking and cycling significantly increased, and depression scores dramatically decreased. Pain scores were reduced by half, Dr. Cheatle said.

Further, employment increased from 5% to 74%, and health care utilization dropped by 78%.

It is important to note that the population which completed the treatment program was a motivated population–nonmotivated patients dropped out early–thus the findings are somewhat skewed, but the approach does appear to be of benefit, he said.

As for the use of opioids for the treatment of pain in patients with a substance use disorder or substance abuse history, these drugs aren't necessarily contraindicated. Data are lacking, but noncompliance with prescription nonopioid drugs, insistence on rapid release formulations of pain medication, complaints of pain at varying body sites (initial treatment for back pain and a later call with tooth pain), and numerous phone calls or clinic/emergency department visits requesting pain medication are among the signs of an increased risk for substance abuse.

History of substance abuse, smoking, or psychiatric disorders also should be considered when deciding the best approach for treating pain.

A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse. DR. CHEATLE

ATLANTA – A biopsychosocial approach may offer the most effective way to manage chronic pain in patients with a comorbid mood or substance use disorder without compromising recovery processes, Martin D. Cheatle, Ph.D., said at the Southeastern conference on alcohol and drug addiction.

The key is treating the whole patient, and treating the disorders concurrently rather than sequentially. A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse, and the effects of depression and anxiety on pain and treatment outcomes, and vice versa, also have to be considered, said Dr. Cheatle of the Behavioral Medicine Center, Reading (Pa.) Hospital and Medical Center.

The biopsychosocial model involves the use of evidence-based medication management along with cognitive-behavioral therapy and an exercise/physical therapy program with a goal of empowering the patient to take charge of the pain. Relaxation and thought focus techniques, and development of adaptive resources such as coping skills, strength, and stamina can help in providing that empowerment.

Also key to success is community support via a network of specially trained primary care doctors and specialists working together in the patient's interest.

Programs incorporating this approach have been shown to improve treatment outcomes, promote return to gainful employment, reduce pain, and increase functionality. For example, a study of 123 patients at the Behavioral Medicine Center showed that from admission to 1.5 years following completion of a 3-week residential behaviorally based pain program including rehabilitation and group cognitive-behavioral therapy, the use of opioids, benzodiazepines, nonsteroidal anti-inflammatories, and antidepressants dropped dramatically, and the use of over-the-counter treatments for pain increased.

The frequency of walking and cycling significantly increased, and depression scores dramatically decreased. Pain scores were reduced by half, Dr. Cheatle said.

Further, employment increased from 5% to 74%, and health care utilization dropped by 78%.

It is important to note that the population which completed the treatment program was a motivated population–nonmotivated patients dropped out early–thus the findings are somewhat skewed, but the approach does appear to be of benefit, he said.

As for the use of opioids for the treatment of pain in patients with a substance use disorder or substance abuse history, these drugs aren't necessarily contraindicated. Data are lacking, but noncompliance with prescription nonopioid drugs, insistence on rapid release formulations of pain medication, complaints of pain at varying body sites (initial treatment for back pain and a later call with tooth pain), and numerous phone calls or clinic/emergency department visits requesting pain medication are among the signs of an increased risk for substance abuse.

History of substance abuse, smoking, or psychiatric disorders also should be considered when deciding the best approach for treating pain.

A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse. DR. CHEATLE

ATLANTA – A biopsychosocial approach may offer the most effective way to manage chronic pain in patients with a comorbid mood or substance use disorder without compromising recovery processes, Martin D. Cheatle, Ph.D., said at the Southeastern conference on alcohol and drug addiction.

The key is treating the whole patient, and treating the disorders concurrently rather than sequentially. A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse, and the effects of depression and anxiety on pain and treatment outcomes, and vice versa, also have to be considered, said Dr. Cheatle of the Behavioral Medicine Center, Reading (Pa.) Hospital and Medical Center.

The biopsychosocial model involves the use of evidence-based medication management along with cognitive-behavioral therapy and an exercise/physical therapy program with a goal of empowering the patient to take charge of the pain. Relaxation and thought focus techniques, and development of adaptive resources such as coping skills, strength, and stamina can help in providing that empowerment.

Also key to success is community support via a network of specially trained primary care doctors and specialists working together in the patient's interest.

Programs incorporating this approach have been shown to improve treatment outcomes, promote return to gainful employment, reduce pain, and increase functionality. For example, a study of 123 patients at the Behavioral Medicine Center showed that from admission to 1.5 years following completion of a 3-week residential behaviorally based pain program including rehabilitation and group cognitive-behavioral therapy, the use of opioids, benzodiazepines, nonsteroidal anti-inflammatories, and antidepressants dropped dramatically, and the use of over-the-counter treatments for pain increased.

The frequency of walking and cycling significantly increased, and depression scores dramatically decreased. Pain scores were reduced by half, Dr. Cheatle said.

Further, employment increased from 5% to 74%, and health care utilization dropped by 78%.

It is important to note that the population which completed the treatment program was a motivated population–nonmotivated patients dropped out early–thus the findings are somewhat skewed, but the approach does appear to be of benefit, he said.

As for the use of opioids for the treatment of pain in patients with a substance use disorder or substance abuse history, these drugs aren't necessarily contraindicated. Data are lacking, but noncompliance with prescription nonopioid drugs, insistence on rapid release formulations of pain medication, complaints of pain at varying body sites (initial treatment for back pain and a later call with tooth pain), and numerous phone calls or clinic/emergency department visits requesting pain medication are among the signs of an increased risk for substance abuse.

History of substance abuse, smoking, or psychiatric disorders also should be considered when deciding the best approach for treating pain.

A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse. DR. CHEATLE

SALT LAKE CITY – Continuous positive airway pressure adherence rates are suboptimal, findings from a study of sleep clinic patients suggest.

Of 528 adults diagnosed with obstructive sleep apnea and followed for a mean of 5 months, 63% had relatively poor adherence (use of less than 4 hours per night), 21% had adequate adherence (use of 4–6 hours per night), and only 16% had optimal adherence (use of more than 6 hours per night). Mean adherence was 3.1 hours per night, Carl Stepnowsky, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

Adherence was specifically defined as use at the prescribed pressure, and was measured by an internal clock. Baseline disease severity correlated with higher levels of adherence.

Patients had a mean age of 59 years, and most had moderate to severe obstructive sleep apnea, with a mean apnea-hypopnea index of 38.8 events per night. Mean change scores (0.68 pounds in weight, -1.6 mm Hg in diastolic blood pressure, and -2.6 mm Hg in systolic blood pressure) were not statistically different from zero, noted Dr. Stepnowsky of the VA San Diego Healthcare System.

The findings are of concern, he said, because suboptimal use of continuous positive airway pressure therapy leads to ineffective treatment and can increase the risk of morbidity and mortality.

