MDedge Dermatology

An injection of bupivacaine following Mohs micrographic surgery procedures that have notable postsurgical pain significantly reduces pain scores and, importantly, use of postsurgical narcotics, a randomized trial shows.

“Single-dose, in-office bupivacaine administration immediately following reconstructions known to be high risk for pain reduces postoperative narcotic use and acute pain during the time period when our patients have the highest levels of pain,” said first author Vanessa B. Voss, MD, of the University of Missouri–Columbia, who presented the findings at the annual meeting of the American College of Mohs Surgery.

Dr. Vanessa Voss

“It was well tolerated, there were no adverse effects, and we recommend the consideration of using this in Mohs micrographic surgery reconstructions that are at the highest risk for pain,” she said.

Recent research has shown that Mohs micrographic surgeons have the highest rates of opioid prescribing of all dermatologists, with about 11% of patients undergoing a Mohs procedure prescribed the drugs for postoperative use, Dr. Voss explained.

Yet, with the ongoing opioid epidemic and even short courses of postoperative opioids placing patients at risk for addiction, the pressure is on to find alternative, nonaddictive strategies for the treatment of acute postoperative pain.

Bupivacaine is commonly used intraoperatively with other types of surgeries to reduce postoperative pain, with a favorable duration of action lasting up to 7 hours, compared with just 2-3 hours with lidocaine. And while its use in Mohs surgery is typically also intraoperative, along with lidocaine, the unique postoperative treatment approach in Mohs surgery has not been well studied, Dr. Voss noted.

To investigate, Dr. Voss and colleagues conducted the prospective, multicenter randomized trial, enrolling 174 patients undergoing Mohs micrographic surgery for skin cancer.

Patients were receiving complex flap reconstructions that have been specifically designated in an American Academy of Dermatology position statement to be high risk for pain following Mohs surgeries, and hence, more likely to involve prescriptions for opioids. These include reconstruction flaps of the scalp, ear, nose or lip, a wedge repair of the ear or lip, or a Mustarde cheek rotation flap.

The mean age of the patients was about 69 years, and about 65% were male. The two groups had no significant differences in demographics, tumor types, or repairs. They were randomized to receive either local injections of bupivacaine 0.5% (with no epinephrine) or placebo with sterile saline injection immediately following the procedure, with the total amount of injection standardized and dependent upon the flap surface area, ranging from 2.5 to 5 cm³.

For postoperative pain, all patients were prescribed acetaminophen 1,000 mg alternating with ibuprofen 400 mg, and tramadol, with instructions to only use tramadol as needed for breakthrough pain.

The reported use of narcotic analgesics by participants was significantly higher among those receiving placebo versus bupivacaine in the first 24 hours following surgery (odds ratio, 2.18; P = .03), as well as in the second 24 hours (OR, 2.18; P = .08) and at 48 hours combined (OR, 2.58; P < .01).

Those in the bupivacaine group also reported lower average pain scores, on a scale of 0-10, during the first 8-hour interval (mean difference, 1.6; P < .001). Importantly, overall, reports of pain medication use and the percentage of patients reporting pain under control were similar between groups, despite lower opioid use in the bupivacaine group.

“The percentage of patients reporting their pain to be under control was similar at all time intervals in both groups, so this means the bupivacaine group had their pain well-controlled despite fewer narcotics, with significant reductions in opioid use,” Dr. Voss noted.

Bupivacaine, though generally regarded as safe, has a reputation for being the most cardiotoxic of the local anesthetic agents; however, there were no such side effects reported in the study. Dr. Voss said the likely explanation is the use of low doses.

“In our study, we had no cardiotoxic effects when using up to 5 cc of 0.5%, which equates to 25 mg per patient,” she explained. This is considered a “very low dose,” since the maximum in the Food and Drug Administration pamphlet for local infiltration is 175 mg per patient every 3 hours, “yet is sufficient for reducing pain/narcotic use.”

She added that “surgeons must be careful to avoid accidental intravascular injection, which could increase risks of systemic toxicity, but this is very rare in the reconstruction settings described.”

Overall, the study suggests a potentially beneficial and unique nonopioid approach that is currently lacking for Mohs procedures associated with a high level of pain. “These findings offer a very effective intervention to reduce postoperative opioid use in this subset of patients,” Dr. Voss told this news organization. “There is not any other intervention that I am aware of to address this, although further study into other long-acting anesthetics may demonstrate similar effects.”

Dr. Justin J. Leitenberger

Commenting on the study, Justin J. Leitenberger, MD, session moderator, said that these “data could be impactful for reducing pain as well as the need for opioid medication after dermatologic surgery, both of which would be significant for our patients and public health outcomes.”

Among the challenges in treating pain following Mohs surgeries is that “every patient has a different pain threshold and expectation after surgery,” said Dr. Leitenberger, assistant professor of medicine and dermatology and codirector of dermatologic surgery, Mohs micrographic surgery, and laser and cosmetic surgery at Oregon Health & Science University, Portland.

“Patients undergoing larger repairs in tense areas of skin can experience increased pain and require prescription pain medication,” he said. “Bupivacaine, in this study, shows promise to provide longer lasting pain control from the surgical appointment and easier bridging to nonopioid pain control.”

Regarding the potential cardiotoxicities associated with the drug, Dr. Leitenberger agreed that the risks are low, and added that many surgeons have, in fact, switched to full use of bupivacaine, as opposed to combination with lidocaine, apparently without problems. “This is a small dose locally to the area after a procedure and I agree that the risks are minuscule,” he said.

“Of note, during national lidocaine shortages over the past few years, many practices transitioned to exclusive use of bupivacaine for the entire Mohs procedure, and [anecdotally], this transition did not result in toxicities that were reported,” Dr. Leitenberger said.

GW Medical Faculty Associates

Commenting further, Vishal Patel, MD, assistant professor of dermatology and hematology/oncology at George Washington University and director of cutaneous oncology at the GW Cancer Center, both in Washington, also agreed that the benefits appear important. “The benefit from using bupivacaine is encouraging on multiple levels,” he said in an interview.

“Given all that we know about opioids and their negative side effect profile as well as their limited help in cutaneous surgery pain control, the use of long-acting anesthetics is an innovative and reasonable approach to provide pain control in the immediate postoperative window when patients tend to have the most pain,” said Dr. Patel, who is also director of dermatologic surgery at George Washington University.

“After this window, acetaminophen and ibuprofen, which have been shown when used in tandem in an alternating schedule to be superior to opioids, provides an effective pain regimen,” he said. “For larger and more pain-sensitive patients, this appears to be a promising combination.”

Dr. Voss, Dr. Leitenberger, and Dr. Patel have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

An injection of bupivacaine following Mohs micrographic surgery procedures that have notable postsurgical pain significantly reduces pain scores and, importantly, use of postsurgical narcotics, a randomized trial shows.

“Single-dose, in-office bupivacaine administration immediately following reconstructions known to be high risk for pain reduces postoperative narcotic use and acute pain during the time period when our patients have the highest levels of pain,” said first author Vanessa B. Voss, MD, of the University of Missouri–Columbia, who presented the findings at the annual meeting of the American College of Mohs Surgery.

Dr. Vanessa Voss

“It was well tolerated, there were no adverse effects, and we recommend the consideration of using this in Mohs micrographic surgery reconstructions that are at the highest risk for pain,” she said.

Recent research has shown that Mohs micrographic surgeons have the highest rates of opioid prescribing of all dermatologists, with about 11% of patients undergoing a Mohs procedure prescribed the drugs for postoperative use, Dr. Voss explained.

Yet, with the ongoing opioid epidemic and even short courses of postoperative opioids placing patients at risk for addiction, the pressure is on to find alternative, nonaddictive strategies for the treatment of acute postoperative pain.

Bupivacaine is commonly used intraoperatively with other types of surgeries to reduce postoperative pain, with a favorable duration of action lasting up to 7 hours, compared with just 2-3 hours with lidocaine. And while its use in Mohs surgery is typically also intraoperative, along with lidocaine, the unique postoperative treatment approach in Mohs surgery has not been well studied, Dr. Voss noted.

