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Alopecia areata linked to dental infection
People who develop alopecia areata should visit their dentist for a check-up, according to researchers at the University of Granada in Spain. They claim to have discovered an association between localised hair loss and dental infection. They say the alopecia patches are sometimes located far from an infection outbreak, but usually appear on a line projected from the dental infection and thus can be located on the face at the level of the maxillary teeth, above a line through the lip-angle to the scalp, beard, or even to the eyebrow.
Gil Montoya JA, Cutando Soriano A. Online Science News, University of Granada

Treating scalp ringworm in children
A review has assessed the efficacy and tolerability of treatments for scalp ringworm in children. The authors state that newer antifungals (terbinafine, fluconazole, itraconazole) have a similar efficacy to griseofulvin, the only antifungal licensed for this indication in children, but shorter treatment courses. They express concern that terbinafine is still not licensed for children, despite being increasingly recommended as a first-line option for the most common cause of infection (Trichophyton tonsurans) and having a good evidence base. However, they add that more suitable preparations of terbinafine and itraconazole are needed to allow administration on a dose per weight basis, and suggest fluconazole is a reasonable alternative.
Drug Thera Bull 2007; 45: 89-92

Mortality in psoriasis patients

Patients with severe psoriasis have a 40–50 per cent increased risk of overall mortality, according to an analysis of the UK General Practice Research Database (GPRD). The study included data on patients with psoriasis and those without the disease (controls) from 1987 to 2002. There was no overall effect of mild psoriasis on mortality, but males with severe psoriasis died 3.5 years younger and females, 4.4 years younger, than those without the disease. A second study, also based on GPRD data, estimated an incidence rate for psoriasis in the UK of 14 per 10,000 person-years and confirmed the association between psoriasis, skin disorders and smoking.
Gelfand JM, Troxel AB, Lewis JD et al. Arch Dermatol 2007; 143(12): 1493-9.
Huerta C, Rivero E, García Rodríguez LA. Arch Dermatol 2007; 143(12): 1559-65

Treatments for fungal nail infections

Systemic treatment of fungal nail infections with oral terbinafine is low cost and most likely to achieve a cure, the authors of a review have concluded. They suggest that oral itraconazole, which is more expensive, may be useful for candidal infections, although only a minority of patients are cured at one year and relapse rate is high. They cite a lack of evidence on topical therapy, which appears less effective than systemic therapy, but say that a combination of a systemic and a topical preparation (unlicensed) may help those with infections resistant to monotherapy. They also point out that there is insufficient evidence to justify nail debridement plus topical or systemic therapy.
Drug and Therapeutics Bulletin 2008; 46:3-8

Use of honey for ulcer healing questioned

Honey-impregnated dressings do not significantly improve venous ulcer healing at 12 weeks compared with usual care, researchers in New Zealand have concluded. Their community-based trial randomised 368 patients with a venous ulcer to calcium alginate dressings impregnated with manuka honey, or to usual care. At 12 weeks, 104 ulcers (55.6 per cent) in the honey-treated group and 90 (49.7 per cent) in the usual care group had healed – this difference was not significant. However, treatment with honey was probably more expensive and associated with a 30 per cent greater risk of adverse events.
Jull A, Walker N, Parag V et al. Br J Surg 2008; 95: 175-82

Dietary prevention of allergy
Breastfeeding is the most effective dietary regimen for the prevention of allergic disease such as eczema, say Danish researchers. The results of their review of observational and interventional studies indicate that breastfeeding is highly recommended for all infants, irrespective of atopic heredity. The researchers state that the most effective regimen is exclusive breastfeeding for at least four to six months or, in the absence of breast milk, formula with documented reduced allergenicity for at least the first four months, combined with avoidance of solid food and cow’s milk for the first four months.
Høst A, Halken S, Muraro A et al. Pediatr Allergy Immunol 2008; 19(1): 1-4

Reduced gut flora and eczema
Infants with atopic eczema have a reduced gut flora during the first 18 months of life, an international study has suggested. The researchers selected 35 infants aged 18 months from a cohort of 300 who had had their intestinal flora (faecal samples) analysed at one week old, using molecular biology techniques. Twenty of the infants were healthy; the other 15 had been diagnosed with atopic eczema at 18 months. The researchers found that infants with a limited variety of bacteria in their faeces at one week old were more likely to develop atopic eczema by 18 months. They suggest several factors may be to blame, including certain hygiene measures, such as antibiotics given in connection with delivery, which may skew the mother’s bacterial flora and hence the child’s.
Wang M, Karlsson C, Olsson C et al. J Allergy Clin Immunol 2008; 121: 129-34

Ketoconazole SPC updated
UK product information for ketoconazole has been updated in light of a systematic review, which found a risk of serious hepatotoxicity associated with its use. Duration of treatment is highlighted as the main factor determining the risk of hepatotoxicity; advice on monitoring of hepatic function before and after treatment has been amended. The therapeutic indications listed in the Summary of Product Characteristics (SPC) have been restricted to patients who are resistant to, or intolerant of, other effective antifungals. In addition, other drugs have been added to the list of contraindications, including disopyramide, eplerenone and ergot alkaloids. Prescribers should consult the SPC for full details.

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