A closer look at adherence rates showed that patterns of adherence were established as early as the first night of therapy, suggesting that preexisting factors might explain these patterns. Further studies in large, U.S.-based populations are needed to replicate these findings, as are studies to help identify the factors associated with adherence and to develop tools for improvement, he said.

SALT LAKE CITY – Continuous positive airway pressure adherence rates are suboptimal, findings from a study of sleep clinic patients suggest.

Of 528 adults diagnosed with obstructive sleep apnea and followed for a mean of 5 months, 63% had relatively poor adherence (use of less than 4 hours per night), 21% had adequate adherence (use of 4–6 hours per night), and only 16% had optimal adherence (use of more than 6 hours per night). Mean adherence was 3.1 hours per night, Carl Stepnowsky, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

Adherence was specifically defined as use at the prescribed pressure, and was measured by an internal clock. Baseline disease severity correlated with higher levels of adherence.

Patients had a mean age of 59 years, and most had moderate to severe obstructive sleep apnea, with a mean apnea-hypopnea index of 38.8 events per night. Mean change scores (0.68 pounds in weight, -1.6 mm Hg in diastolic blood pressure, and -2.6 mm Hg in systolic blood pressure) were not statistically different from zero, noted Dr. Stepnowsky of the VA San Diego Healthcare System.

The findings are of concern, he said, because suboptimal use of continuous positive airway pressure therapy leads to ineffective treatment and can increase the risk of morbidity and mortality.

A closer look at adherence rates showed that patterns of adherence were established as early as the first night of therapy, suggesting that preexisting factors might explain these patterns. Further studies in large, U.S.-based populations are needed to replicate these findings, as are studies to help identify the factors associated with adherence and to develop tools for improvement, he said.

SALT LAKE CITY – Continuous positive airway pressure adherence rates are suboptimal, findings from a study of sleep clinic patients suggest.

Of 528 adults diagnosed with obstructive sleep apnea and followed for a mean of 5 months, 63% had relatively poor adherence (use of less than 4 hours per night), 21% had adequate adherence (use of 4–6 hours per night), and only 16% had optimal adherence (use of more than 6 hours per night). Mean adherence was 3.1 hours per night, Carl Stepnowsky, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.

Adherence was specifically defined as use at the prescribed pressure, and was measured by an internal clock. Baseline disease severity correlated with higher levels of adherence.

Patients had a mean age of 59 years, and most had moderate to severe obstructive sleep apnea, with a mean apnea-hypopnea index of 38.8 events per night. Mean change scores (0.68 pounds in weight, -1.6 mm Hg in diastolic blood pressure, and -2.6 mm Hg in systolic blood pressure) were not statistically different from zero, noted Dr. Stepnowsky of the VA San Diego Healthcare System.

The findings are of concern, he said, because suboptimal use of continuous positive airway pressure therapy leads to ineffective treatment and can increase the risk of morbidity and mortality.

A closer look at adherence rates showed that patterns of adherence were established as early as the first night of therapy, suggesting that preexisting factors might explain these patterns. Further studies in large, U.S.-based populations are needed to replicate these findings, as are studies to help identify the factors associated with adherence and to develop tools for improvement, he said.

SALT LAKE CITY – Studies consistently show a link between obstructive sleep apnea and stroke, with the most recent data showing that sleep apnea is an independent risk factor for stroke and death.

The cumulative data in regard to sleep apnea and stroke suggest that patients with sleep apnea should be treated with continuous positive airway pressure (CPAP) or other measures, Dr. Vahid Mohsenin said at the annual meeting of the Associated Professional Sleep Societies.

The evidence supporting the efficacy of CPAP is overwhelming–with good compliance, efficacy is about 90%–and the expectation is that treatment will reduce the risk of stroke, although more research is needed to confirm this, said Dr. Mohsenin, professor of medicine and director of the Yale Center for Sleep Medicine, Yale University, New Haven, Conn.

In fact, a guideline from the American Heart Association/American Stroke Association Stroke Council for the primary prevention of ischemic stroke was updated earlier this year to incorporate new information about stroke prevention, including data on the role of sleep-disordered breathing in stroke. The guideline was initially published in 2001.

Although the guideline stops short of making specific treatment recommendations, and instead states that treatment should be individualized, it does address patient evaluation. It is reasonable that patients and their bed partners be questioned about symptoms of sleep-disordered breathing and that appropriate patients be referred to a sleep specialist for further evaluation, the guideline states.

This is particularly important if the patient has drug-resistant hypertension or certain risk factors for stroke, such as abdominal obesity and hypertension (Stroke 2006;37:1583–633).

In making its recommendation, the AHA/ASA Stroke Council cited data from several studies, including a case-control study of 181 patients, which showed an association between excessive daytime sleepiness (likely caused by obstructive sleep apnea) and stroke (odds ratio 3.07).

The council also cited a 10-year observational study of more than 1,600 men, which showed that those with severe obstructive sleep apnea-hypopnea had an increased risk of fatal and nonfatal cardiovascular events including stroke, compared with healthy individuals (OR 2.87 and 3.17, respectively).

The guideline noted that there are a number of biologically plausible mechanisms for a link between sleep apnea and stroke; Dr. Mohsenin agreed.

Several studies suggest that the mechanism by which sleep-disordered breathing increases stroke risk is by “leading to or worsening hypertension and heart disease and possibly by causing reductions in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, hypercoagulability, inflammation, and paradoxical embolism in patients with patent foramen ovale,” the guideline states.

But the real question, Dr. Mohsenin said, is whether there is an independent association between sleep apnea and stroke, and a recent study on which he was an author shows that there is indeed such an association.

In the observational cohort study of 697 patients with obstructive sleep apnea and 325 controls (mean apnea-hypopnea index of 35 vs. 2 in the patients and controls, respectively), obstructive sleep apnea was found to have a statistically significant association with stroke or death (hazard ratio of 1.91) after adjustment for numerous factors, including age, sex, race, smoking status, alcohol consumption, body mass index, diabetes, hyperlipidemia, atrial fibrillation, and hypertension.

A trend analysis also showed a significant dose-response relationship between sleep apnea severity at baseline and development of a composite end point of stroke or death from any cause (N. Engl. J. Med. 2005;353:2034–41).

While randomized controlled trials are needed to firmly establish a causal link between sleep apnea and stroke–to “put the last nail in the coffin and say, 'ok, sleep apnea is indeed a cause of stroke in a high-risk patient population,'” as Dr. Mohsenin put it, the findings increasingly suggest this is the case. Also, sleep apnea occurs as commonly in transient ischemic attack as it does in stroke, further underscoring the need for sleep apnea treatment in affected patients, he noted.

Additionally, a number of studies have shown that sleep apnea is associated with worse functional outcomes in stroke patients, Dr. Mohsenin said.

Patients with stroke who have sleep apnea have been shown to have more delirium, depression, impaired functional capacity, longer rehabilitation time, and longer hospitalization, he said.