To investigate, Dr. Voss and colleagues conducted the prospective, multicenter randomized trial, enrolling 174 patients undergoing Mohs micrographic surgery for skin cancer.

Patients were receiving complex flap reconstructions that have been specifically designated in an American Academy of Dermatology position statement to be high risk for pain following Mohs surgeries, and hence, more likely to involve prescriptions for opioids. These include reconstruction flaps of the scalp, ear, nose or lip, a wedge repair of the ear or lip, or a Mustarde cheek rotation flap.

The mean age of the patients was about 69 years, and about 65% were male. The two groups had no significant differences in demographics, tumor types, or repairs. They were randomized to receive either local injections of bupivacaine 0.5% (with no epinephrine) or placebo with sterile saline injection immediately following the procedure, with the total amount of injection standardized and dependent upon the flap surface area, ranging from 2.5 to 5 cm³.

For postoperative pain, all patients were prescribed acetaminophen 1,000 mg alternating with ibuprofen 400 mg, and tramadol, with instructions to only use tramadol as needed for breakthrough pain.

The reported use of narcotic analgesics by participants was significantly higher among those receiving placebo versus bupivacaine in the first 24 hours following surgery (odds ratio, 2.18; P = .03), as well as in the second 24 hours (OR, 2.18; P = .08) and at 48 hours combined (OR, 2.58; P < .01).

Those in the bupivacaine group also reported lower average pain scores, on a scale of 0-10, during the first 8-hour interval (mean difference, 1.6; P < .001). Importantly, overall, reports of pain medication use and the percentage of patients reporting pain under control were similar between groups, despite lower opioid use in the bupivacaine group.

“The percentage of patients reporting their pain to be under control was similar at all time intervals in both groups, so this means the bupivacaine group had their pain well-controlled despite fewer narcotics, with significant reductions in opioid use,” Dr. Voss noted.

Bupivacaine, though generally regarded as safe, has a reputation for being the most cardiotoxic of the local anesthetic agents; however, there were no such side effects reported in the study. Dr. Voss said the likely explanation is the use of low doses.

“In our study, we had no cardiotoxic effects when using up to 5 cc of 0.5%, which equates to 25 mg per patient,” she explained. This is considered a “very low dose,” since the maximum in the Food and Drug Administration pamphlet for local infiltration is 175 mg per patient every 3 hours, “yet is sufficient for reducing pain/narcotic use.”

She added that “surgeons must be careful to avoid accidental intravascular injection, which could increase risks of systemic toxicity, but this is very rare in the reconstruction settings described.”

Overall, the study suggests a potentially beneficial and unique nonopioid approach that is currently lacking for Mohs procedures associated with a high level of pain. “These findings offer a very effective intervention to reduce postoperative opioid use in this subset of patients,” Dr. Voss told this news organization. “There is not any other intervention that I am aware of to address this, although further study into other long-acting anesthetics may demonstrate similar effects.”

Dr. Justin J. Leitenberger

Commenting on the study, Justin J. Leitenberger, MD, session moderator, said that these “data could be impactful for reducing pain as well as the need for opioid medication after dermatologic surgery, both of which would be significant for our patients and public health outcomes.”

Among the challenges in treating pain following Mohs surgeries is that “every patient has a different pain threshold and expectation after surgery,” said Dr. Leitenberger, assistant professor of medicine and dermatology and codirector of dermatologic surgery, Mohs micrographic surgery, and laser and cosmetic surgery at Oregon Health & Science University, Portland.

“Patients undergoing larger repairs in tense areas of skin can experience increased pain and require prescription pain medication,” he said. “Bupivacaine, in this study, shows promise to provide longer lasting pain control from the surgical appointment and easier bridging to nonopioid pain control.”

Regarding the potential cardiotoxicities associated with the drug, Dr. Leitenberger agreed that the risks are low, and added that many surgeons have, in fact, switched to full use of bupivacaine, as opposed to combination with lidocaine, apparently without problems. “This is a small dose locally to the area after a procedure and I agree that the risks are minuscule,” he said.

“Of note, during national lidocaine shortages over the past few years, many practices transitioned to exclusive use of bupivacaine for the entire Mohs procedure, and [anecdotally], this transition did not result in toxicities that were reported,” Dr. Leitenberger said.

GW Medical Faculty Associates

Commenting further, Vishal Patel, MD, assistant professor of dermatology and hematology/oncology at George Washington University and director of cutaneous oncology at the GW Cancer Center, both in Washington, also agreed that the benefits appear important. “The benefit from using bupivacaine is encouraging on multiple levels,” he said in an interview.

“Given all that we know about opioids and their negative side effect profile as well as their limited help in cutaneous surgery pain control, the use of long-acting anesthetics is an innovative and reasonable approach to provide pain control in the immediate postoperative window when patients tend to have the most pain,” said Dr. Patel, who is also director of dermatologic surgery at George Washington University.

“After this window, acetaminophen and ibuprofen, which have been shown when used in tandem in an alternating schedule to be superior to opioids, provides an effective pain regimen,” he said. “For larger and more pain-sensitive patients, this appears to be a promising combination.”

Dr. Voss, Dr. Leitenberger, and Dr. Patel have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

An injection of bupivacaine following Mohs micrographic surgery procedures that have notable postsurgical pain significantly reduces pain scores and, importantly, use of postsurgical narcotics, a randomized trial shows.

“Single-dose, in-office bupivacaine administration immediately following reconstructions known to be high risk for pain reduces postoperative narcotic use and acute pain during the time period when our patients have the highest levels of pain,” said first author Vanessa B. Voss, MD, of the University of Missouri–Columbia, who presented the findings at the annual meeting of the American College of Mohs Surgery.

Dr. Vanessa Voss

“It was well tolerated, there were no adverse effects, and we recommend the consideration of using this in Mohs micrographic surgery reconstructions that are at the highest risk for pain,” she said.

Recent research has shown that Mohs micrographic surgeons have the highest rates of opioid prescribing of all dermatologists, with about 11% of patients undergoing a Mohs procedure prescribed the drugs for postoperative use, Dr. Voss explained.

Yet, with the ongoing opioid epidemic and even short courses of postoperative opioids placing patients at risk for addiction, the pressure is on to find alternative, nonaddictive strategies for the treatment of acute postoperative pain.

Bupivacaine is commonly used intraoperatively with other types of surgeries to reduce postoperative pain, with a favorable duration of action lasting up to 7 hours, compared with just 2-3 hours with lidocaine. And while its use in Mohs surgery is typically also intraoperative, along with lidocaine, the unique postoperative treatment approach in Mohs surgery has not been well studied, Dr. Voss noted.

To investigate, Dr. Voss and colleagues conducted the prospective, multicenter randomized trial, enrolling 174 patients undergoing Mohs micrographic surgery for skin cancer.

Patients were receiving complex flap reconstructions that have been specifically designated in an American Academy of Dermatology position statement to be high risk for pain following Mohs surgeries, and hence, more likely to involve prescriptions for opioids. These include reconstruction flaps of the scalp, ear, nose or lip, a wedge repair of the ear or lip, or a Mustarde cheek rotation flap.

The mean age of the patients was about 69 years, and about 65% were male. The two groups had no significant differences in demographics, tumor types, or repairs. They were randomized to receive either local injections of bupivacaine 0.5% (with no epinephrine) or placebo with sterile saline injection immediately following the procedure, with the total amount of injection standardized and dependent upon the flap surface area, ranging from 2.5 to 5 cm³.

For postoperative pain, all patients were prescribed acetaminophen 1,000 mg alternating with ibuprofen 400 mg, and tramadol, with instructions to only use tramadol as needed for breakthrough pain.

The reported use of narcotic analgesics by participants was significantly higher among those receiving placebo versus bupivacaine in the first 24 hours following surgery (odds ratio, 2.18; P = .03), as well as in the second 24 hours (OR, 2.18; P = .08) and at 48 hours combined (OR, 2.58; P < .01).

Those in the bupivacaine group also reported lower average pain scores, on a scale of 0-10, during the first 8-hour interval (mean difference, 1.6; P < .001). Importantly, overall, reports of pain medication use and the percentage of patients reporting pain under control were similar between groups, despite lower opioid use in the bupivacaine group.

