Journal of Cutaneous Medicine and Surgery

Treatment of childhood atopic dermatitis (AD) is hindered by nonadherence, but caregiver reassurance may help overcome this hurdle.

To assess caregivers’ willingness to treat childhood AD with a corticosteroid when presented with clinical trial evidence, anecdote, or both.

A total of 476 caregivers were recruited through a dermatology clinic and online crowdsourcing platform. Subjects were randomized to receive clinical trial evidence, anecdote, or both, using either the term “medication” or “topical steroid.” Additional caregivers were queried about their willingness to treat with the doctor’s recommendation or without knowledge of its safety information. Responses were recorded on a 10-point Likert scale.

Caregivers’ willingness to treat was higher in all information assignment groups compared to those not provided with safety information: clinical trial evidence of a “medication” (P = .003; Cohen’s d = 0.83) or “topical steroid” (P = .030; d = 0.55), anecdote of a “medication” (P < .0001; d = 1.37) or “topical steroid” (P < .0001; d = 0.85), both clinical trial evidence and anecdote of a “medication” (P < .0001; d = 1.00) or “topical steroid” (P = .000; d = 0.89), and simply the doctor’s recommendation (P < .0001; d = 0.92). Significance was corrected for multiple comparisons to 0.0018. There were no differences between caregivers of children with and without AD (P = .36).

Providing anecdotal reassurance, even in the setting of reported high willingness to treat with the doctor’s recommendation, may be an effective strategy to improve caregivers’ perceptions of starting new medications.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful nodules, sinus tracts, and significant scarring. Although the pathogenesis of this disease is not well established, there is increasing evidence to suggest that it is an immune-mediated disorder. Previous studies have suggested a relationship between HS and thyroid disease, which is also driven by an autoimmune process. We sought to assess whether an association exists between HS and thyroid disease.

To determine whether HS is associated with thyroid disease via meta-analysis of case-control studies.

A systematic review and meta-analysis was performed according to recommended PRISMA guidelines. Electronic searches were performed using 6 electronic databases from their inception until August 2018. Data were extracted and analyzed according to predefined clinical endpoints. Odds ratio (OR) was used as the summary effect size.

We identified 5 case-controls studies included for meta-analysis. There were a total of 36 103 HS cases compared with 170 517 control cases. We found a significant association between HS and thyroid disease (OR 1.36, 95% CI 1.13-1.64, I ² = 78%, P = .001).

This pooled analysis of existing case-control studies to date supports an association between HS and any thyroid disease. Clinicians treating patients with HS should be aware of this potential association with thyroid disease.

Punctate palmoplantar keratoderma type 1 (PPPK1) presents in late childhood to adulthood with multiple small discrete hyperkeratotic papules on palms and soles. PPPK1 is an autosomal dominant skin disease caused by AAGAB mutations. It has been suggested that PPPK1 may be associated with an increased predisposition to systemic malignancies.

To evaluate the presence of AAGAB mutations in Canadian families with PPPK1 and the possible increased predisposition to systemic malignancies.

Eighteen unrelated Canadian families with PPPK1 were recruited for this study. Genomic DNA was extracted from saliva and PCR amplification was performed for all AAGAB exons and exon/intron junctions. PCR products were sequenced and analyzed for mutations. A family history of malignancy was obtained from the index case and, when possible, from other family members.

We have identified 5 heterozygous AAGAB loss of function mutations in 11 families. The mutation c.370 C>T, p.Arg124* was the most prevalent and was identified in 6 families. A splice site mutation, c.451+3delAAGT, was identified in 2 families. The other mutations c.473delG, p.Gly158Glufs*0; c.550-551insAAT, p.Gly183*; and c.505-506 dupAA, p.Asn169Lysfs*6 were each identified in 1 family. Different cancers were reported in 11 families (Table 1 and Supplemental Figure S1).

AAGAB mutations were found in 11 of 18 families with PPPK1. In some families there appears to be an association with cancer.

Keratoacanthomas (KAs) are neoplasms of squamous epithelium which exhibit rapid growth and are often difficult to distinguish clinically from squamous cell carcinoma. Excision is the most common treatment, but in refractory cases or for KAs in cosmetically sensitive areas, nonoperative modalities may be better suited.

To compare efficacies of topical and intralesional therapies for the treatment of KAs.

A systematic literature review was performed using Medline, Ovid, and Embase. Studies looking at the efficacy of topical or intralesional treatments for KAs were included. To compare efficacy, 2-tailed t-tests were performed, with P < .05 considered statistically significant.