“Sleep apnea does affect the outcome of stroke,” he said, noting that in some studies these effects lasted out to 12 months.

Patients who have had a stroke should be evaluated for sleep disordered breathing, he advised.

In addition, patients using long-term CPAP should be reevaluated for residual symptoms of the disorder to ensure adequate treatment and compliance, he added.

SALT LAKE CITY – Studies consistently show a link between obstructive sleep apnea and stroke, with the most recent data showing that sleep apnea is an independent risk factor for stroke and death.

The cumulative data in regard to sleep apnea and stroke suggest that patients with sleep apnea should be treated with continuous positive airway pressure (CPAP) or other measures, Dr. Vahid Mohsenin said at the annual meeting of the Associated Professional Sleep Societies.

The evidence supporting the efficacy of CPAP is overwhelming–with good compliance, efficacy is about 90%–and the expectation is that treatment will reduce the risk of stroke, although more research is needed to confirm this, said Dr. Mohsenin, professor of medicine and director of the Yale Center for Sleep Medicine, Yale University, New Haven, Conn.

In fact, a guideline from the American Heart Association/American Stroke Association Stroke Council for the primary prevention of ischemic stroke was updated earlier this year to incorporate new information about stroke prevention, including data on the role of sleep-disordered breathing in stroke. The guideline was initially published in 2001.

Although the guideline stops short of making specific treatment recommendations, and instead states that treatment should be individualized, it does address patient evaluation. It is reasonable that patients and their bed partners be questioned about symptoms of sleep-disordered breathing and that appropriate patients be referred to a sleep specialist for further evaluation, the guideline states.

This is particularly important if the patient has drug-resistant hypertension or certain risk factors for stroke, such as abdominal obesity and hypertension (Stroke 2006;37:1583–633).

In making its recommendation, the AHA/ASA Stroke Council cited data from several studies, including a case-control study of 181 patients, which showed an association between excessive daytime sleepiness (likely caused by obstructive sleep apnea) and stroke (odds ratio 3.07).

The council also cited a 10-year observational study of more than 1,600 men, which showed that those with severe obstructive sleep apnea-hypopnea had an increased risk of fatal and nonfatal cardiovascular events including stroke, compared with healthy individuals (OR 2.87 and 3.17, respectively).

The guideline noted that there are a number of biologically plausible mechanisms for a link between sleep apnea and stroke; Dr. Mohsenin agreed.

Several studies suggest that the mechanism by which sleep-disordered breathing increases stroke risk is by “leading to or worsening hypertension and heart disease and possibly by causing reductions in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, hypercoagulability, inflammation, and paradoxical embolism in patients with patent foramen ovale,” the guideline states.

But the real question, Dr. Mohsenin said, is whether there is an independent association between sleep apnea and stroke, and a recent study on which he was an author shows that there is indeed such an association.

In the observational cohort study of 697 patients with obstructive sleep apnea and 325 controls (mean apnea-hypopnea index of 35 vs. 2 in the patients and controls, respectively), obstructive sleep apnea was found to have a statistically significant association with stroke or death (hazard ratio of 1.91) after adjustment for numerous factors, including age, sex, race, smoking status, alcohol consumption, body mass index, diabetes, hyperlipidemia, atrial fibrillation, and hypertension.

A trend analysis also showed a significant dose-response relationship between sleep apnea severity at baseline and development of a composite end point of stroke or death from any cause (N. Engl. J. Med. 2005;353:2034–41).

While randomized controlled trials are needed to firmly establish a causal link between sleep apnea and stroke–to “put the last nail in the coffin and say, 'ok, sleep apnea is indeed a cause of stroke in a high-risk patient population,'” as Dr. Mohsenin put it, the findings increasingly suggest this is the case. Also, sleep apnea occurs as commonly in transient ischemic attack as it does in stroke, further underscoring the need for sleep apnea treatment in affected patients, he noted.

Additionally, a number of studies have shown that sleep apnea is associated with worse functional outcomes in stroke patients, Dr. Mohsenin said.

Patients with stroke who have sleep apnea have been shown to have more delirium, depression, impaired functional capacity, longer rehabilitation time, and longer hospitalization, he said.

“Sleep apnea does affect the outcome of stroke,” he said, noting that in some studies these effects lasted out to 12 months.

Patients who have had a stroke should be evaluated for sleep disordered breathing, he advised.

In addition, patients using long-term CPAP should be reevaluated for residual symptoms of the disorder to ensure adequate treatment and compliance, he added.

SALT LAKE CITY – Studies consistently show a link between obstructive sleep apnea and stroke, with the most recent data showing that sleep apnea is an independent risk factor for stroke and death.

The cumulative data in regard to sleep apnea and stroke suggest that patients with sleep apnea should be treated with continuous positive airway pressure (CPAP) or other measures, Dr. Vahid Mohsenin said at the annual meeting of the Associated Professional Sleep Societies.

The evidence supporting the efficacy of CPAP is overwhelming–with good compliance, efficacy is about 90%–and the expectation is that treatment will reduce the risk of stroke, although more research is needed to confirm this, said Dr. Mohsenin, professor of medicine and director of the Yale Center for Sleep Medicine, Yale University, New Haven, Conn.

In fact, a guideline from the American Heart Association/American Stroke Association Stroke Council for the primary prevention of ischemic stroke was updated earlier this year to incorporate new information about stroke prevention, including data on the role of sleep-disordered breathing in stroke. The guideline was initially published in 2001.

Although the guideline stops short of making specific treatment recommendations, and instead states that treatment should be individualized, it does address patient evaluation. It is reasonable that patients and their bed partners be questioned about symptoms of sleep-disordered breathing and that appropriate patients be referred to a sleep specialist for further evaluation, the guideline states.

This is particularly important if the patient has drug-resistant hypertension or certain risk factors for stroke, such as abdominal obesity and hypertension (Stroke 2006;37:1583–633).

In making its recommendation, the AHA/ASA Stroke Council cited data from several studies, including a case-control study of 181 patients, which showed an association between excessive daytime sleepiness (likely caused by obstructive sleep apnea) and stroke (odds ratio 3.07).

The council also cited a 10-year observational study of more than 1,600 men, which showed that those with severe obstructive sleep apnea-hypopnea had an increased risk of fatal and nonfatal cardiovascular events including stroke, compared with healthy individuals (OR 2.87 and 3.17, respectively).

The guideline noted that there are a number of biologically plausible mechanisms for a link between sleep apnea and stroke; Dr. Mohsenin agreed.

Several studies suggest that the mechanism by which sleep-disordered breathing increases stroke risk is by “leading to or worsening hypertension and heart disease and possibly by causing reductions in cerebral blood flow, altered cerebral autoregulation, impaired endothelial function, accelerated atherogenesis, hypercoagulability, inflammation, and paradoxical embolism in patients with patent foramen ovale,” the guideline states.

