4 Noviembre 2011

Gabapentin and Valacyclovir in Patients With Acute Herpes Zoster

Archivado en: Clinica y Terapeutica — dermatologia @ 14:29

Postherpetic Neuralgia in Patients With Acute Herpes Zoster
Graeme M. Lipper, MD

Postherpetic neuralgia (PHN) is a painful and often debilitating complication of acute herpes zoster virus infection that is characterized by intense neuropathic pain. Victims typically describe their pain as a relentless stabbing, throbbing, or burning that often keeps them awake at night. The disorder, thought to occur due to inflammatory nerve injury during infection, may last months to years and causes intractable pain and morbidity. Risk factors for developing PHN include older age (> 50 years), worse pain associated with the acute viral infection, extensive cutaneous involvement (eg, widespread blistering), and severe prodromal pain.[1] Acyclovir and its analogues (ie, valacyclovir, famciclovir) speed the resolution of herpetic skin lesions and acute pain while reducing viral shedding. However, it remains unclear whether these antiviral drugs reduce the true incidence or severity of PHN.[2-4] In contrast, the herpes zoster vaccine may decrease the incidence of PHN by up to 66.5%.[5]

Tricyclic antidepressants and the anticonvulsant drug gabapentin may reduce the pain of PHN, but few data exist to support their use during the acute phase of zoster to prevent PHN.[6,7] To address this important question, Lapolla and colleagues conducted an open-label study assessing the incidence of PHN after therapy with both valacyclovir and gabapentin (300 mg/day, titrated up to a maximum dose 1200 mg orally 3 times a day as tolerated). Investigators enrolled 133 patients with acute zoster who had moderate to severe pain (mean age, 64.6 years; 67% women, 82% non-Hispanic whites). All patients received both valacyclovir (1000 mg orally 3 times a day x 7 days) and gabapentin (300 mg/day, titrated upward weekly as tolerated to a maximum dose of 3600 mg divided 3 times a day) at the onset of acute zoster. Gabapentin was discontinued for patients who reported mild to no pain over 1 week.


1 Noviembre 2011

Briakinumab vs Methotrexate en Psoriasis

Archivado en: Actualidad dermatologica — dermatologia @ 9:19

From Medscape Medical News
Briakinumab More Effective Than Methotrexate in Psoriasis
Laura Newman
October 26, 2011 — Briakinumab (Abbott) has been proven to be a far more effective drug than methotrexate for improving moderate to severe psoriasis, according to a 52-week, head-to-head-trial published in the October 27 issue of the New England Journal of Medicine. But an outside expert criticized the trial for including too few patients and criticized Abbott for hiring a ghost writer to prepare the first draft of the article.

“There have been no head-to-head trials in the short term and intermediate term,” Kim A. Papp, MD, told Medscape Medical News. “From that aspect alone, this is an important and useful piece of work, and it will be instrumental in supplying effectiveness and tolerability information” on both drugs.

Dr. Papp, a dermatologist at Probity Medical Research, Inc, in Windsor, Ontario, Canada, is one of the co-investigators on the trial, which involved 7 researchers from Canada and Europe. Abbott withdrew its US Food and Drug Administration application for the drug in January 2011 after the agency requested additional safety information.


25 Octubre 2011

Artritis psoriática y puntos de vistas del dermatólogo

Archivado en: Debates interesantes, Interesante — dermatologia @ 13:28

Management of Psoriatic Arthritis From the View of the Dermatologist CME
Caroline A. Chang, MD; Alice B. Gottlieb, MD, PhD; Paul F. Lizzul, MD, PhD, MPH, MBA

Psoriatic arthritis (PsA) is an inflammatory seronegative spondyloarthropathy associated with psoriasis. Although the main assessment measures for PsA are borrowed from the standard criteria used to assess rheumatoid arthritis, a number of new criteria such as the PsAJAI and CPDAI are being developed specifically for PsA. Long-term consequences of untreated PsA include persistent inflammation, progressive joint damage and, in many cases, substantial functional limitations, pain and disability. Moreover, patients with PsA have an increased mortality risk and an increased risk of developing cardiovascular disease and metabolic syndrome. Both GRAPPA and the AAD have developed treatment guidelines, which are discussed here. Psoriasis commonly precedes arthritic symptoms; thus, dermatologists are ideally placed to make the initial diagnosis of PsA and treat it appropriately, affording the opportunity to slow disease progression, improve physical function and enhance quality of life. This Review explores the management of patients with PsA, with a particular emphasis on assessment tools, long-term consequences and treatment issues from the viewpoint of the dermatologist.


19 Octubre 2011

Piel y Obesidad

Archivado en: Debates interesantes, Interesante — dermatologia @ 11:45

Obesity and the Skin
A.R. Shipman; G.W.M. Millington
Obesity is a serious global health problem, perhaps the biggest public health issue of our times. Excess body weight may be a factor in carcinogenesis in general, as well as contributing to the pathogenesis of metabolic, cardiovascular and musculoskeletal disorders. Obesity also has many cutaneous features, which form the basis for this review article. Many of these clinical entities are common to the majority of obese patients, e.g. striae distensae, plantar hyperkeratosis and an increased risk of skin infections. However, it may also be associated with poor wound healing, malignant melanoma and an increased risk of inflammatory dermatoses, such as psoriasis, as well as some rarer disorders. Therapeutic interventions for obesity, whether over-the-counter, prescription medicines or surgical interventions, are increasingly commonplace. All of these treatment modalities potentially have dermatological side-effects too.


