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At-a-glance guide to articles in recent journals

Follow-up of patients with acne

Electronic follow-up of patients with acne can achieve similar outcomes to that of conventional face-to-face follow-up, a prospective trial has shown. Patients with mild to moderate acne were asked to 'attend' four follow-up sessions, either via the internet or in a conventional consultation with a dermatologist. At six-week intervals, those in the electronic visit group were prompted to use a secure website to send images of their skin and an update to their dermatologist, who responded with advice and electronic prescriptions. Among the 121 patients who completed the study, the decrease in total inflammatory lesion count was similar for both groups. Patients and dermatologists reported comparable satisfaction with care, regardless of visit type.
Watson AJ, Bergman H, Williams CM et al. Arch Dermatol 2010; 146: 406-11

Eczema risk in urban areas
The risk of developing eczema may be higher in urban areas compared with rural areas, according to a study carried out in The Netherlands. The systematic review included 26 papers comparing eczema prevalence in urban and rural areas. Nineteen studies showed a higher risk for eczema in an urban area (11 statistically significant); six studies showed a lower risk of eczema in an urban area (one statistically significant). The researchers say that place of residence might have a role in the pathogenesis of eczema.
Schram ME, Tedja AM, Spijker R et al. Br J Dermatol 2010; 162: 964-73

Treatment of infantile haemangioma
Prophylaxis, for example with trimethoprim, should be considered for infants treated with corticosteroids for infantile haemangioma, US researchers advise. Their study of 16 patients found significant reductions in B and T lymphocytes after corticosteroid administration. Immune function was also found to be affected: 13 patients had protective diphtheria titres and five had protective tetanus titres three months after discontinuing corticosteroid therapy, compared with baseline. The researchers recommend checking tetanus and diphtheria antibodies in patients treated with oral corticosteroids during the immunisation period, and additional immunisation if titres are not protective after corticosteroid therapy.
Kelly ME, Juern AM, Grossman WJ et al. Arch Dermatol 2010; 146: doi:10.1001/archdermatol.2010.90

Treatment of psoriasis at home
Home-based treatment should be the primary option for patients with psoriasis who are eligible for phototherapy with narrowband (TL-01) UVB, say researchers in The Netherlands. Average total cost by the end of phototherapy was 800 euros for home treatment and 752 euros for treatment in an outpatient setting, an incremental cost per patient of 48 euros. Cost utility analyses revealed that patients experienced equal health benefits from home versus outpatient phototherapy by the end of treatment and one year later. The study, which involved 196 adults, found that home phototherapy was cost-effective; the researchers say that because patients prefer home treatment, it should be the primary option offered.
Koek MB, Sigurdsson V, van Weelden H et al. BMJ 2010; 340: c1490

Post-treatment pain in varicose veins
Radiofrequency ablation (RFA) is associated with less post-procedural pain in the treatment of varicose veins than endovenous laser ablation (EVLA), the results of a clinical trial have shown. However, after six weeks, clinical and quality of life improvements were found to be similar for the two treatments. A total of 131 patients with primary great saphenous vein reflux from one centre were randomised to EVLA (n = 64) or RFA (n = 67). The results showed lower pain levels and analgesia use in the RFA group, together with a faster return to normal activities.
Shepherd AC, Gohel MS, Brown LC et al. Br J Surg 2010; 97(6): 810-18

Insufficient evidence on silver dressings
Silver is known to possess both antibacterial and antifungal properties and so is used in a variety of wound dressings. However, a review has concluded that there is insufficient evidence to show that silver dressings are better than conventional dressings. The authors say that few scientifically sound trials have been carried out on silver dressings, while those that have been undertaken have involved small sample sizes, short duration (three to eight weeks) and in some cases, a lack of blinding to treatment. The authors also state that the methodological shortcomings of these studies raise questions about the widespread preferential use of silver dressings.
DTB 2010; 48: 38-42

Biological therapies could cut costs.
Using biological therapies for patients who would otherwise require long periods of hospitalisation could save money, despite the high cost of these drugs. A retrospective cohort study in The Netherlands, involving 67 patients with high-need psoriasis, analysed the cost and effectiveness of biological therapy and patient satisfaction. Mean total direct costs were 10,146 euros per patient per year in the pre-biologic treatment period, compared with 17,712 euros during the treatment period. However, introduction of biological therapies in six of the patients led to a reduction of direct costs, because these patients did not need long hospitalisations. Patient satisfaction with treatment was high and led to a decrease in PASI score from 19.0 at the start of treatment to 6.4 at analysis.
Driessen RJ, Bisschops LA, Adang EM et al. Br J Dermatol 2010; doi: 10.1111/j.1365-2133.2010.09693.x

Wrinkles scare tanning salon users more than melanoma

The threat of wrinkles in later life is more likely to deter young women from using tanning salons than the risk of melanoma, say US researchers. They found that warning women about the effects on their appearance caused a 35 per cent drop in tanning salon visits, up to six months after the intervention. The study included 435 college women aged 18 to 22 years who visited tanning salons, and focused on those who attended up to four times a week and who tanned for psychological reasons (for example, body dysmorphia, seasonal affective disorder). The women received a 25-page booklet on the effects of tanning on appearance, as well as alternatives such as spray-on tan or self-tanning cream. The researchers say that fear of 'looking horrible' trumped everything else.
Hillhouse J, Turrisi R, Stapleton J et al. Arch Dermatol 2010; 146: 485-91

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