But the real question, Dr. Mohsenin said, is whether there is an independent association between sleep apnea and stroke, and a recent study on which he was an author shows that there is indeed such an association.

In the observational cohort study of 697 patients with obstructive sleep apnea and 325 controls (mean apnea-hypopnea index of 35 vs. 2 in the patients and controls, respectively), obstructive sleep apnea was found to have a statistically significant association with stroke or death (hazard ratio of 1.91) after adjustment for numerous factors, including age, sex, race, smoking status, alcohol consumption, body mass index, diabetes, hyperlipidemia, atrial fibrillation, and hypertension.

A trend analysis also showed a significant dose-response relationship between sleep apnea severity at baseline and development of a composite end point of stroke or death from any cause (N. Engl. J. Med. 2005;353:2034–41).

While randomized controlled trials are needed to firmly establish a causal link between sleep apnea and stroke–to “put the last nail in the coffin and say, 'ok, sleep apnea is indeed a cause of stroke in a high-risk patient population,'” as Dr. Mohsenin put it, the findings increasingly suggest this is the case. Also, sleep apnea occurs as commonly in transient ischemic attack as it does in stroke, further underscoring the need for sleep apnea treatment in affected patients, he noted.

Additionally, a number of studies have shown that sleep apnea is associated with worse functional outcomes in stroke patients, Dr. Mohsenin said.

Patients with stroke who have sleep apnea have been shown to have more delirium, depression, impaired functional capacity, longer rehabilitation time, and longer hospitalization, he said.

“Sleep apnea does affect the outcome of stroke,” he said, noting that in some studies these effects lasted out to 12 months.

Patients who have had a stroke should be evaluated for sleep disordered breathing, he advised.

In addition, patients using long-term CPAP should be reevaluated for residual symptoms of the disorder to ensure adequate treatment and compliance, he added.

RHODES, GREECE—CO₂ lasers can be an effective and valuable tool in patients with darker skin types, Dr. Mukta Sachdev said at the 15th Congress of the European Academy of Dermatology and Venereology.

"A lot of the fears about treating darker skin are unfounded," she said, describing the favorable results she has achieved for numerous indications in her patients in southern India, who have predominantly Fitzpatrick skin types IV-VI.

The key to good outcomes is careful patient selection and good pre- and posttreatment care, said Dr. Sachdev of Manipal Hospital, Bangalore, India.

She has achieved success with CO₂ lasers for a number of indications, including verrucae, freckles, skin tags, epidermal nevi, traumatic tattoos, granuloma pyogenicum, rhinophyma, xanthelasma, seborrheic keratosis, acne scars, and deep cystic acne, she said, noting that because of the photoprotection associated with her patients' darker pigmentation, their use for rhytides and resurfacing is minimal.

Selection of an appropriate and conservative parameter for the indication is important, as are test pulses and test spots to observe tissue response. Use adequate cooling, do not overtreat, and cover your risks for ulcerations, infection, pigmentation, and scarring, she advised.

Postoperative care should include the use of hydrocolloid dressings for at least a month, regular and frequent use of a mild nonsoap cleanser, and sunscreen. If pigmentation occurs, hydroquinone and kojic acid can be used, and the problem should resolve in 6–8 weeks.

Many dermatologists use hydroquinone and kojic acid prophylactically for at least 3 months to minimize the risk, she noted.

For some conditions, such as xanthelasma and lentigines, results are not permanent, lasting only about 12–18 months. And for others—such as acne scarring, which is particularly challenging in darker skin types—the results are less impressive. With acne there is typically about a 40% improvement, but patients, if advised of these limitations in advance, are generally happy with the results.

Advantages of the CO₂ laser include its outpatient, routine, and relatively noninvasive nature. Downsides include the need for multiple passes, the risk of bleeding if treatment is too deep, and the potential for complications. Many complications can be prevented by avoiding overlapping of laser spots or scans and by adhering to strict postoperative recovery regimens; when complications such as infection and pigmentary alterations do occur, most are treatable with a variety of topical and/or oral treatment, she said, stressing that proper training is a must. "Take time to master the art of resurfacing," she advised.

And take time when it comes to obtaining informed consent, she added, noting that "conversation is the heart and soul of obtaining informed consent."

RHODES, GREECE—CO₂ lasers can be an effective and valuable tool in patients with darker skin types, Dr. Mukta Sachdev said at the 15th Congress of the European Academy of Dermatology and Venereology.

"A lot of the fears about treating darker skin are unfounded," she said, describing the favorable results she has achieved for numerous indications in her patients in southern India, who have predominantly Fitzpatrick skin types IV-VI.

The key to good outcomes is careful patient selection and good pre- and posttreatment care, said Dr. Sachdev of Manipal Hospital, Bangalore, India.

She has achieved success with CO₂ lasers for a number of indications, including verrucae, freckles, skin tags, epidermal nevi, traumatic tattoos, granuloma pyogenicum, rhinophyma, xanthelasma, seborrheic keratosis, acne scars, and deep cystic acne, she said, noting that because of the photoprotection associated with her patients' darker pigmentation, their use for rhytides and resurfacing is minimal.

Selection of an appropriate and conservative parameter for the indication is important, as are test pulses and test spots to observe tissue response. Use adequate cooling, do not overtreat, and cover your risks for ulcerations, infection, pigmentation, and scarring, she advised.

Postoperative care should include the use of hydrocolloid dressings for at least a month, regular and frequent use of a mild nonsoap cleanser, and sunscreen. If pigmentation occurs, hydroquinone and kojic acid can be used, and the problem should resolve in 6–8 weeks.

Many dermatologists use hydroquinone and kojic acid prophylactically for at least 3 months to minimize the risk, she noted.

For some conditions, such as xanthelasma and lentigines, results are not permanent, lasting only about 12–18 months. And for others—such as acne scarring, which is particularly challenging in darker skin types—the results are less impressive. With acne there is typically about a 40% improvement, but patients, if advised of these limitations in advance, are generally happy with the results.

Advantages of the CO₂ laser include its outpatient, routine, and relatively noninvasive nature. Downsides include the need for multiple passes, the risk of bleeding if treatment is too deep, and the potential for complications. Many complications can be prevented by avoiding overlapping of laser spots or scans and by adhering to strict postoperative recovery regimens; when complications such as infection and pigmentary alterations do occur, most are treatable with a variety of topical and/or oral treatment, she said, stressing that proper training is a must. "Take time to master the art of resurfacing," she advised.

And take time when it comes to obtaining informed consent, she added, noting that "conversation is the heart and soul of obtaining informed consent."

RHODES, GREECE—CO₂ lasers can be an effective and valuable tool in patients with darker skin types, Dr. Mukta Sachdev said at the 15th Congress of the European Academy of Dermatology and Venereology.

"A lot of the fears about treating darker skin are unfounded," she said, describing the favorable results she has achieved for numerous indications in her patients in southern India, who have predominantly Fitzpatrick skin types IV-VI.