“The percentage of patients reporting their pain to be under control was similar at all time intervals in both groups, so this means the bupivacaine group had their pain well-controlled despite fewer narcotics, with significant reductions in opioid use,” Dr. Voss noted.

Bupivacaine, though generally regarded as safe, has a reputation for being the most cardiotoxic of the local anesthetic agents; however, there were no such side effects reported in the study. Dr. Voss said the likely explanation is the use of low doses.

“In our study, we had no cardiotoxic effects when using up to 5 cc of 0.5%, which equates to 25 mg per patient,” she explained. This is considered a “very low dose,” since the maximum in the Food and Drug Administration pamphlet for local infiltration is 175 mg per patient every 3 hours, “yet is sufficient for reducing pain/narcotic use.”

She added that “surgeons must be careful to avoid accidental intravascular injection, which could increase risks of systemic toxicity, but this is very rare in the reconstruction settings described.”

Overall, the study suggests a potentially beneficial and unique nonopioid approach that is currently lacking for Mohs procedures associated with a high level of pain. “These findings offer a very effective intervention to reduce postoperative opioid use in this subset of patients,” Dr. Voss told this news organization. “There is not any other intervention that I am aware of to address this, although further study into other long-acting anesthetics may demonstrate similar effects.”

Dr. Justin J. Leitenberger

Commenting on the study, Justin J. Leitenberger, MD, session moderator, said that these “data could be impactful for reducing pain as well as the need for opioid medication after dermatologic surgery, both of which would be significant for our patients and public health outcomes.”

Among the challenges in treating pain following Mohs surgeries is that “every patient has a different pain threshold and expectation after surgery,” said Dr. Leitenberger, assistant professor of medicine and dermatology and codirector of dermatologic surgery, Mohs micrographic surgery, and laser and cosmetic surgery at Oregon Health & Science University, Portland.

“Patients undergoing larger repairs in tense areas of skin can experience increased pain and require prescription pain medication,” he said. “Bupivacaine, in this study, shows promise to provide longer lasting pain control from the surgical appointment and easier bridging to nonopioid pain control.”

Regarding the potential cardiotoxicities associated with the drug, Dr. Leitenberger agreed that the risks are low, and added that many surgeons have, in fact, switched to full use of bupivacaine, as opposed to combination with lidocaine, apparently without problems. “This is a small dose locally to the area after a procedure and I agree that the risks are minuscule,” he said.

“Of note, during national lidocaine shortages over the past few years, many practices transitioned to exclusive use of bupivacaine for the entire Mohs procedure, and [anecdotally], this transition did not result in toxicities that were reported,” Dr. Leitenberger said.

GW Medical Faculty Associates

Commenting further, Vishal Patel, MD, assistant professor of dermatology and hematology/oncology at George Washington University and director of cutaneous oncology at the GW Cancer Center, both in Washington, also agreed that the benefits appear important. “The benefit from using bupivacaine is encouraging on multiple levels,” he said in an interview.

“Given all that we know about opioids and their negative side effect profile as well as their limited help in cutaneous surgery pain control, the use of long-acting anesthetics is an innovative and reasonable approach to provide pain control in the immediate postoperative window when patients tend to have the most pain,” said Dr. Patel, who is also director of dermatologic surgery at George Washington University.

“After this window, acetaminophen and ibuprofen, which have been shown when used in tandem in an alternating schedule to be superior to opioids, provides an effective pain regimen,” he said. “For larger and more pain-sensitive patients, this appears to be a promising combination.”

Dr. Voss, Dr. Leitenberger, and Dr. Patel have reported no relevant financial relationships.

A version of this article first appeared on Medscape.com.

That Toxoplasma gondii looks good on you

Parasite and attractiveness don’t usually go together, but it appears that nobody told Toxoplasma gondii. The world’s most successful parasite affects 30%-50% of the world’s population, and it’s mainly thought to go after the brain in humans, possibly changing behavior and leading to neurological disorders and mental illness.

Now, are you ready to be super confused? According to a recent study, those affected with T. gondii were seen as more attractive and healthy looking, compared with noninfected people. It doesn’t make much sense to us, but it could be an evolutionary thing: The more attractive the parasite makes a person or animal, the more likely it is to spread.

RapidEye/iStock/Getty Images Plus

“Some sexually transmitted parasites, such as T. gondii, may produce changes in the appearance and behavior of the human host, either as a by-product of the infection or as the result of the manipulation of the parasite to increase its spread to new hosts,” Javier Borráz-León, PhD, of the University of Turku (Finland), and associates wrote in PeerJ.

Previous research has suggested that men with more testosterone are more likely to become infected because of their behavior with the extra hormones. It’s also been noted that the parasite may manipulate hormones for its own gain, but that’s not proven. Infected women were found to have a lower BMI, more confidence in their appearance, and more partners. Dr. Borráz-León and associates also found that “Toxoplasma-infected subjects had significantly lower facial fluctuating asymmetry than the noninfected people,” ScienceAlert said.

We usually perceive parasites as a bad thing, but honestly this one isn’t sounding too bad. It seems to help with some confidence boosters, and who doesn’t want that? We’re thinking that T. gondii could be the Next Big Thing. All it needs is some marketing and … what if it was covered with nonpareils?

Give it to me straight, Doc. Don’t sugar coat it.

Okay, so he’s not a doctor – not a medical doctor, anyway – but that’s exactly what he did. William H. Grover, PhD, has sugar coated drugs in the name of fraud prevention. We will explain.

The sugar coating comes in the form of nonpareils, the tiny and colorful round sprinkles often found covering small discs of chocolate. Dr. Grover, a bioengineering professor at the University of California, Riverside, who has been working on ways to ensure the authenticity of pharmaceuticals, “started wondering how many different patterns of colored nonpareils were possible on these candies,” he said in a statement from the university.

PxHere

With just eight colors and an average of 92 individual nonpareils on each candy, the combinations, he found out, are almost endless. Could the same thing be done with a pill? Could the nonpareils be applied as a coating to a pill, giving it a unique pattern that could be stored by the manufacturer and used later as identification?

After much time and effort involving edible cake-decorating glue, Tylenol capsules, smartphones, and computer simulations, he produced CandyCode, an algorithm that converts a photo of a nonpareil-covered pill “into a set of text strings suitable for storing in a computer database and querying by consumers,” the statement explained.

Dr. Grover also mentioned a side benefit: “Anecdotally, I found that CandyCoded caplets were more pleasant to swallow than plain caplets, confirming Mary Poppins’ classic observation about the relationship between sugar and medicine.”

First of all, we can’t believe we just used a Mary Poppins reference. Not exactly what you’d call MDedgey, is it? Second of all, what about the children? We’re talking about drugs that, literally, have been turned into candy. Are the kids going to love them, too? Sounds more like a job for Mr. Yuk.
 

So you want to be a superhero?

Be honest, who didn’t want to be a superhero when they were a kid? There’s a reason every other movie released in the past decade has been a superhero movie. That’s how we’ve ended up with the millionth Batman reboot and Marvel scraping the bottom of the C-list hero barrel. (Seriously, who’d actually heard of Moon Knight before now?)

rudall30/iStockphoto.com

Point is, we all like to fantasize, and now a meta-analysis from researchers in Germany and the United States has given us all a reason to strike those dashing superhero poses. Through evaluation of 130 studies and over 10,000 people, the researchers found that power posing (and perfect posture) was strongly associated with increased confidence and self-worth. It was also associated with improved behavior, though the connection was less strong.

Sadly though, the research found no connection with power posing and changes in testosterone or cortisol levels. Standing like a superhero may make you feel good, but it won’t give your body any cool powers or superhuman abilities. But don’t despair, because we’re not finished yet. In fact, it may be the biggest news we’ve ever reported for LOTME: A group of scientists from the University of Kentucky has assembled the full genome of a salamander.