Forty-one studies were identified across 5 modalities. Both topical and intralesional treatments had high KA eradication rates (92%-100%). Intralesional 5-fluorouracil led to faster KA healing times when compared to intralesional methotrexate (3.7 vs 4.6 weeks, P = .017). Similarly, topical 5-fluorouracil led to faster time to heal than topical imiquimod (3.8 vs 7.6 weeks with imiquimod, P < .0001).

For nonoperative treatment of KAs, strong evidence currently exists for both topical and intralesional therapies. Decisions on which modality to use should be made on a case-by-case basis.

Skin diseases are among the most common diseases encountered by healthcare professionals. Despite this, dedicated dermatology teaching is limited in most Canadian medical school training programs. This is especially true of clinical skills training.

To determine the impact of early introduction of dermatology clinical skills in Canadian undergraduate medical training. Secondary objectives included examining the impact of having sessions co-led by a clinician with expertise in the field of dermatology.

A half-day dermatology clinical skills session was introduced in the University of Toronto preclerkship medical school during the dermatology week. Sessions were co-led by staff or resident dermatologists. Sessions were evaluated using student pre- and postclinical skills test scores, as well as experience questionnaires completed by both tutors and students.

The clinical skills session was well received by both students and tutors, with no cumulative score less than 4.34 on a 5-point Likert scale. The majority of students agreed or strongly agreed that the introduction of clinical skills in the early years of the curriculum facilitated learning consolidation (99.5%). Comparison of pre- and post-test scores showed that students’ dermatology comprehension improved by an average of 12.1% following completion of the session. In questionnaire responses, students and nondermatology co-tutors emphasized the impact of having an expert in the field of dermatology co-lead the session.

Students valued early clinical skills exposure to dermatology and felt it enhanced their knowledge and abilities. This study demonstrates learning consolidation when dermatologic didactic teachings are paired with practical clinical skills sessions.

The literature contains conflicting reports on the epidemiology and frequency of hidradenitis suppurativa (HS), a chronic, recurrent inflammatory disease of the apocrine glands.

To evaluate the clinical and demographic characteristics of HS cases in Turkey and investigate the similarities with world epidemiology.

The records of 208 patients that presented to our polyclinics and were diagnosed with HS between June 2012 and July 2017 were retrospectively evaluated.

Of the cases, 68.3% were male and 31.7% were female. Of the patients, 75.5% had no family history of HS, 60.6% were smokers, 39.4% were aged 20-29 years, and 36.1% were aged 30-39 years. The most commonly involved regions were the axilla (62%), groin (50.5%), and gluteus (15.9%). According to univariate analyses, male patients had higher disease stages than females (odds ratio=1.67). The patients with groin involvement, high body mass index (BMI), and low education level (0-8 years) had higher risk of severe disease stage (odds ratio=1.63, 8.91, and 1.51, respectively). The most commonly used treatment was oral antibiotics in Hurley stages I and II, and surgical intervention in Hurley III. In all 3 Hurley stages, clavulanic acid–amoxicillin combination was the mostly used systemic antibiotic (41.8%, 43.2%, and 47.8%, respectively).

This is the first epidemiological study on HS in the Turkish population, where HS shows male predominance. Male gender, low education level, absence of acne, high BMI, and groin involvement were associated with severe disease stages. Determining associated comorbidities and possible risk factors is important in progression and prevention of the disease.

Nonmedicinal ingredients in topical corticosteroids might exacerbate pre-existing conditions in patients with contact allergies. In Canada, no database exists to help the clinician identify rapidly the ingredients in a topical product. Thus, prescribing topical corticosteroids to patients with contact allergies represents a challenge.

This study aimed to identify potential allergens contained in topical corticosteroids available in Canada.

Ingredients from 140 topical corticosteroids available in Canada were compiled. Ingredients with stronger allergenic potential were identified.

The most frequent potential allergens found in topical corticosteroids were propylene glycol (42.9%) and parabens (27.9%). Chlorocresol was listed in 11.4% of topical corticosteroids, mostly in high potency products. Formaldehyde releasers were also found in 7.1% of topical products.

This study confirms that ingredients in topical corticosteroids may be the cause of recalcitrant dermatitis in certain patients with contact allergies. Prescribing an adapted topical corticosteroid to patients with allergies is primordial in order to ensure optimal care.