18 Octubre 2011

Melanoma: Epidemiología, factores de riesgo y prevención

Archivado en: Prevencion — dermatologia @ 13:59

Dres. Veronique Bataile, Esther de Vries.
BMJ, nov 2008.
La incidencia de melanoma ha aumentado en los últimos 30 años en la mayoría de las personas de piel blanca.  El reconocimiento temprano del melanoma es una tarea importante para los profesionales de la salud.  En éste articulo se examina la epidemiología genética del melanoma y las interacciones complejas entre la incidencia, mortalidad y sobrevida, también se discute sobre la prevención.


5 Octubre 2011

Vismodegib en carcinoma de células basales

Archivado en: Actualidad dermatologica — dermatologia @ 14:21

The investigational drug vismodegib, which has a novel mechanism of action (inhibiting the hedgehog signaling pathway), has shown “substantial clinical benefit” in advanced basal cell carcinoma, in both metastatic and locally advanced settings.

This finding comes from a pivotal trial of the product in 104 patients, presented here at the 2011 European Multidisciplinary Cancer Congress. The results were presented by Luc Dirix, MD, from the Iridium Kankernetwerk, Antwerp, Belgium, from a paper selected as a best abstract for the presidential session.

Vismodegib is “a potential new therapy” for advanced basal cell carcinoma, he told the meeting attendees. It is under development by Genentech/Roche, which has recently filed an approval application with the US Food and Drug Administration for its use in the treatment of inoperable advanced basal cell carcinoma.

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Archivado en: Medicaciones — dermatologia @ 10:59

Instructivo de aplicación del producto HEBERPROT-P

El Centro de Ingeniería Genética y Biotecnológica de Cuba ha publicado este folleto que explica resumidamente la forma de aplicación de este nuevo producto que favorece la cicatrización de las úlceras del pié diabético. El folleto además posee secciones que describen la historia, resultados preclínicos, resultados clínicos, publicaciones, patentes y preguntas frecuentes.


29 Septiembre 2011

Vitamina D y prevención de enfermedades autoinmunes

Archivado en: Prevencion — dermatologia @ 10:47

Dr. Ersoy-Evans S
J Am Acad Dermatol. 2010 Jun;62(6):942-4.
La activación inmune y la pérdida de la tolerancia a lo propio son las principales características de las enfermedades autoinmunes. Aunque todavía no se conocen con precisión los factores que intervienen en la autoinmunidad, la susceptibilidad genética y ciertos factores ambientales, por ejemplo el estado de la vitamina D, desempeñarían un papel decisivo en este sentido.

La deficiencia de vitamina D podría desencadenar o exacerbar las reacciones autoinmunes; el trabajo de Silverberg y col. reveló una concentración de vitamina D baja en los pacientes con vitiligo y con otros trastornos autoinmunes.


Granuloma anular, necrobiosis lipoidica diabeticorum y diabetes de la infancia

Archivado en: Debates interesantes, Interesante — dermatologia @ 10:32

Dres. James E. Davison, Alison Davies y col.
Pediatric Dermatology Vol. 27 No. 2 178–181, 2010
La necrobiosis lipoídica diabeticorum (NLD) está asociada fuertemente con la diabetes, mientras que el granuloma anular (GA) ocurre más comúnmente en pacientes no diabéticos, particularmente en niños.

Sin embargo, la similitud histológica de GA y NLD, y la rara ocurrencia de ambas NLD y GA en el mismo paciente diabético apoya la idea que el GA se asocia significativamente con DM.


28 Septiembre 2011

Crioterapia vs ácido salicílico en verrugas

Archivado en: Actualidad dermatologica — dermatologia @ 15:41

Crioterapia no es mejor que el ácido salicílico en el tratamiento de las verrugas.

From Medscape Medical News
Cryotherapy No Better Than 50% Salicylic Acid, Costs More
Emma Hitt, PhD

September 26, 2011 — For the treatment of verrucae, cryotherapy using liquid nitrogen and patient daily self-treatment with 50% salicylic acid appear to result in similar efficacy outcomes, although cryotherapy is more expensive, according to the findings of a new randomized trial conducted in the United Kingdom.

Sarah Cockayne, MSc, from the Department of Health Sciences, York Trials Unit, University of York, United Kingdom, and colleague reported their findings in the September issue of Health Technology Assessment.

According to the researchers, it is estimated that almost 2 million people in England and Wales visit their general practitioner for the treatment of cutaneous warts each year, at a cost of £40 million. However, the “evidence base on which to inform clinical decision-making is poor,” according to the authors. In addition, they note, a 2006 Cochrane review of 60 studies concluded that a trial comparing topical salicylic acid with cryotherapy was “urgently needed.”

The current study, called the Effective Verruca Treatments trial, sought to assess the clinical effectiveness, acceptability, and cost-effectiveness of cryotherapy compared with salicylic acid for the treatment of verrucae.


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