Wait, we have more! Beyond having a genome ten times bigger than a human, this salamander, the axolotl from Mexico, is the model of natural regeneration. Name a body part, and the axolotl can grow it back. It can even regenerate portions of its brain. And now that we have access to the complete genome, it’s possible that one day we could use the axolotl’s regeneration for ourselves. Growing back limbs, regenerating spinal cords, the sky’s the limit. And if Wolverine and Deadpool are anything to go by, it’s all you need to get that superhero career off the ground. Salamander powers may not have the cachet of a radioactive spider, but we’ll take what we can get.
 

Post your way to financial hardship

After you pump your gas at the gas station, how do you pay? At the pump or inside? How frequently do you post to your social media pages? What kind of content are you posting?

That kind of nontraditional credit data hasn’t been considered by lenders and credit agencies, but that is changing. The reasoning? It’s opening more opportunities for those without much credit history. But according to a paper published by Janine S. Hiller of Virginia Tech and Lindsay Sain Jones, a financial regulation researcher at the University of Georgia, this just opens a can of worms.

SonerCdem/Thinkstock

Why is this so dangerous? Well, alternative credit scoring isn’t covered by the Fair Credit Reporting Act or Equal Opportunity Act, so the consumer doesn’t have the ability to dispute any data the credit agencies or lenders receive. Then there’s the “credit boost,” which some companies offer to gain access to the consumer’s data. Often there are no limitations on how long it’s kept. That purchase you made 2 years ago can come back to haunt you.

It also creates a cause for the possibility of discrimination based on “lifestyle-related data points,” which some lenders use to determine creditworthiness: zip code, age, gender, race, socioeconomic status. Even where the consumer went to college is a factor taken under consideration.

“There are all kinds of factors that can be correlated with creditworthiness, but that doesn’t mean they should be used,” Ms. Jones said in the EurekAlert statement.

Let’s say someone applies for a loan needed for a medical procedure. They could be denied because the lender or a credit-reporting agency didn’t like the data they received (most times without the consumer’s consent). Talk about a broken system.
 

That Toxoplasma gondii looks good on you

Parasite and attractiveness don’t usually go together, but it appears that nobody told Toxoplasma gondii. The world’s most successful parasite affects 30%-50% of the world’s population, and it’s mainly thought to go after the brain in humans, possibly changing behavior and leading to neurological disorders and mental illness.

Now, are you ready to be super confused? According to a recent study, those affected with T. gondii were seen as more attractive and healthy looking, compared with noninfected people. It doesn’t make much sense to us, but it could be an evolutionary thing: The more attractive the parasite makes a person or animal, the more likely it is to spread.

RapidEye/iStock/Getty Images Plus

“Some sexually transmitted parasites, such as T. gondii, may produce changes in the appearance and behavior of the human host, either as a by-product of the infection or as the result of the manipulation of the parasite to increase its spread to new hosts,” Javier Borráz-León, PhD, of the University of Turku (Finland), and associates wrote in PeerJ.

Previous research has suggested that men with more testosterone are more likely to become infected because of their behavior with the extra hormones. It’s also been noted that the parasite may manipulate hormones for its own gain, but that’s not proven. Infected women were found to have a lower BMI, more confidence in their appearance, and more partners. Dr. Borráz-León and associates also found that “Toxoplasma-infected subjects had significantly lower facial fluctuating asymmetry than the noninfected people,” ScienceAlert said.

We usually perceive parasites as a bad thing, but honestly this one isn’t sounding too bad. It seems to help with some confidence boosters, and who doesn’t want that? We’re thinking that T. gondii could be the Next Big Thing. All it needs is some marketing and … what if it was covered with nonpareils?

Give it to me straight, Doc. Don’t sugar coat it.

Okay, so he’s not a doctor – not a medical doctor, anyway – but that’s exactly what he did. William H. Grover, PhD, has sugar coated drugs in the name of fraud prevention. We will explain.

The sugar coating comes in the form of nonpareils, the tiny and colorful round sprinkles often found covering small discs of chocolate. Dr. Grover, a bioengineering professor at the University of California, Riverside, who has been working on ways to ensure the authenticity of pharmaceuticals, “started wondering how many different patterns of colored nonpareils were possible on these candies,” he said in a statement from the university.

PxHere

With just eight colors and an average of 92 individual nonpareils on each candy, the combinations, he found out, are almost endless. Could the same thing be done with a pill? Could the nonpareils be applied as a coating to a pill, giving it a unique pattern that could be stored by the manufacturer and used later as identification?

After much time and effort involving edible cake-decorating glue, Tylenol capsules, smartphones, and computer simulations, he produced CandyCode, an algorithm that converts a photo of a nonpareil-covered pill “into a set of text strings suitable for storing in a computer database and querying by consumers,” the statement explained.

Dr. Grover also mentioned a side benefit: “Anecdotally, I found that CandyCoded caplets were more pleasant to swallow than plain caplets, confirming Mary Poppins’ classic observation about the relationship between sugar and medicine.”

First of all, we can’t believe we just used a Mary Poppins reference. Not exactly what you’d call MDedgey, is it? Second of all, what about the children? We’re talking about drugs that, literally, have been turned into candy. Are the kids going to love them, too? Sounds more like a job for Mr. Yuk.
 

So you want to be a superhero?

Be honest, who didn’t want to be a superhero when they were a kid? There’s a reason every other movie released in the past decade has been a superhero movie. That’s how we’ve ended up with the millionth Batman reboot and Marvel scraping the bottom of the C-list hero barrel. (Seriously, who’d actually heard of Moon Knight before now?)

rudall30/iStockphoto.com

Point is, we all like to fantasize, and now a meta-analysis from researchers in Germany and the United States has given us all a reason to strike those dashing superhero poses. Through evaluation of 130 studies and over 10,000 people, the researchers found that power posing (and perfect posture) was strongly associated with increased confidence and self-worth. It was also associated with improved behavior, though the connection was less strong.

Sadly though, the research found no connection with power posing and changes in testosterone or cortisol levels. Standing like a superhero may make you feel good, but it won’t give your body any cool powers or superhuman abilities. But don’t despair, because we’re not finished yet. In fact, it may be the biggest news we’ve ever reported for LOTME: A group of scientists from the University of Kentucky has assembled the full genome of a salamander.

Wait, we have more! Beyond having a genome ten times bigger than a human, this salamander, the axolotl from Mexico, is the model of natural regeneration. Name a body part, and the axolotl can grow it back. It can even regenerate portions of its brain. And now that we have access to the complete genome, it’s possible that one day we could use the axolotl’s regeneration for ourselves. Growing back limbs, regenerating spinal cords, the sky’s the limit. And if Wolverine and Deadpool are anything to go by, it’s all you need to get that superhero career off the ground. Salamander powers may not have the cachet of a radioactive spider, but we’ll take what we can get.
 

Post your way to financial hardship

After you pump your gas at the gas station, how do you pay? At the pump or inside? How frequently do you post to your social media pages? What kind of content are you posting?

That kind of nontraditional credit data hasn’t been considered by lenders and credit agencies, but that is changing. The reasoning? It’s opening more opportunities for those without much credit history. But according to a paper published by Janine S. Hiller of Virginia Tech and Lindsay Sain Jones, a financial regulation researcher at the University of Georgia, this just opens a can of worms.

SonerCdem/Thinkstock

Why is this so dangerous? Well, alternative credit scoring isn’t covered by the Fair Credit Reporting Act or Equal Opportunity Act, so the consumer doesn’t have the ability to dispute any data the credit agencies or lenders receive. Then there’s the “credit boost,” which some companies offer to gain access to the consumer’s data. Often there are no limitations on how long it’s kept. That purchase you made 2 years ago can come back to haunt you.

It also creates a cause for the possibility of discrimination based on “lifestyle-related data points,” which some lenders use to determine creditworthiness: zip code, age, gender, race, socioeconomic status. Even where the consumer went to college is a factor taken under consideration.

“There are all kinds of factors that can be correlated with creditworthiness, but that doesn’t mean they should be used,” Ms. Jones said in the EurekAlert statement.

Let’s say someone applies for a loan needed for a medical procedure. They could be denied because the lender or a credit-reporting agency didn’t like the data they received (most times without the consumer’s consent). Talk about a broken system.
 