The key to good outcomes is careful patient selection and good pre- and posttreatment care, said Dr. Sachdev of Manipal Hospital, Bangalore, India.

She has achieved success with CO₂ lasers for a number of indications, including verrucae, freckles, skin tags, epidermal nevi, traumatic tattoos, granuloma pyogenicum, rhinophyma, xanthelasma, seborrheic keratosis, acne scars, and deep cystic acne, she said, noting that because of the photoprotection associated with her patients' darker pigmentation, their use for rhytides and resurfacing is minimal.

Selection of an appropriate and conservative parameter for the indication is important, as are test pulses and test spots to observe tissue response. Use adequate cooling, do not overtreat, and cover your risks for ulcerations, infection, pigmentation, and scarring, she advised.

Postoperative care should include the use of hydrocolloid dressings for at least a month, regular and frequent use of a mild nonsoap cleanser, and sunscreen. If pigmentation occurs, hydroquinone and kojic acid can be used, and the problem should resolve in 6–8 weeks.

Many dermatologists use hydroquinone and kojic acid prophylactically for at least 3 months to minimize the risk, she noted.

For some conditions, such as xanthelasma and lentigines, results are not permanent, lasting only about 12–18 months. And for others—such as acne scarring, which is particularly challenging in darker skin types—the results are less impressive. With acne there is typically about a 40% improvement, but patients, if advised of these limitations in advance, are generally happy with the results.

Advantages of the CO₂ laser include its outpatient, routine, and relatively noninvasive nature. Downsides include the need for multiple passes, the risk of bleeding if treatment is too deep, and the potential for complications. Many complications can be prevented by avoiding overlapping of laser spots or scans and by adhering to strict postoperative recovery regimens; when complications such as infection and pigmentary alterations do occur, most are treatable with a variety of topical and/or oral treatment, she said, stressing that proper training is a must. "Take time to master the art of resurfacing," she advised.

And take time when it comes to obtaining informed consent, she added, noting that "conversation is the heart and soul of obtaining informed consent."

RHODES, GREECE—Photodynamic therapy using topical methyl aminolevulinate has efficacy comparable to cryotherapy for the treatment of basal cell carcinoma and actinic keratoses but provides substantially better cosmetic outcomes, according to data presented at the 15th Congress of the European Academy of Dermatology and Venereology.

In a multicenter study of 120 patients with superficial basal cell carcinoma who were randomized to photodynamic therapy with methyl aminolevulinate (MAL-PDT) or cryotherapy, complete responses were seen in 97% of those in the MAL-PDT group and 95% of those in the cryotherapy group at 3 months, Dr. Nicole Basset-Seguin reported in a poster.

The recurrence rate at 60 months also was similar in the two groups: 22% in the MAL-PDT group and 20% for cryotherapy patients, reported Dr. Basset-Seguin of Hôpital Saint Louis, Paris.

The investigators, however, rated cosmetic outcomes as excellent far more frequently in the MAL-PDT group (56%) than in the cryotherapy group (14%) at the 60-month follow-up.

In this study, MAL-PDT was provided as a single treatment. Patients who failed to respond at 3 months were retreated with an additional two consecutive MAL-PDT sessions 7 days apart. Cryotherapy was applied in two freeze-thaw cycles using liquid nitrogen spray. Patients who failed to respond were retreated with double freeze-thaw cryotherapy.

In another study presented at the meeting, MAL-PDT was superior to cryotherapy for treatment of actinic keratoses.

A total of 119 subjects with 1,501 cumulative lesions were treated on one side of the face or scalp with MAL-PDT and on the other side with double freeze-thaw cryotherapy. The treatments were randomly allocated to the sides of the face/scalp and were repeated at 12 weeks in those with incomplete response, Dr. Colin Morton of the Falkirk (Scotland) Royal Infirmary, reported in a poster.

At 12 weeks, significantly more patients in the MAL-PDT group had a reduction from baseline in the number of lesions, compared with cryotherapy (84% vs. 75%, respectively), and at 24 weeks, both groups showed similar reductions in the number of lesions from baseline (89% and 88%).

Both treatments were safe and well tolerated, and subject and investigator ratings of cosmetic outcome "clearly favored MAL-PDT," Dr. Morton wrote.

Both studies were sponsored by Galderma, maker of the PDT devices used.

RHODES, GREECE—Photodynamic therapy using topical methyl aminolevulinate has efficacy comparable to cryotherapy for the treatment of basal cell carcinoma and actinic keratoses but provides substantially better cosmetic outcomes, according to data presented at the 15th Congress of the European Academy of Dermatology and Venereology.

In a multicenter study of 120 patients with superficial basal cell carcinoma who were randomized to photodynamic therapy with methyl aminolevulinate (MAL-PDT) or cryotherapy, complete responses were seen in 97% of those in the MAL-PDT group and 95% of those in the cryotherapy group at 3 months, Dr. Nicole Basset-Seguin reported in a poster.

The recurrence rate at 60 months also was similar in the two groups: 22% in the MAL-PDT group and 20% for cryotherapy patients, reported Dr. Basset-Seguin of Hôpital Saint Louis, Paris.

The investigators, however, rated cosmetic outcomes as excellent far more frequently in the MAL-PDT group (56%) than in the cryotherapy group (14%) at the 60-month follow-up.

In this study, MAL-PDT was provided as a single treatment. Patients who failed to respond at 3 months were retreated with an additional two consecutive MAL-PDT sessions 7 days apart. Cryotherapy was applied in two freeze-thaw cycles using liquid nitrogen spray. Patients who failed to respond were retreated with double freeze-thaw cryotherapy.

In another study presented at the meeting, MAL-PDT was superior to cryotherapy for treatment of actinic keratoses.

A total of 119 subjects with 1,501 cumulative lesions were treated on one side of the face or scalp with MAL-PDT and on the other side with double freeze-thaw cryotherapy. The treatments were randomly allocated to the sides of the face/scalp and were repeated at 12 weeks in those with incomplete response, Dr. Colin Morton of the Falkirk (Scotland) Royal Infirmary, reported in a poster.

At 12 weeks, significantly more patients in the MAL-PDT group had a reduction from baseline in the number of lesions, compared with cryotherapy (84% vs. 75%, respectively), and at 24 weeks, both groups showed similar reductions in the number of lesions from baseline (89% and 88%).

Both treatments were safe and well tolerated, and subject and investigator ratings of cosmetic outcome "clearly favored MAL-PDT," Dr. Morton wrote.

Both studies were sponsored by Galderma, maker of the PDT devices used.

RHODES, GREECE—Photodynamic therapy using topical methyl aminolevulinate has efficacy comparable to cryotherapy for the treatment of basal cell carcinoma and actinic keratoses but provides substantially better cosmetic outcomes, according to data presented at the 15th Congress of the European Academy of Dermatology and Venereology.

