Faculty Bibliography

BACKGROUND:The demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures have not been well described. There is a growing interest in nonsurgical cosmetic procedures. The patients studied in clinical trials may not be reflective of the real-world demographic of patients seeking nonsurgical cosmetic procedures. OBJECTIVE:To examine the demographics of men and minorities in clinical studies of nonsurgical cosmetic procedures. METHODS:A systematic review of clinical trials of botulinum toxin A (BTX-A) for facial rhytides and hyaluronic acid (HA) injectable fillers for soft-tissue augmentation was performed. Data on ethnicity and sex were collected and examined. RESULTS:Nineteen randomized controlled trials (RCTs) on BTX-A and 22 RCTs on HA were included for analysis. Men represented 11.8% of all participants. Men were more represented in the BTX-A RCTs (13.9%) compared with the HA RCTs (6.4%). Caucasian patients represented 67.1% of the total patients. Asian, Hispanic, and black patients represented 16.8%, 6.5%, and 5.4% of study participants, respectively. CONCLUSION/CONCLUSIONS:The proportion of men in clinical trials of BTX-A and HA reflects the real-world demographics of men undergoing these procedures. Hispanic and black patients were underrepresented in clinical trials.

Background/UNASSIGNED:Conflict of interest as it relates to medical education is a burgeoning topic of concern. Dermatology textbooks are an influential resource for dermatologists. This study evaluates industry payments to authors of major dermatology textbooks. Objective/UNASSIGNED:The primary objective of this study is to evaluate whether authors of dermatology textbooks had appreciable conflicts of interest in the form of payments from industry. Methods/UNASSIGNED:This is a retrospective study in which the authors and editors of eight commonly used general dermatology textbooks were entered into the ProPublica Dollars for Docs database to identify industry payments data from 2016. Results/UNASSIGNED:The total compensation for 381 authors in 2016 was $5,892,221. Zero payments were reported for 39.6% of authors. Of the dermatologists, 50%, 66%, 70%, and 81% received less than $100, $500, $1000, and $5000, respectively. The top 10% of dermatologists who collected payments received $5,267,494, which represented 89% of the total payment amount. Limitations/UNASSIGNED:The study was limited to eight textbooks. Data are only as accurate as reported to the Centers for Medicare and Medicaid Services. The database does not include information on dermatologists from non-U.S. institutions. Funding for clinical trials and other avenues of support (e.g., lasers, cosmetic instruments, institutional payments) are also not captured in this database. Conclusion/UNASSIGNED:A minority of authors of influential dermatology textbooks received the lion's share of payments from industry.

Background: Chronic pruritus is a debilitating condition associated with a wide range of dermatologic, systemic and psychogenic etiologies. In patients with chronic pruritus that is refractory to conventional therapy, symptoms can significantly decrease quality of life by contributing to anxiety, sleep disturbances, and in many cases depression. Recent studies have demonstrated the effectiveness of mirtazapine in relieving chronic itch that is refractory to standard first-line therapies. Methods: We searched PubMed for English-language articles containing the words ("pruritus" or "itch") AND "antidepressant" and then conducted a systematic review of the current literature to summarize the efficacy of mirtazapine in treating chronic itch. Results: All studies reported a reduction in itch intensity following the administration of mirtazapine. Conclusion: Collectively, these studies suggest the potential for mirtazapine to relieve chronic itch attributed to dermatological causes and malignancies. As, such mirtazapine may be an option for patients with chronic pruritus that is refractory to typical first-line treatments.

BACKGROUND:Differentiating scarring and nonscarring alopecia poses a diagnostic dilemma for clinicians, with histopathology used to distinguish. The extent to which dermatologists are able to clinically classify alopecia has not been evaluated. METHODS:A retrospective study of pathology reports on 458 patients was used to calculate a kappa coefficient to correlate clinical presence of scarring or nonscarring alopecia to histopathologic presence of scarring or nonscarring. A multivariate analysis was performed to assess for associations with scarring. RESULTS:The kappa correlation coefficient was 0.59 (P < 0.0001), indicating moderate agreement and varied by race and sex. There were 15 times higher odds of making the clinical diagnosis of scarring alopecia (OR 14.64 95% CI [8.64-24.18]; P < 0.001), and this increased with age. CONCLUSIONS:These results suggest that clinical exam is moderately reliable in distinguishing between scarring and nonscarring alopecia. Our results highlight the need for education and diagnostic schemata for evaluation of alopecia based on gender and in skin of color.

Macular lymphocytic arteritis or lymphocytic thrombophilic arteritis (LTA) is a recently described cutaneous arteritis that is characterized by asymptomatic macules and patches of the extremities associated with lymphocytic arteritis at the deep dermal/subcuticular junction for which little information exists on demographics, evaluation, and management. There has been recent debate in the literature whether this disease is a new distinct entity, misdiagnosed cutaneous polyarteritis nodosa (cPAN), or a disease on a spectrum with cPAN. We systematically review the literature on demographic information, medical history, histopathology findings, and treatment management to analyze trends and clarify controversies in characterizations of LTA. Forty detailed cases of LTA have been published. We submit that, although literature is limited, a review of the data still suggests that LTA is distinct from cPAN and systemic PAN. In addition, to better reflect the pathophysiologic natural history of this condition and correct for the historical artifact of how the disease was identified, we encourage the disease to be referred to as LTA and discourage ongoing use of macular lymphocytic arteritis.

Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory skin disease that disproportionately affects women of childbearing age. Yet, little has been written about the impact of pregnancy on the natural history of HS. It has been postulated that apocrine-gland activity diminishes in pregnancy, accounting for symptom remission.