That Toxoplasma gondii looks good on you

Parasite and attractiveness don’t usually go together, but it appears that nobody told Toxoplasma gondii. The world’s most successful parasite affects 30%-50% of the world’s population, and it’s mainly thought to go after the brain in humans, possibly changing behavior and leading to neurological disorders and mental illness.

Now, are you ready to be super confused? According to a recent study, those affected with T. gondii were seen as more attractive and healthy looking, compared with noninfected people. It doesn’t make much sense to us, but it could be an evolutionary thing: The more attractive the parasite makes a person or animal, the more likely it is to spread.

RapidEye/iStock/Getty Images Plus

“Some sexually transmitted parasites, such as T. gondii, may produce changes in the appearance and behavior of the human host, either as a by-product of the infection or as the result of the manipulation of the parasite to increase its spread to new hosts,” Javier Borráz-León, PhD, of the University of Turku (Finland), and associates wrote in PeerJ.

Previous research has suggested that men with more testosterone are more likely to become infected because of their behavior with the extra hormones. It’s also been noted that the parasite may manipulate hormones for its own gain, but that’s not proven. Infected women were found to have a lower BMI, more confidence in their appearance, and more partners. Dr. Borráz-León and associates also found that “Toxoplasma-infected subjects had significantly lower facial fluctuating asymmetry than the noninfected people,” ScienceAlert said.

We usually perceive parasites as a bad thing, but honestly this one isn’t sounding too bad. It seems to help with some confidence boosters, and who doesn’t want that? We’re thinking that T. gondii could be the Next Big Thing. All it needs is some marketing and … what if it was covered with nonpareils?

Give it to me straight, Doc. Don’t sugar coat it.

Okay, so he’s not a doctor – not a medical doctor, anyway – but that’s exactly what he did. William H. Grover, PhD, has sugar coated drugs in the name of fraud prevention. We will explain.

The sugar coating comes in the form of nonpareils, the tiny and colorful round sprinkles often found covering small discs of chocolate. Dr. Grover, a bioengineering professor at the University of California, Riverside, who has been working on ways to ensure the authenticity of pharmaceuticals, “started wondering how many different patterns of colored nonpareils were possible on these candies,” he said in a statement from the university.

PxHere

With just eight colors and an average of 92 individual nonpareils on each candy, the combinations, he found out, are almost endless. Could the same thing be done with a pill? Could the nonpareils be applied as a coating to a pill, giving it a unique pattern that could be stored by the manufacturer and used later as identification?

After much time and effort involving edible cake-decorating glue, Tylenol capsules, smartphones, and computer simulations, he produced CandyCode, an algorithm that converts a photo of a nonpareil-covered pill “into a set of text strings suitable for storing in a computer database and querying by consumers,” the statement explained.

Dr. Grover also mentioned a side benefit: “Anecdotally, I found that CandyCoded caplets were more pleasant to swallow than plain caplets, confirming Mary Poppins’ classic observation about the relationship between sugar and medicine.”

First of all, we can’t believe we just used a Mary Poppins reference. Not exactly what you’d call MDedgey, is it? Second of all, what about the children? We’re talking about drugs that, literally, have been turned into candy. Are the kids going to love them, too? Sounds more like a job for Mr. Yuk.
 

So you want to be a superhero?

Be honest, who didn’t want to be a superhero when they were a kid? There’s a reason every other movie released in the past decade has been a superhero movie. That’s how we’ve ended up with the millionth Batman reboot and Marvel scraping the bottom of the C-list hero barrel. (Seriously, who’d actually heard of Moon Knight before now?)

rudall30/iStockphoto.com

Point is, we all like to fantasize, and now a meta-analysis from researchers in Germany and the United States has given us all a reason to strike those dashing superhero poses. Through evaluation of 130 studies and over 10,000 people, the researchers found that power posing (and perfect posture) was strongly associated with increased confidence and self-worth. It was also associated with improved behavior, though the connection was less strong.

Sadly though, the research found no connection with power posing and changes in testosterone or cortisol levels. Standing like a superhero may make you feel good, but it won’t give your body any cool powers or superhuman abilities. But don’t despair, because we’re not finished yet. In fact, it may be the biggest news we’ve ever reported for LOTME: A group of scientists from the University of Kentucky has assembled the full genome of a salamander.

Wait, we have more! Beyond having a genome ten times bigger than a human, this salamander, the axolotl from Mexico, is the model of natural regeneration. Name a body part, and the axolotl can grow it back. It can even regenerate portions of its brain. And now that we have access to the complete genome, it’s possible that one day we could use the axolotl’s regeneration for ourselves. Growing back limbs, regenerating spinal cords, the sky’s the limit. And if Wolverine and Deadpool are anything to go by, it’s all you need to get that superhero career off the ground. Salamander powers may not have the cachet of a radioactive spider, but we’ll take what we can get.
 

Post your way to financial hardship

After you pump your gas at the gas station, how do you pay? At the pump or inside? How frequently do you post to your social media pages? What kind of content are you posting?

That kind of nontraditional credit data hasn’t been considered by lenders and credit agencies, but that is changing. The reasoning? It’s opening more opportunities for those without much credit history. But according to a paper published by Janine S. Hiller of Virginia Tech and Lindsay Sain Jones, a financial regulation researcher at the University of Georgia, this just opens a can of worms.

SonerCdem/Thinkstock

Why is this so dangerous? Well, alternative credit scoring isn’t covered by the Fair Credit Reporting Act or Equal Opportunity Act, so the consumer doesn’t have the ability to dispute any data the credit agencies or lenders receive. Then there’s the “credit boost,” which some companies offer to gain access to the consumer’s data. Often there are no limitations on how long it’s kept. That purchase you made 2 years ago can come back to haunt you.

It also creates a cause for the possibility of discrimination based on “lifestyle-related data points,” which some lenders use to determine creditworthiness: zip code, age, gender, race, socioeconomic status. Even where the consumer went to college is a factor taken under consideration.

“There are all kinds of factors that can be correlated with creditworthiness, but that doesn’t mean they should be used,” Ms. Jones said in the EurekAlert statement.

Let’s say someone applies for a loan needed for a medical procedure. They could be denied because the lender or a credit-reporting agency didn’t like the data they received (most times without the consumer’s consent). Talk about a broken system.
 

Key clinical point: Atopic dermatitis (AD) had a detrimental impact on the families of pediatric patients, with not only severe AD but even mild AD having a substantial impact on family life.

Major finding: There was a substantial impact of AD on families across geographic regions, as assessed by Dermatitis Family Impact (DFI) score, which increased with the severity of AD (mild: 3.3-11.3, moderate: 6.9-17.1, and severe: 11-20.3). A DFI score of >9.6 was reported for 37.2%, 70.7%, and 78.0% of patients with mild, moderate, and severe AD, respectively.

Study details: Findings are from the cross-sectional, web-based survey including 7465 pairs of pediatric patients with AD and their parents/caregivers.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals Inc. Five authors declared being current or former employees or stockholders of Sanofi or Regeneron Pharmaceuticals, and some others declared ties with various sources.

Source: Barbarot S et al. The family impact of atopic dermatitis in the pediatric population: Results from an international cross-sectional study. J Pediatr. 2022 (Apr 28). Doi: 10.1016/j.jpeds.2022.04.027

Key clinical point: Atopic dermatitis (AD) had a detrimental impact on the families of pediatric patients, with not only severe AD but even mild AD having a substantial impact on family life.

Major finding: There was a substantial impact of AD on families across geographic regions, as assessed by Dermatitis Family Impact (DFI) score, which increased with the severity of AD (mild: 3.3-11.3, moderate: 6.9-17.1, and severe: 11-20.3). A DFI score of >9.6 was reported for 37.2%, 70.7%, and 78.0% of patients with mild, moderate, and severe AD, respectively.

Study details: Findings are from the cross-sectional, web-based survey including 7465 pairs of pediatric patients with AD and their parents/caregivers.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals Inc. Five authors declared being current or former employees or stockholders of Sanofi or Regeneron Pharmaceuticals, and some others declared ties with various sources.