In a multicenter study of 120 patients with superficial basal cell carcinoma who were randomized to photodynamic therapy with methyl aminolevulinate (MAL-PDT) or cryotherapy, complete responses were seen in 97% of those in the MAL-PDT group and 95% of those in the cryotherapy group at 3 months, Dr. Nicole Basset-Seguin reported in a poster.

The recurrence rate at 60 months also was similar in the two groups: 22% in the MAL-PDT group and 20% for cryotherapy patients, reported Dr. Basset-Seguin of Hôpital Saint Louis, Paris.

The investigators, however, rated cosmetic outcomes as excellent far more frequently in the MAL-PDT group (56%) than in the cryotherapy group (14%) at the 60-month follow-up.

In this study, MAL-PDT was provided as a single treatment. Patients who failed to respond at 3 months were retreated with an additional two consecutive MAL-PDT sessions 7 days apart. Cryotherapy was applied in two freeze-thaw cycles using liquid nitrogen spray. Patients who failed to respond were retreated with double freeze-thaw cryotherapy.

In another study presented at the meeting, MAL-PDT was superior to cryotherapy for treatment of actinic keratoses.

A total of 119 subjects with 1,501 cumulative lesions were treated on one side of the face or scalp with MAL-PDT and on the other side with double freeze-thaw cryotherapy. The treatments were randomly allocated to the sides of the face/scalp and were repeated at 12 weeks in those with incomplete response, Dr. Colin Morton of the Falkirk (Scotland) Royal Infirmary, reported in a poster.

At 12 weeks, significantly more patients in the MAL-PDT group had a reduction from baseline in the number of lesions, compared with cryotherapy (84% vs. 75%, respectively), and at 24 weeks, both groups showed similar reductions in the number of lesions from baseline (89% and 88%).

Both treatments were safe and well tolerated, and subject and investigator ratings of cosmetic outcome "clearly favored MAL-PDT," Dr. Morton wrote.

Both studies were sponsored by Galderma, maker of the PDT devices used.

RHODES, GREECE—Targeted ultraviolet B phototherapy—the use of fiber-optic light delivery systems—allows treatment of previously inaccessible body sites such as the scalp and the oral and intranasal mucosa, Dr. Lajos Kemeny said at the 15th Congress of the European Academy of Dermatology and Venereology.

The fiber optics guide delivery of incoherent ultraviolet light to small areas while protecting nonlesional skin from excessive UV exposure. This has further enhanced phototherapy, improving delivery to areas like the scalp and nasal mucosa, and has led to investigation of its use for new applications, namely intranasal treatment for allergic rhinitis, said Dr. Kemeny of the University of Szeged (Hungary).

In a randomized double-blind clinical trial using a novel device for intranasal phototherapy, "rhinophototherapy" significantly reduced the symptoms of hay fever, reported Dr. Kemeny, who is a cofounder of the Rhinolight company, maker of the Rhinolight device used in the study.

In 49 patients, each intranasal cavity was illuminated three times weekly for 3 weeks with 5% UVB, 25% UVA, and 70% visible light (an approach known as mUV/VIS), or with just low-intensity visible light. Scores for sneezing, rhinorrhea, and nasal itching improved significantly in the treated patients but not in the control patients, he said.

Furthermore, scores for nasal obstruction improved slightly in the treated patients and increased significantly in control patients (J. Allergy Clin. Immunol. 2005;115:541–7).

In an open-label follow-up study using a similar protocol but with gradual increases in doses of mUV/VIS light, rhinophototherapy significantly inhibited allergic rhinitis symptoms in 90% of 70 treated patients. Significant improvements were seen in sneezing, rhinorrhea, nasal itching, nasal obstruction, and total nasal scores in this study.

Evaluation of nasal lavage in treated patients suggests that the mechanism of action can be at least partially attributed to apoptosis induction of cells that play an important role in the pathogenesis of allergic rhinitis: The mUV/VIS irradiation induces a dose-dependent increase in apoptosis of memory T cells, naive T cells, and eosinophils, Dr. Kemeny noted.

Intranasal phototherapy may represent a novel treatment for allergic rhinitis as well as other inflammatory and immune-mediated mucosal diseases, he said.

The Rhinolight device is available in Europe but has not yet been approved in the United States.

RHODES, GREECE—Targeted ultraviolet B phototherapy—the use of fiber-optic light delivery systems—allows treatment of previously inaccessible body sites such as the scalp and the oral and intranasal mucosa, Dr. Lajos Kemeny said at the 15th Congress of the European Academy of Dermatology and Venereology.

The fiber optics guide delivery of incoherent ultraviolet light to small areas while protecting nonlesional skin from excessive UV exposure. This has further enhanced phototherapy, improving delivery to areas like the scalp and nasal mucosa, and has led to investigation of its use for new applications, namely intranasal treatment for allergic rhinitis, said Dr. Kemeny of the University of Szeged (Hungary).

In a randomized double-blind clinical trial using a novel device for intranasal phototherapy, "rhinophototherapy" significantly reduced the symptoms of hay fever, reported Dr. Kemeny, who is a cofounder of the Rhinolight company, maker of the Rhinolight device used in the study.

In 49 patients, each intranasal cavity was illuminated three times weekly for 3 weeks with 5% UVB, 25% UVA, and 70% visible light (an approach known as mUV/VIS), or with just low-intensity visible light. Scores for sneezing, rhinorrhea, and nasal itching improved significantly in the treated patients but not in the control patients, he said.

Furthermore, scores for nasal obstruction improved slightly in the treated patients and increased significantly in control patients (J. Allergy Clin. Immunol. 2005;115:541–7).

In an open-label follow-up study using a similar protocol but with gradual increases in doses of mUV/VIS light, rhinophototherapy significantly inhibited allergic rhinitis symptoms in 90% of 70 treated patients. Significant improvements were seen in sneezing, rhinorrhea, nasal itching, nasal obstruction, and total nasal scores in this study.

Evaluation of nasal lavage in treated patients suggests that the mechanism of action can be at least partially attributed to apoptosis induction of cells that play an important role in the pathogenesis of allergic rhinitis: The mUV/VIS irradiation induces a dose-dependent increase in apoptosis of memory T cells, naive T cells, and eosinophils, Dr. Kemeny noted.

Intranasal phototherapy may represent a novel treatment for allergic rhinitis as well as other inflammatory and immune-mediated mucosal diseases, he said.

The Rhinolight device is available in Europe but has not yet been approved in the United States.

RHODES, GREECE—Targeted ultraviolet B phototherapy—the use of fiber-optic light delivery systems—allows treatment of previously inaccessible body sites such as the scalp and the oral and intranasal mucosa, Dr. Lajos Kemeny said at the 15th Congress of the European Academy of Dermatology and Venereology.

The fiber optics guide delivery of incoherent ultraviolet light to small areas while protecting nonlesional skin from excessive UV exposure. This has further enhanced phototherapy, improving delivery to areas like the scalp and nasal mucosa, and has led to investigation of its use for new applications, namely intranasal treatment for allergic rhinitis, said Dr. Kemeny of the University of Szeged (Hungary).

