UK psoriasis care scrutinised
Deficiencies in the care of patients with psoriasis have been highlighted in an audit of 100 dermatology units. The most significant findings included a shortage of specialist dermatology nurses, treatment delivery by untrained nurses and financial constraints on the prescription of biologics for psoriasis. The audit showed that 18 per cent (18 out of 98) of units had fewer than two whole-time equivalent consultants and 20 per cent had no specialist dermatology nurse. Units were also found to vary in their capacity to meet British Association of Dermatologists guidelines and standards. The authors say that gaps in data collection and record-keeping jeopardise efforts to improve standards of care.
Eedy DJ, Griffiths CE, Chalmers RJ et al. Br J Dermatol 2009; 160: 557-64
Online support for patients with psoriasis
Psoriasis virtual communities can provide psychological and social support for patients, a US study has shown. An online survey of 260 people with psoriasis using online support groups showed that about half of respondents had noted improvements in quality of life (49.5 per cent) and psoriasis severity (41 per cent) since joining a group. Key factors associated with use of online support included availability of resources (95.3 per cent), convenience (94 per cent), access to good advice (91 per cent) and lack of embarrassment (90.8 per cent). The researchers suggest the benefits could be enhanced by clinicians engaging with online communities.
Idriss SZ, Kvedar JC, Watson AJ. Arch Dermatol 2009; 145: 46-51
Tretinoin and risk of mortality
Topical tretinoin has been associated with an elevated risk of mortality in a randomised placebo-controlled trial, but the researchers do not believe the association is causal. The original trial involved 1,131 participants (mostly men) aged a mean 71 years, randomised to tretinoin 0.1% or vehicle control cream, used twice daily on the face and ears. The trial was terminated six months early because of excess deaths in the tretinoin group. Post-hoc analysis showed that after adjusting for minor imbalances in age, comorbidity and smoking status, the difference in mortality between the groups remained significant. However, the researchers say additional analyses do not support tretinoin as a cause of death. An accompanying editorial suggests that, as a minimum, prescribers should discuss the results of the trial with elderly men using topical tretinoin.
Weinstock MA, Bingham SF, Lew RA et al. Arch Dermatol 2009; 145: 18-24.
Schilling LM, Dellavalle RP. Arch Dermatol 2009; 145: 76
Treatment of pressure ulcers reviewed
There is little evidence to back the use of one support surface or dressing in preference to another in the treatment of pressure ulcers, according to US research. The authors reviewed 103 randomised controlled trials of variable methodological quality. Among 12 trials evaluating support surfaces, no clear evidence favoured one support surface over another. Among 54 trials evaluating absorbent wound dressings, one found calcium alginate dressings improved healing compared with dextranomer paste; no other dressing was superior to alternatives. The researchers also found little evidence to support routine nutritional supplementation or adjunctive therapies over standard care.
Reddy M, Gill SS, Kalkar SR et al. JAMA 2008; 300: 2647-62
Dietary intervention for atopic eczema
There is little good evidence to support the use of exclusion diets in atopic eczema, University of Nottingham researchers conclude. They reviewed nine trials involving a total of 421 participants and found no benefit from an egg- and milk-free diet in unselected participants with atopic eczema. However, evidence from one trial suggested some benefit from an egg-free diet in infants with suspected egg allergy and positive specific IgE to eggs. Other diets (elemental or few-foods diets) showed no benefit in unselected cases of atopic eczema.
Bath-Hextall F, Delamere FM, Williams HC. Allergy 2009; 64: 258-64
Choosing topical corticosteroids
The use of topical corticosteroids in skin conditions has been assessed in a review study. The authors say that although topical steroids are commonly used, evidence of their effectiveness exists only for certain conditions, such as psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis and lichen sclerosus. In contrast, they say evidence for their use in melasma, chronic idiopathic urticaria and alopecia areata is limited. They conclude that successful treatment depends on accurate diagnosis, as well as the delivery vehicle, potency, frequency of application, duration of treatment and side-effects.
Ference JD, Last AR. Am Fam Physician 2009; 79: 135-40
Inflammation, psoriasis and heart disease
An expert panel of US cardiologists and dermatologists believes current evidence is strong enough to recommend that doctors assess coronary risk in patients with psoriasis. Their consensus statement advises that patients with moderate to severe psoriasis should be educated about the association with cardiovascular disease and receive screening and treatment of modifiable cardiovascular risk factors. Evaluation is recommended for those with milder psoriasis if other cardiovascular risk factors are present.
Friedewald VE, Cather JC, Gelfand JM et al. Am J Cardiol 2008; 102: 1631-43
Hair goes grey because it bleaches itself
European research has found that wear and tear in hair follicles leads to a build-up of hydrogen peroxide, which blocks pigment synthesis. Using cell cultures of human grey/white hair follicles, they found the presence of elevated levels of hydrogen peroxide owing to a lack of catalase, which breaks down hydrogen peroxide. Hair follicles could not repair the damage because of low levels of enzymes that perform this function. Both factors disrupted the formation of tyrosinase, an enzyme involved in melanin formation. The researchers speculate that vitiligo could result from a similar breakdown in skin.
Wood JM, Decker H, Hartmann H et al. FASEB J 2009; doi:10.1096/fj.08-125435.