Source: Barbarot S et al. The family impact of atopic dermatitis in the pediatric population: Results from an international cross-sectional study. J Pediatr. 2022 (Apr 28). Doi: 10.1016/j.jpeds.2022.04.027

Key clinical point: Atopic dermatitis (AD) had a detrimental impact on the families of pediatric patients, with not only severe AD but even mild AD having a substantial impact on family life.

Major finding: There was a substantial impact of AD on families across geographic regions, as assessed by Dermatitis Family Impact (DFI) score, which increased with the severity of AD (mild: 3.3-11.3, moderate: 6.9-17.1, and severe: 11-20.3). A DFI score of >9.6 was reported for 37.2%, 70.7%, and 78.0% of patients with mild, moderate, and severe AD, respectively.

Study details: Findings are from the cross-sectional, web-based survey including 7465 pairs of pediatric patients with AD and their parents/caregivers.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals Inc. Five authors declared being current or former employees or stockholders of Sanofi or Regeneron Pharmaceuticals, and some others declared ties with various sources.

Source: Barbarot S et al. The family impact of atopic dermatitis in the pediatric population: Results from an international cross-sectional study. J Pediatr. 2022 (Apr 28). Doi: 10.1016/j.jpeds.2022.04.027

Key clinical point: Children diagnosed with atopic dermatitis (AD) within the first 10 years of life are more likely to develop a more proinflammatory dietary pattern and consume less fiber and several vitamins, which may worsen the atopic outcome itself.

Major finding: The intake of fiber (P = .04), vitamin C (P = .02), vitamin E (P = .03), and vitamin B₇ (biotin) (P = .047) were significantly lower among children who developed vs did not develop AD in the first 10 years of life, with a significant association observed between presence of AD and a proinflammatory dietary pattern at 10 years of age (odds ratio 2.22; P = .02).

Study details: Findings are from the population-based LiNA cohort study including 211 10-year-old children.

Disclosures: This LiNA study was funded by the Department of Environmental Immunology, Helmholtz Centre for Environmental Research. JR Hebert declared owning controlling interest in Connecting Health Innovations LLC.

Source: Schütte O et al. Pro-inflammatory diet pictured in children with atopic dermatitis or food allergy: Nutritional data of the LiNA cohort. Front Nutr. 2022;9:868872 (Apr 8). Doi: 10.3389/fnut.2022.868872

Key clinical point: Children diagnosed with atopic dermatitis (AD) within the first 10 years of life are more likely to develop a more proinflammatory dietary pattern and consume less fiber and several vitamins, which may worsen the atopic outcome itself.

Major finding: The intake of fiber (P = .04), vitamin C (P = .02), vitamin E (P = .03), and vitamin B₇ (biotin) (P = .047) were significantly lower among children who developed vs did not develop AD in the first 10 years of life, with a significant association observed between presence of AD and a proinflammatory dietary pattern at 10 years of age (odds ratio 2.22; P = .02).

Study details: Findings are from the population-based LiNA cohort study including 211 10-year-old children.

Disclosures: This LiNA study was funded by the Department of Environmental Immunology, Helmholtz Centre for Environmental Research. JR Hebert declared owning controlling interest in Connecting Health Innovations LLC.

Source: Schütte O et al. Pro-inflammatory diet pictured in children with atopic dermatitis or food allergy: Nutritional data of the LiNA cohort. Front Nutr. 2022;9:868872 (Apr 8). Doi: 10.3389/fnut.2022.868872

Key clinical point: Children diagnosed with atopic dermatitis (AD) within the first 10 years of life are more likely to develop a more proinflammatory dietary pattern and consume less fiber and several vitamins, which may worsen the atopic outcome itself.

Major finding: The intake of fiber (P = .04), vitamin C (P = .02), vitamin E (P = .03), and vitamin B₇ (biotin) (P = .047) were significantly lower among children who developed vs did not develop AD in the first 10 years of life, with a significant association observed between presence of AD and a proinflammatory dietary pattern at 10 years of age (odds ratio 2.22; P = .02).

Study details: Findings are from the population-based LiNA cohort study including 211 10-year-old children.

Disclosures: This LiNA study was funded by the Department of Environmental Immunology, Helmholtz Centre for Environmental Research. JR Hebert declared owning controlling interest in Connecting Health Innovations LLC.

Source: Schütte O et al. Pro-inflammatory diet pictured in children with atopic dermatitis or food allergy: Nutritional data of the LiNA cohort. Front Nutr. 2022;9:868872 (Apr 8). Doi: 10.3389/fnut.2022.868872

Key clinical point: Antioxidants show favorable efficacy and safety as an adjunct therapy for atopic dermatitis (AD), particularly when supplemented with oral vitamin D and topical vitamin B₁₂.

Major finding: Overall, antioxidants vs placebo were associated with a significant reduction in disease severity scores (P < .0001), with a significant decrease in AD severity observed for oral supplementation with vitamin D (P = .01); combined vitamins D and E (P = .003); combined vitamins A, D, and E (P = .02); and topical vitamin B₁₂ (P < .0001). No serious adverse events were reported.

Study details: Findings are from a meta-analysis of 18 studies including 763 patients with AD.

Disclosures: This study did not receive any funding. No conflict of interests was reported.

Source: Yang H et al. Efficacy and safety profile of antioxidants in the treatment of atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials. Dermatol Ther. 2022 (May 3). Doi: 10.1111/dth.15549

Key clinical point: Antioxidants show favorable efficacy and safety as an adjunct therapy for atopic dermatitis (AD), particularly when supplemented with oral vitamin D and topical vitamin B₁₂.

Major finding: Overall, antioxidants vs placebo were associated with a significant reduction in disease severity scores (P < .0001), with a significant decrease in AD severity observed for oral supplementation with vitamin D (P = .01); combined vitamins D and E (P = .003); combined vitamins A, D, and E (P = .02); and topical vitamin B₁₂ (P < .0001). No serious adverse events were reported.

Study details: Findings are from a meta-analysis of 18 studies including 763 patients with AD.

Disclosures: This study did not receive any funding. No conflict of interests was reported.

Source: Yang H et al. Efficacy and safety profile of antioxidants in the treatment of atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials. Dermatol Ther. 2022 (May 3). Doi: 10.1111/dth.15549

Key clinical point: Antioxidants show favorable efficacy and safety as an adjunct therapy for atopic dermatitis (AD), particularly when supplemented with oral vitamin D and topical vitamin B₁₂.

Major finding: Overall, antioxidants vs placebo were associated with a significant reduction in disease severity scores (P < .0001), with a significant decrease in AD severity observed for oral supplementation with vitamin D (P = .01); combined vitamins D and E (P = .003); combined vitamins A, D, and E (P = .02); and topical vitamin B₁₂ (P < .0001). No serious adverse events were reported.

Study details: Findings are from a meta-analysis of 18 studies including 763 patients with AD.

Disclosures: This study did not receive any funding. No conflict of interests was reported.

Source: Yang H et al. Efficacy and safety profile of antioxidants in the treatment of atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials. Dermatol Ther. 2022 (May 3). Doi: 10.1111/dth.15549

Key clinical point: Dupilumab improved clinical scores in a real-world population of adolescents with moderate-to-severe atopic dermatitis (AD) and had a tolerable safety profile.

Major finding: After 16 weeks, the mean Eczema Area and Severity Index (EASI) score and Children Dermatology Life Quality Index and Numeric Rating Scale sleep loss scores reduced significantly by 79.8%, 72.9%, and 75.8%, respectively (all P < .01), with a higher proportion of patients with diffuse eczema vs. other clinical phenotypes reporting ≥90% and 100% improvement in EASI scores (P < .05). Adverse events (AE) were reported by 20.1% of adolescents, but none discontinued dupilumab because of AE.

Study details: This prospective study included 139 adolescents aged ≥12 to <18 years with moderate-to-severe AD who received dupilumab for 16 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as principal investigators, advisory board members, speakers, or consultants, or receiving personal fees, consulting fees, or payments or honoraria from several sources.