In a randomized double-blind clinical trial using a novel device for intranasal phototherapy, "rhinophototherapy" significantly reduced the symptoms of hay fever, reported Dr. Kemeny, who is a cofounder of the Rhinolight company, maker of the Rhinolight device used in the study.

In 49 patients, each intranasal cavity was illuminated three times weekly for 3 weeks with 5% UVB, 25% UVA, and 70% visible light (an approach known as mUV/VIS), or with just low-intensity visible light. Scores for sneezing, rhinorrhea, and nasal itching improved significantly in the treated patients but not in the control patients, he said.

Furthermore, scores for nasal obstruction improved slightly in the treated patients and increased significantly in control patients (J. Allergy Clin. Immunol. 2005;115:541–7).

In an open-label follow-up study using a similar protocol but with gradual increases in doses of mUV/VIS light, rhinophototherapy significantly inhibited allergic rhinitis symptoms in 90% of 70 treated patients. Significant improvements were seen in sneezing, rhinorrhea, nasal itching, nasal obstruction, and total nasal scores in this study.

Evaluation of nasal lavage in treated patients suggests that the mechanism of action can be at least partially attributed to apoptosis induction of cells that play an important role in the pathogenesis of allergic rhinitis: The mUV/VIS irradiation induces a dose-dependent increase in apoptosis of memory T cells, naive T cells, and eosinophils, Dr. Kemeny noted.

Intranasal phototherapy may represent a novel treatment for allergic rhinitis as well as other inflammatory and immune-mediated mucosal diseases, he said.

The Rhinolight device is available in Europe but has not yet been approved in the United States.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, Dr. Ribet said.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, Dr. Ribet said.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

RHODES, GREECE — Lactamide monoethanolamine, a lactic acid-derived humectant commonly found in over-the-counter lotions and bath gels, appears to be beneficial for the treatment of cradle cap, Virginie Ribet, Ph.D., said at the 15th Congress of the European Academy of Dermatology and Venereology.

A lactamide monoethanolamine-based gel was safe, effective, and well tolerated in a randomized, controlled, open-label phase III study of 124 infants with mild to moderate seborrheic dermatitis of the scalp, Dr. Ribet of Pierre Fabre Research Institute in Ramonville Saint Agne, France, reported in a poster presentation.

Lesional scores, which were based on the area of involvement and intensity of scaling on four zones of the scalp, decreased significantly more in the 63 infants in the treatment group, compared with the 61 infants in the control group, at day 7 (55% vs. 42%), day 21 (81% vs. 70%), and day 42 (96% vs. 86%).

A lesional score of 0 was noted in 73% of infants in the treatment group at the end of the study, compared with 50% of those in the control group, Dr. Ribet said.

Parents of the 63 infants in the treatment group were asked to apply the gel, followed by a soft shampoo, daily for the first week, then two to three times per week thereafter for the course of the study. Only soft shampoo was applied to the 61 infants in the control group.

The gel was safe and well tolerated in both groups. Erythema was significantly improved from baseline to study end in both groups.

Both the investigators and the parents reported satisfaction on overall assessment; the product led to recovery or definite improvement in all treated infants, she noted.

SALT LAKE CITY – Increased caffeine intake was associated with better cognitive functioning in patients with obstructive sleep apnea, according to the results of a small study.

In 42 patients with untreated obstructive sleep apnea, a statistically significant inverse relationship was found between caffeine intake and a global deficit score that was derived from an aggregate measure of neuropsychological functioning, Dr. Daniel Norman reported at the annual meeting of the Associated Professional Sleep Societies.

The association persisted after controlling for body mass index and apnea-hypopnea index, said Dr. Norman of the University of California, San Diego.

Patients had a mean apnea-hypopnea index of 63 episodes per hour, indicating severe sleep apnea. The neuropsychological assessment battery included tests of speed of information processing, executive functioning, memory skills, verbal skills, and attention and working memory domains.

Caffeine intake was assessed using a detailed instrument that has been shown to characterize usual caffeine consumption based on 24-hour recall.

Daily caffeine intake in cognitively impaired patients was one-sixth that of non-cognitively impaired patients (30 mg vs. 180 mg), Dr. Norman said. Previous findings that obstructive sleep apnea patients consume three times the caffeine of nonapneic individuals on a daily basis led to speculation that those with sleep apnea were self-medicating with caffeine to counteract daytime sleepiness. Caffeine has been shown to enhance cognition, and the findings of the current study suggest this is an additional effect experienced by those who use caffeine for that purpose.

SALT LAKE CITY – Increased caffeine intake was associated with better cognitive functioning in patients with obstructive sleep apnea, according to the results of a small study.

In 42 patients with untreated obstructive sleep apnea, a statistically significant inverse relationship was found between caffeine intake and a global deficit score that was derived from an aggregate measure of neuropsychological functioning, Dr. Daniel Norman reported at the annual meeting of the Associated Professional Sleep Societies.

The association persisted after controlling for body mass index and apnea-hypopnea index, said Dr. Norman of the University of California, San Diego.

Patients had a mean apnea-hypopnea index of 63 episodes per hour, indicating severe sleep apnea. The neuropsychological assessment battery included tests of speed of information processing, executive functioning, memory skills, verbal skills, and attention and working memory domains.

Caffeine intake was assessed using a detailed instrument that has been shown to characterize usual caffeine consumption based on 24-hour recall.

Daily caffeine intake in cognitively impaired patients was one-sixth that of non-cognitively impaired patients (30 mg vs. 180 mg), Dr. Norman said. Previous findings that obstructive sleep apnea patients consume three times the caffeine of nonapneic individuals on a daily basis led to speculation that those with sleep apnea were self-medicating with caffeine to counteract daytime sleepiness. Caffeine has been shown to enhance cognition, and the findings of the current study suggest this is an additional effect experienced by those who use caffeine for that purpose.

SALT LAKE CITY – Increased caffeine intake was associated with better cognitive functioning in patients with obstructive sleep apnea, according to the results of a small study.

In 42 patients with untreated obstructive sleep apnea, a statistically significant inverse relationship was found between caffeine intake and a global deficit score that was derived from an aggregate measure of neuropsychological functioning, Dr. Daniel Norman reported at the annual meeting of the Associated Professional Sleep Societies.

The association persisted after controlling for body mass index and apnea-hypopnea index, said Dr. Norman of the University of California, San Diego.

Patients had a mean apnea-hypopnea index of 63 episodes per hour, indicating severe sleep apnea. The neuropsychological assessment battery included tests of speed of information processing, executive functioning, memory skills, verbal skills, and attention and working memory domains.

Caffeine intake was assessed using a detailed instrument that has been shown to characterize usual caffeine consumption based on 24-hour recall.