Source: Stingeni L et al. Moderate-to-severe atopic dermatitis in adolescents treated with dupilumab: A multicentre Italian real-world experience. J Eur Acad Dermatol Venereol. 2022 (Apr 12). Doi: 10.1111/jdv.18141

Key clinical point: Dupilumab improved clinical scores in a real-world population of adolescents with moderate-to-severe atopic dermatitis (AD) and had a tolerable safety profile.

Major finding: After 16 weeks, the mean Eczema Area and Severity Index (EASI) score and Children Dermatology Life Quality Index and Numeric Rating Scale sleep loss scores reduced significantly by 79.8%, 72.9%, and 75.8%, respectively (all P < .01), with a higher proportion of patients with diffuse eczema vs. other clinical phenotypes reporting ≥90% and 100% improvement in EASI scores (P < .05). Adverse events (AE) were reported by 20.1% of adolescents, but none discontinued dupilumab because of AE.

Study details: This prospective study included 139 adolescents aged ≥12 to <18 years with moderate-to-severe AD who received dupilumab for 16 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as principal investigators, advisory board members, speakers, or consultants, or receiving personal fees, consulting fees, or payments or honoraria from several sources.

Source: Stingeni L et al. Moderate-to-severe atopic dermatitis in adolescents treated with dupilumab: A multicentre Italian real-world experience. J Eur Acad Dermatol Venereol. 2022 (Apr 12). Doi: 10.1111/jdv.18141

Key clinical point: Dupilumab improved clinical scores in a real-world population of adolescents with moderate-to-severe atopic dermatitis (AD) and had a tolerable safety profile.

Major finding: After 16 weeks, the mean Eczema Area and Severity Index (EASI) score and Children Dermatology Life Quality Index and Numeric Rating Scale sleep loss scores reduced significantly by 79.8%, 72.9%, and 75.8%, respectively (all P < .01), with a higher proportion of patients with diffuse eczema vs. other clinical phenotypes reporting ≥90% and 100% improvement in EASI scores (P < .05). Adverse events (AE) were reported by 20.1% of adolescents, but none discontinued dupilumab because of AE.

Study details: This prospective study included 139 adolescents aged ≥12 to <18 years with moderate-to-severe AD who received dupilumab for 16 weeks.

Disclosures: This study did not receive any funding. Some authors declared serving as principal investigators, advisory board members, speakers, or consultants, or receiving personal fees, consulting fees, or payments or honoraria from several sources.

Source: Stingeni L et al. Moderate-to-severe atopic dermatitis in adolescents treated with dupilumab: A multicentre Italian real-world experience. J Eur Acad Dermatol Venereol. 2022 (Apr 12). Doi: 10.1111/jdv.18141

Key clinical point: Nemolizumab was safe and more effective than placebo in reducing the severity of atopic dermatitis (AD) or pruritus.

Major finding: Nemolizumab vs placebo significantly reduced the pruritus visual analogue scale score (weighted mean difference [WMD] −18.86; P < .001) and Eczema Area and Severity Index score (WMD −11.76; P = .009). Adverse events were mostly mild and similar in both the groups (P = .593).

Study details: This was a meta-analysis of 14 cohorts of participants from six randomized controlled studies that included 569 and 240 patients with AD or pruritus who received nemolizumab and placebo, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Liang J et al. Safety and efficacy of nemolizumab for atopic dermatitis with pruritus: a systematic review and meta-regression analysis of randomized controlled trials. Front Immunol. 2022;13:825312 (Apr 26). Doi: 10.3389/fimmu.2022.825312

Key clinical point: Nemolizumab was safe and more effective than placebo in reducing the severity of atopic dermatitis (AD) or pruritus.

Major finding: Nemolizumab vs placebo significantly reduced the pruritus visual analogue scale score (weighted mean difference [WMD] −18.86; P < .001) and Eczema Area and Severity Index score (WMD −11.76; P = .009). Adverse events were mostly mild and similar in both the groups (P = .593).

Study details: This was a meta-analysis of 14 cohorts of participants from six randomized controlled studies that included 569 and 240 patients with AD or pruritus who received nemolizumab and placebo, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Liang J et al. Safety and efficacy of nemolizumab for atopic dermatitis with pruritus: a systematic review and meta-regression analysis of randomized controlled trials. Front Immunol. 2022;13:825312 (Apr 26). Doi: 10.3389/fimmu.2022.825312

Key clinical point: Nemolizumab was safe and more effective than placebo in reducing the severity of atopic dermatitis (AD) or pruritus.

Major finding: Nemolizumab vs placebo significantly reduced the pruritus visual analogue scale score (weighted mean difference [WMD] −18.86; P < .001) and Eczema Area and Severity Index score (WMD −11.76; P = .009). Adverse events were mostly mild and similar in both the groups (P = .593).

Study details: This was a meta-analysis of 14 cohorts of participants from six randomized controlled studies that included 569 and 240 patients with AD or pruritus who received nemolizumab and placebo, respectively.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Liang J et al. Safety and efficacy of nemolizumab for atopic dermatitis with pruritus: a systematic review and meta-regression analysis of randomized controlled trials. Front Immunol. 2022;13:825312 (Apr 26). Doi: 10.3389/fimmu.2022.825312

Key clinical point: Children with atopic dermatitis (AD) may have a higher sensitivity to contact allergens, such as fragrances and metals, than children without AD.

Major finding: Overall, 36.9% vs 26.4% of children with vs without AD presented with at least one positive patch test. Children with v. without AD showed a higher prevalence of ≥1 positive patch test for allergens, such as nickel sulfate, cobalt chloride, methylisothiazolinone, fragrance mix-2, potassium dichromate, fragrance mix-1, methylchloroisothiazolinone/methylisothiazolinone, and neomycin sulfate, with the prevalence difference being highest for fragrance mix-1 (5.8% vs 0.9%; P = .004293).

Study details: This retrospective study included 432 children aged 0-14 years with eczematous dermatitis who underwent patch testing, of which 23.8% of children were diagnosed with AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Bonamonte D et al. Contact allergy in children with and without atopic dermatitis: An Italian multicentre study. Contact Dermatitis. 2022 (Apr 21). Doi: 10.1111/cod.14130

Key clinical point: Children with atopic dermatitis (AD) may have a higher sensitivity to contact allergens, such as fragrances and metals, than children without AD.

Major finding: Overall, 36.9% vs 26.4% of children with vs without AD presented with at least one positive patch test. Children with v. without AD showed a higher prevalence of ≥1 positive patch test for allergens, such as nickel sulfate, cobalt chloride, methylisothiazolinone, fragrance mix-2, potassium dichromate, fragrance mix-1, methylchloroisothiazolinone/methylisothiazolinone, and neomycin sulfate, with the prevalence difference being highest for fragrance mix-1 (5.8% vs 0.9%; P = .004293).

Study details: This retrospective study included 432 children aged 0-14 years with eczematous dermatitis who underwent patch testing, of which 23.8% of children were diagnosed with AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Bonamonte D et al. Contact allergy in children with and without atopic dermatitis: An Italian multicentre study. Contact Dermatitis. 2022 (Apr 21). Doi: 10.1111/cod.14130

Key clinical point: Children with atopic dermatitis (AD) may have a higher sensitivity to contact allergens, such as fragrances and metals, than children without AD.

Major finding: Overall, 36.9% vs 26.4% of children with vs without AD presented with at least one positive patch test. Children with v. without AD showed a higher prevalence of ≥1 positive patch test for allergens, such as nickel sulfate, cobalt chloride, methylisothiazolinone, fragrance mix-2, potassium dichromate, fragrance mix-1, methylchloroisothiazolinone/methylisothiazolinone, and neomycin sulfate, with the prevalence difference being highest for fragrance mix-1 (5.8% vs 0.9%; P = .004293).

Study details: This retrospective study included 432 children aged 0-14 years with eczematous dermatitis who underwent patch testing, of which 23.8% of children were diagnosed with AD.

Disclosures: This study did not receive any funding. The authors declared no conflict of interests.

Source: Bonamonte D et al. Contact allergy in children with and without atopic dermatitis: An Italian multicentre study. Contact Dermatitis. 2022 (Apr 21). Doi: 10.1111/cod.14130

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 4 years in adults with moderate-to-severe atopic dermatitis (AD).

Major finding: At 4 years, the exposure-adjusted incidence rate of treatment emergent adverse events (TEAE) was 256.86 events/100 patient-years, with most events being mild to moderate in severity. At least one serious and severe TEAE was experienced by 10.4% and 9.8% of patients in two dose categories. At week 204, the mean Eczema Area and Severity Index (EASI) score improved by 91.07%, with patients switching from 300 mg dupilumab weekly to every-2-weeks dosing while maintaining EASI scores up to 48 weeks post-transition.

Study details: Findings are from an interim analysis of the ongoing phase 3, LIBERTY AD open-label extension study including 2677 adults with moderate-to-severe AD who received 300 mg dupilumab  weekly or every 2 weeks in previous phase 1-3 AD trials.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and other authors reported ties with various sources.

Source: Beck LA et al. Dupilumab provides acceptable safety and sustained efficacy for up to 4 years in an open-label study of adults with moderate-to-severe atopic dermatitis. Am J Clin Dermatol. 2022 (May 3). Doi: 10.1007/s40257-022-00685-0

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 4 years in adults with moderate-to-severe atopic dermatitis (AD).

Major finding: At 4 years, the exposure-adjusted incidence rate of treatment emergent adverse events (TEAE) was 256.86 events/100 patient-years, with most events being mild to moderate in severity. At least one serious and severe TEAE was experienced by 10.4% and 9.8% of patients in two dose categories. At week 204, the mean Eczema Area and Severity Index (EASI) score improved by 91.07%, with patients switching from 300 mg dupilumab weekly to every-2-weeks dosing while maintaining EASI scores up to 48 weeks post-transition.

Study details: Findings are from an interim analysis of the ongoing phase 3, LIBERTY AD open-label extension study including 2677 adults with moderate-to-severe AD who received 300 mg dupilumab  weekly or every 2 weeks in previous phase 1-3 AD trials.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and other authors reported ties with various sources.

Source: Beck LA et al. Dupilumab provides acceptable safety and sustained efficacy for up to 4 years in an open-label study of adults with moderate-to-severe atopic dermatitis. Am J Clin Dermatol. 2022 (May 3). Doi: 10.1007/s40257-022-00685-0

Key clinical point: Dupilumab showed an acceptable safety profile and sustained efficacy through 4 years in adults with moderate-to-severe atopic dermatitis (AD).

Major finding: At 4 years, the exposure-adjusted incidence rate of treatment emergent adverse events (TEAE) was 256.86 events/100 patient-years, with most events being mild to moderate in severity. At least one serious and severe TEAE was experienced by 10.4% and 9.8% of patients in two dose categories. At week 204, the mean Eczema Area and Severity Index (EASI) score improved by 91.07%, with patients switching from 300 mg dupilumab weekly to every-2-weeks dosing while maintaining EASI scores up to 48 weeks post-transition.

Study details: Findings are from an interim analysis of the ongoing phase 3, LIBERTY AD open-label extension study including 2677 adults with moderate-to-severe AD who received 300 mg dupilumab  weekly or every 2 weeks in previous phase 1-3 AD trials.

Disclosures: This study was funded by Sanofi and Regeneron Pharmaceuticals, Inc. Seven authors declared being employees or shareholders of Regeneron Pharmaceuticals or Sanofi, and other authors reported ties with various sources.

Source: Beck LA et al. Dupilumab provides acceptable safety and sustained efficacy for up to 4 years in an open-label study of adults with moderate-to-severe atopic dermatitis. Am J Clin Dermatol. 2022 (May 3). Doi: 10.1007/s40257-022-00685-0

Key clinical point: Baricitinib plus topical corticosteroids (TCS) improved the signs and symptoms of atopic dermatitis (AD) through 1 year along with a consistent safety profile in patients with moderate-to-severe AD and an inadequate response, intolerance, or contraindication to cyclosporine A (CyA).

Major finding: At week 16, ≥75% improvement in the Eczema Area and Severity Index was achieved by a significantly higher proportion of patients receiving 4 mg baricitinib+TCS vs placebo+TCS (32% vs 17%; P = .031), with improvements maintained through week 52. Treatment emergent adverse events were more frequent with baricitinib, but were mostly mild or moderate in severity.

Study details: Findings are from the phase 3 BREEZE-AD4 study including 463 patients with moderate-to-severe AD and an inadequate response, contraindication, or intolerance to CyA who were randomly assigned to receive placebo+TCS or 1, 2, or 4 mg baricitinib+TCS for 52 weeks.

Disclosures: Eli Lilly and Company developed baricitinib. Six authors declared being employees and shareholders of Eli Lilly, and other authors reported ties with various sources, including Eli Lilly.

Source: Bieber T et al. Efficacy and safety of baricitinib in combination with topical corticosteroids in patients with moderate-to-severe atopic dermatitis with inadequate response, intolerance, or contraindication to cyclosporine: Results from a randomized, placebo-controlled, phase III clinical trial (BREEZE-AD4). Br J Dermatol. 2022 (Apr 28). Doi: 10.1111/bjd.21630

Key clinical point: Baricitinib plus topical corticosteroids (TCS) improved the signs and symptoms of atopic dermatitis (AD) through 1 year along with a consistent safety profile in patients with moderate-to-severe AD and an inadequate response, intolerance, or contraindication to cyclosporine A (CyA).

Major finding: At week 16, ≥75% improvement in the Eczema Area and Severity Index was achieved by a significantly higher proportion of patients receiving 4 mg baricitinib+TCS vs placebo+TCS (32% vs 17%; P = .031), with improvements maintained through week 52. Treatment emergent adverse events were more frequent with baricitinib, but were mostly mild or moderate in severity.

Study details: Findings are from the phase 3 BREEZE-AD4 study including 463 patients with moderate-to-severe AD and an inadequate response, contraindication, or intolerance to CyA who were randomly assigned to receive placebo+TCS or 1, 2, or 4 mg baricitinib+TCS for 52 weeks.

Disclosures: Eli Lilly and Company developed baricitinib. Six authors declared being employees and shareholders of Eli Lilly, and other authors reported ties with various sources, including Eli Lilly.

Source: Bieber T et al. Efficacy and safety of baricitinib in combination with topical corticosteroids in patients with moderate-to-severe atopic dermatitis with inadequate response, intolerance, or contraindication to cyclosporine: Results from a randomized, placebo-controlled, phase III clinical trial (BREEZE-AD4). Br J Dermatol. 2022 (Apr 28). Doi: 10.1111/bjd.21630

Key clinical point: Baricitinib plus topical corticosteroids (TCS) improved the signs and symptoms of atopic dermatitis (AD) through 1 year along with a consistent safety profile in patients with moderate-to-severe AD and an inadequate response, intolerance, or contraindication to cyclosporine A (CyA).

Major finding: At week 16, ≥75% improvement in the Eczema Area and Severity Index was achieved by a significantly higher proportion of patients receiving 4 mg baricitinib+TCS vs placebo+TCS (32% vs 17%; P = .031), with improvements maintained through week 52. Treatment emergent adverse events were more frequent with baricitinib, but were mostly mild or moderate in severity.

Study details: Findings are from the phase 3 BREEZE-AD4 study including 463 patients with moderate-to-severe AD and an inadequate response, contraindication, or intolerance to CyA who were randomly assigned to receive placebo+TCS or 1, 2, or 4 mg baricitinib+TCS for 52 weeks.

Disclosures: Eli Lilly and Company developed baricitinib. Six authors declared being employees and shareholders of Eli Lilly, and other authors reported ties with various sources, including Eli Lilly.

Source: Bieber T et al. Efficacy and safety of baricitinib in combination with topical corticosteroids in patients with moderate-to-severe atopic dermatitis with inadequate response, intolerance, or contraindication to cyclosporine: Results from a randomized, placebo-controlled, phase III clinical trial (BREEZE-AD4). Br J Dermatol. 2022 (Apr 28). Doi: 10.1111/bjd.21630