Daily caffeine intake in cognitively impaired patients was one-sixth that of non-cognitively impaired patients (30 mg vs. 180 mg), Dr. Norman said. Previous findings that obstructive sleep apnea patients consume three times the caffeine of nonapneic individuals on a daily basis led to speculation that those with sleep apnea were self-medicating with caffeine to counteract daytime sleepiness. Caffeine has been shown to enhance cognition, and the findings of the current study suggest this is an additional effect experienced by those who use caffeine for that purpose.

RHODES, GREECE — Botulinum toxin type A is a safe and effective treatment for crow's feet at doses of 15, 30, and 45 U per eye, Dr. Benjamin Ascher said in a poster presented at the 15th Congress of the European Academy of Dermatology and Venereology.

The 15-U dose appears to be an appropriate starting point for treatment in younger subjects, while the higher doses appear to provide greater benefit in older patients, said Dr. Ascher of the Hospital of St. Cloud, Paris.

A total of 220 adults aged 18–65 years were enrolled in the randomized, multicenter, double-blind, placebo-controlled dose-ranging study of botulinum toxin type A, which is available in Europe as Dysport and is currently in clinical trials under the name Reloxin in the United States. The subjects, who had moderate or severe crow's feet at maximum smile and mild to severe crow's feet at rest, were treated with placebo or 15, 30, or 45 U per eye. Efficacy and safety were evaluated at 2, 4, 8, 12, 16, 20, and 24 weeks following injection.

For all three doses of Dysport, compared with placebo, a highly significant difference in apparent severity of crow's feet at maximum smile was noted after 4 weeks, as determined by independent panel and "live" investigator assessments. At the 2- to 16-week follow-ups, the independent panel assessed the appearance of crow's feet at rest as being statistically significantly improved, compared with placebo, at the two higher doses of Dysport; live investigators assessed their appearance at rest to be significantly improved at all doses, Dr. Ascher said.

When results were considered according to age, those aged 50 years and younger were more likely than older patients to respond to all doses of Dysport. At week 2, between 9 and 12 patients (depending on dose) aged 51 and older were assessed by the independent panel as having significant improvement, compared with 17–20 subjects (depending on dose) aged 50 years and younger. In those aged 51 and older, the higher doses appeared to confer greater benefit, he said.

Patient satisfaction was good in this study, which was funded by Ipsen Ltd., the maker of Dysport.

Self-assessment of satisfaction with the change in crow's feet appearance was significantly greater with Dysport at all doses, compared with placebo, at up to 16 weeks' follow-up. The safety profile of Dysport was also good: 23 treatment-related adverse events were reported by 22 subjects, but none were serious and all resolved without sequelae.

RHODES, GREECE — Botulinum toxin type A is a safe and effective treatment for crow's feet at doses of 15, 30, and 45 U per eye, Dr. Benjamin Ascher said in a poster presented at the 15th Congress of the European Academy of Dermatology and Venereology.

The 15-U dose appears to be an appropriate starting point for treatment in younger subjects, while the higher doses appear to provide greater benefit in older patients, said Dr. Ascher of the Hospital of St. Cloud, Paris.

A total of 220 adults aged 18–65 years were enrolled in the randomized, multicenter, double-blind, placebo-controlled dose-ranging study of botulinum toxin type A, which is available in Europe as Dysport and is currently in clinical trials under the name Reloxin in the United States. The subjects, who had moderate or severe crow's feet at maximum smile and mild to severe crow's feet at rest, were treated with placebo or 15, 30, or 45 U per eye. Efficacy and safety were evaluated at 2, 4, 8, 12, 16, 20, and 24 weeks following injection.

For all three doses of Dysport, compared with placebo, a highly significant difference in apparent severity of crow's feet at maximum smile was noted after 4 weeks, as determined by independent panel and "live" investigator assessments. At the 2- to 16-week follow-ups, the independent panel assessed the appearance of crow's feet at rest as being statistically significantly improved, compared with placebo, at the two higher doses of Dysport; live investigators assessed their appearance at rest to be significantly improved at all doses, Dr. Ascher said.

When results were considered according to age, those aged 50 years and younger were more likely than older patients to respond to all doses of Dysport. At week 2, between 9 and 12 patients (depending on dose) aged 51 and older were assessed by the independent panel as having significant improvement, compared with 17–20 subjects (depending on dose) aged 50 years and younger. In those aged 51 and older, the higher doses appeared to confer greater benefit, he said.

Patient satisfaction was good in this study, which was funded by Ipsen Ltd., the maker of Dysport.

Self-assessment of satisfaction with the change in crow's feet appearance was significantly greater with Dysport at all doses, compared with placebo, at up to 16 weeks' follow-up. The safety profile of Dysport was also good: 23 treatment-related adverse events were reported by 22 subjects, but none were serious and all resolved without sequelae.

RHODES, GREECE — Botulinum toxin type A is a safe and effective treatment for crow's feet at doses of 15, 30, and 45 U per eye, Dr. Benjamin Ascher said in a poster presented at the 15th Congress of the European Academy of Dermatology and Venereology.

The 15-U dose appears to be an appropriate starting point for treatment in younger subjects, while the higher doses appear to provide greater benefit in older patients, said Dr. Ascher of the Hospital of St. Cloud, Paris.

A total of 220 adults aged 18–65 years were enrolled in the randomized, multicenter, double-blind, placebo-controlled dose-ranging study of botulinum toxin type A, which is available in Europe as Dysport and is currently in clinical trials under the name Reloxin in the United States. The subjects, who had moderate or severe crow's feet at maximum smile and mild to severe crow's feet at rest, were treated with placebo or 15, 30, or 45 U per eye. Efficacy and safety were evaluated at 2, 4, 8, 12, 16, 20, and 24 weeks following injection.

For all three doses of Dysport, compared with placebo, a highly significant difference in apparent severity of crow's feet at maximum smile was noted after 4 weeks, as determined by independent panel and "live" investigator assessments. At the 2- to 16-week follow-ups, the independent panel assessed the appearance of crow's feet at rest as being statistically significantly improved, compared with placebo, at the two higher doses of Dysport; live investigators assessed their appearance at rest to be significantly improved at all doses, Dr. Ascher said.

When results were considered according to age, those aged 50 years and younger were more likely than older patients to respond to all doses of Dysport. At week 2, between 9 and 12 patients (depending on dose) aged 51 and older were assessed by the independent panel as having significant improvement, compared with 17–20 subjects (depending on dose) aged 50 years and younger. In those aged 51 and older, the higher doses appeared to confer greater benefit, he said.

Patient satisfaction was good in this study, which was funded by Ipsen Ltd., the maker of Dysport.

Self-assessment of satisfaction with the change in crow's feet appearance was significantly greater with Dysport at all doses, compared with placebo, at up to 16 weeks' follow-up. The safety profile of Dysport was also good: 23 treatment-related adverse events were reported by 22 subjects, but none were serious and all resolved without sequelae.